Social phobia: Issues in assessment and management

Social phobia was initially classified with phobic anxiety states and was b elieved to be quite rare, but it is now gaining due recognition as a widesp read and often crippling disorder. The boundaries of social phobia merge in to traits of shyness and universal performance anxiety, with symptoms commo nly appearing in the teenage years. If left untreated, social phobia is a r emarkably persistent condition, leading to potentially lifelong impairment in social development and occupational functioning. It may also give rise t o other co-morbid disorders, particularly dysthymia, depression, obsessive- compulsive disorder, other phobic disorders, and substance abuse. Over the years, social phobia has been all too frequently viewed as a somewhat trivi al, minor form of psychiatric illness and has received little clinical atte ntion. This erroneous perception is now giving way under the mounting evide nce in support of the extensive morbidity and disability associated with so cial phobia and the probable role of genetic and environmental influences. Furthermore, data from multiple controlled clinical trials reveal that this is a treatable condition, responding to both psychosocial and pharmacologi c interventions. Were we examine issues to consider in the differential dia gnosis of social phobia, review the goals of treatment, and summarize evide nce in support of the effectiveness of individual pharmacologic treatments.