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07-SEPTEMBER-2008 03:17:44 - phobia Social phobias Classification and external resources ICD-10 F40.1, F93.2 ICD-9 300.23 The factual accuracy of this article is disputed. Please see the relevant discussion on the talk page. June 2008 Social phobia DSM-IV 300.23, also known as social anxiety disorder1 DSM-IV 300.23 is a diagnosis within psychiatry and other mental health professions referring to excessive social anxiety anxiety in social situations 2 causing abnormally considerable distress and impaired ability to function in at least some areas of daily life. The diagnosis can be of a specific disorder when only some particular situations are feared or a generalized disorder. Generalized social anxiety disorder typically involves a persistent, intense, and chronic fear of being judged by others and of potentially being embarrassed or humiliated by one's own actions. These fears can be triggered by perceived or actual scrutiny by others. While the fear of social interaction may be recognized by the person as excessive or unreasonable, considerable difficulty can be encountered overcoming it. Approximately 13.3 percent of the general population may meet criteria for social anxiety disorder at some point in their lifetime, according to the highest survey estimate, with the male to female ratio being 1:1.5.3 Physical symptoms often accompanying social anxiety disorder include excessive blushing, sweating hyperhidrosis, trembling, palpitations, nausea, and stammering. Panic attacks may also occur under intense fear and discomfort. An early diagnosis may help in minimizing the symptoms and the development of additional problems such as depression. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. It is very common for sufferers of social phobia to self-medicate in this fashion, especially if they are undiagnosed and/or untreated. This can lead to alcoholism or other kind of substance abuse. Specific prescription medications have a far better success rate at treating social phobia than self-medication.citation needed A person with the disorder may be treated with psychotherapy, medication, or both. Research has shown cognitive behavior therapy, whether individually or in a group, to be effective in treating social phobia. The cognitive and behavioral components seek to change thought patterns and physical reactions to anxious situations. Prescribed medications include two classes of antidepressants: selective serotonin reuptake inhibitors SSRIs and serotonin-norepinephrine reuptake inhibitors SNRIs. Attention given to social anxiety disorder has significantly increased in the US since 1999 with the approval and marketing of drugs for its treatment. Contents 1 Symptoms 1.1 Cognitive aspects 1.2 Behavioral aspects 1.3 Physiological aspects 2 Prevalence 3 Comorbidity 4 Causes and perspectives 4.1 Genetic and family factors 4.2 Social experiences 4.3 Social/cultural influences 4.4 Evolutionary context 4.5 Neurochemical and neurocognitive influences 4.6 Psychological factors 5 Treatment 5.1 Pharmacological treatments 5.1.1 SSRIs 5.1.2 Other drugs 5.2 Psychotherapy 6 History 7 Criticisms 8 See also 9 References 10 Further reading 11 External links Symptoms Cognitive aspects In cognitive models of Social Anxiety Disorder, social phobics experience dread over how they will be presented to others. They may be overly self-conscious, pay high self-attention after the activity, or have high performance standards for themselves. According to the social psychology theory of self-presentation, a sufferer attempts to create a well-mannered impression on others but believes he or she is unable to do so. Many times, prior to the potentially anxiety-provoking social situation, sufferers may deliberate over what could go wrong and how to deal with each unexpected case. After the event, they may have the perception they performed unsatisfactorily. Consequently, they will review anything that may have possibly been abnormal or embarrassing. These thoughts do not just terminate soon after the encounter, but may extend for weeks or longer.4 Those with social phobia tend to interpret neutral or ambiguous conversations with a negative outlook and many studies suggest that socially anxious individuals remember more negative memories than those less distressed.5 An example of an instance may be that of an employee presenting to his co-workers. During the presentation, the person may stutter a word upon which he or she may worry that other people significantly noticed and think that he or she is a terrible presenter. This cognitive thought propels further anxiety which may lead to further stuttering, sweating and a possible panic attack. Behavioral aspects Social anxiety disorder is a persistent fear of one or more situations in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing. It exceeds normal shyness as it leads to excessive social avoidance and substantial social or occupational impairment. Feared activities may include almost any type of social interaction, especially small groups, dating, parties, talking to strangers, restaurants, etc. Physical symptoms include mind going blank, fast heartbeat, blushing, stomach ache. Cognitive distortions are a hallmark, and learned about in CBT cognitive-behavioral therapy. Thoughts are often self-defeating and inaccurate. The groundless fear of the telephone is typical, both calling somebody and answering the phone. It may appear early in childhood. According to psychologist B.F. Skinner, phobias are controlled by escape and avoidance behaviors. For instance, a student may leave the room when talking in front of the class escape and refrain from doing verbal presentations because of the previously encountered anxiety attack avoid. Minor avoidance behaviors are exposed when a person avoids eye contact and crosses arms to avoid recognizable shaking.5 A fight-or-flight response is then triggered in such events. Preventing these automatic responses