Social phobia: epidemiology, recognition, and treatment

Introduction

Fear of being stared at is common to most animals, including humans. Normal social discourse involves being under the gaze of strangers, friends, and colleagues—interactions that are usually navigated without conscious thought.

Most people admit to social discomfort while under public scrutiny—for example, before performing in public.1 Social phobia, however, is the excessive fear that a performance or social interaction will be inadequate, embarrassing, or humiliating—people with social phobia avert their gaze from their interlocutors and often avoid a feared social setting.

Social phobia is a poorly investigated and misunderstood condition.2 The resulting disability severely impairs educational attainment and gainful productivity. Unless the disorder is accurately diagnosed and promptly treated, a burden is placed on society.

This review examines the epidemiology, recognition, and treatment of this debilitating condition. It is based on articles selected (in December 1995 and January 1996) from the full Medline database. The term “phobic-disorder$ or social adj phobi$” was used to find review articles newer than 1992 and published in English. This search retrieved approximately 70 citations; these were supplemented by papers from my own collection.

Epidemiology

Social phobia is common in the general population. A review of epidemiological studies found that the lifetime prevalence of social phobia in adults varied between 2% and 5%3 (fig 1) with a female:male ratio of 2.5:1.2 Patients may not consult their family doctor until they have had the condition for many years.2 The chronic course increases the risk of comorbid conditions, which may mask the social phobia.4 5

In children and adolescents the prevalence of social phobia is 0.9%-1.1%.3 The lifetime prevalence of simple phobia and social phobia in young adults (mean age 18 years) was found to be 23%; …