is at the core of treatment for social anxiety. Physiological aspects Physiological effects, similar to those in other anxiety disorders, are present in social phobics. Faced with an uncomfortable situation, children with social anxiety may display tantrums, weeping, clinging to parents, and shutting themselves out.6 In adults, it may be tears as well as experiencing excessive sweating, nausea, shaking, and palpitations as a result of the fight-or-flight response. The walk disturbance may appear, especially when passing a group of people. Blushing is commonly exhibited by individuals suffering from social phobia.5 These visible symptoms further reinforce the anxiety in the presence of others. A 2006 study found that the area of the brain called the amygdala, part of the limbic system, is hyperactive when patients are shown threatening faces or confronted with frightening situations. They found that patients with more severe social phobia showed a correlation with the increased response in the amygdala.7 Prevalence Country Prevalence United States 2-7%1 England 0.4% children2 Scotland 1.8% children3 Wales 0.6% children4 Australia 1-2.7%5 Brazil 4.7-7.9%6 When prevalence estimates were based on the examination of psychiatric clinic samples, social anxiety disorder was thought to be a relatively rare disorder. The opposite was instead true; social anxiety was common but many were afraid to seek psychiatric help, leading to an understatement of the problem.5 Prevalence rates vary widely because of its vague diagnostic criteria and its overlapping symptoms with other disorders. There has been some debate on how the studies are conducted and whether the illness truly impairs the respondents as laid out in the official criteria. Psychologist Dr. Ray Crozier argues, it is difficult to ascertain whether the person being interviewed adheres to the DSM-III-R criteria or whether they are merely exhibiting poor social skills or shyness.8 The National Comorbidity Survey of over 8,000 American correspondents in 1994 revealed a 12-month and lifetime prevalence rates of 7.9 percent and 13.3 percent making it the third most prevalent psychiatric disorder after depression and alcohol dependence and the most apparent of the anxiety disorders.9 According to U.S. epidemiological data from the National Institute of Mental Health, social phobia affects 5.3 million adult Americans in any given year. Cross-cultural studies have reached prevalence rates with the conservative rates at 5 percent of the population.1011 However, other estimates vary within 2 percent and 7 percent of the U.S. adult population.12 Onset of social phobia typically occurs between 11 and 19 years of age. Onset after age 25 is rare. Social anxiety disorder occurs in females nearly twice as often as males, although men are more likely to seek help.13 The prevalence of social phobia appears to be increasing among white, married, and well-educated individuals. As a group, those with generalized social phobia are less likely to graduate from high school and are more likely to rely on government financial assistance or have poverty-level salaries.14 Surveys carried out in 2002 show the youth of England, Scotland, and Wales have a prevalence rate of 0.4 percent, 1.8 percent, and 0.6 percent, respectively.15 The prevalence of self-reported social anxiety for Nova Scotians older than 14 years was 4.2 percent in June 2004 with women 4.6 percent reporting more than men 3.8 percent.16 In Australia, social phobia is the 8th and 5th leading disease or illness for males and females between 15-24 years of age as of 2003.17 Because of the difficulty in separating social phobia from poor social skills or shyness, some studies have a large range of prevalence.18 The table also shows higher prevalence in Brazil. Comorbidity There is a high degree of comorbidity with other psychiatric disorders. Social phobia often occurs alongside low self-esteem and clinical depression, due to lack of personal relationships and long periods of isolation from avoiding social situations. To try to reduce their anxiety and alleviate depression, people with social phobia may use alcohol or other drugs, which can lead to substance abuse. It is estimated that one-fifth of patients with social anxiety disorder also suffer from alcohol dependence.19 The most common complementary psychiatric condition is unipolar depression. In a sample of 14,263 people, of the 2.4 percent of persons diagnosed with social phobia, 16.6 percent also met the criteria for clinical depression.20 Besides depression, the most common disorders diagnosed in patients with social phobia are panic disorder 33 percent, generalized anxiety disorder 19 percent, post-traumatic stress disorder 36 percent, substance abuse disorder 18 percent, and attempted suicide 23 percent.21 In one study of social anxiety disorder patients who developed comorbid alcoholism, panic disorder or depression, social anxiety disorder preceded the onset of alcoholism, panic disorder and depression in 75 percent, 61 percent, and 90 percent of patients, respectively. Avoidant personality disorder is also highly correlated with social phobia.22 Because of its close relationship and overlapping symptoms with other illnesses, treating social phobics may help understand underlying connection in other psychiatric disorders. There is research indicating that social anxiety disorder is often correlated with bipolar disorder 7. Some researchers believe they share an underlying cyclothymic-anxious-sensitive disposition. 8 In addition, studies show that more socially phobic patients treated with anti-depressant medication develop hypomania than non-phobic controls9 10, although this can be seen as the medication creating a new problem, and also has this adverse effect in a proportion of those without social phobia. Causes and perspectives Research into the causes of social anxiety and social phobia is wide-ranging, encompassing multiple perspectives from neuroscience to sociology. Scientists have yet to pinpoint the exact causes. Studies suggest that genetics can play a part in combination with environmental factors. Genetic and family factors It has been shown that there is a two to threefold greater risk of having social phobia if a first-degree relative also has the disorder. This could be due to genetics and/or due to children acquiring social fears and avoidance through processes of observational learning or parental psychosocial education. Studies of identical twins brought up via adoption in different families have indicated that, if one twin developed social anxiety disorder, then the other was between 30 percent and 50 percent more likely than average to also develop the disorder.23 To some extent this 'heritability' may not be specific - for example, studies have found that if a parent has any kind of anxiety disorder or clinical depression, then a child is somewhat more likely to develop an anxiety disorder or social phobia.24 Studies suggest that parents of those with social anxiety disorder tend to be more socially isolated themselves Bruch and Heimberg, 1994; Caster et al, 1999, and shyness in adoptive parents is significantly correlated with shyness in adopted children Daniels and Plomin, 1985; Adolescents who were rated as having an insecure anxious-ambivalent attachment with their mother as infants were twice as likely to develop anxiety disorders by late adolescence,25 including social phobia. A related line of research has investigated 'behavioural inhibition' in infants - early signs of an inhibited and introspective or fearful nature. Studies have shown that around 10-15 percent of individuals show this early temperament, which appears to be partly due to genetics. Some continue to show this trait in to adolescence and adulthood, and appear to be more likely to develop social anxiety disorder.26 Social experiences A previous negative social experience can be a trigger to social phobia.2728 perhaps particularly for individuals high in 'interpersonal sensitivity'. For around half of those diagnosed with social anxiety disorder, a specific traumatic or humiliating social event appears to be associated with the onset or worsening of the disorder;29 this kind of event appears to be particularly related to specific performance social phobia, for example regarding public speaking Stemberg et al., 1995. As well as direct experiences, observing or hearing about the socially negative experiences of others e.g. a faux pas committed by someone, or verbal warnings of social problems and dangers, may also make the development of a social anxiety disorder more likely.30 Social anxiety disorder may be caused by the longer-term effects of not fitting in, or being bullied, rejected or ignored Beidel and Turner, 1998. Shy adolescents or avoidant adults have emphasised unpleasant experiences with peers31 or childhood bullying or harassment Gilmartin, 1987. In one study, popularity was found to be negatively correlated with social anxiety, and children who were neglected by their peers reported higher social anxiety and fear of negative evaluation than other categories of children.32 Socially phobic children appear less likely to receive positive reactions from peers33 and anxious or inhibited children may isolate themselves.34 Social/cultural influences Cultural factors that have been related to social anxiety disorder include a society's attitude towards shyness and avoidance, affecting ability to form relationships or access employment or education. One study found that the effects of parenting are different depending on the culture - American children appear more likely to develop social anxiety disorder if their parents emphasise the importance of other's opinions and use shame as a disciplinary strategy Leung et al., 1994, but this association was not found for Chinese/Chinese-American children. In China, research has indicated that shy-inhibited children are more accepted than their peers and more likely to be considered for leadership and considered competent, in contrast to the findings in Western countries.35 Purely demographic variables may also play a role - for example there are possibly lower rates of social anxiety disorder in Merranean countries and higher rates in Scandinavian countries, and it has been hypothesised that hot weather and high-density may reduce avoidance and increase interpersonal contact. Problems in developing social skills, or 'social effectiveness', may be a cause of some social anxiety disorder, through either inability or lack of confidence to interact socially and gain positive reactions and acceptance from others. The studies have been mixed, however, with some studies not finding significant problems in social skills36 while others have.37 What does seem clear is that the socially anxious perceive their own social skills to be low. It may be that the increasing need for sophisticated social skills in forming relationships or careers, and an emphasis on assertiveness and competitiveness, is making social anxiety problems more common, at least among the 'middle classes'.38 An interpersonal or media emphasis on 'normal' or 'attractive' personal characteristics has also been argued to fuel perfectionism and feelings of inferiority or insecurity regarding negative evaluation from others. The need for social acceptance or social standing has been elaborated in other lines of research relating to social anxiety39 Evolutionary context A long-accepted evolutionary explanation of anxiety is that it reflects an in-built 'fight or flight' system, which errs on the side of safety. One line of research suggests that specific dispositions to monitor and react to social threats may have evolved, reflecting the vital and complex importance of social living and social rank in human ancestral environments. Charles Darwin originally wrote about the evolutionary basis of shyness and blushing, and modern evolutionary psychology and psychiatry also addresses social phobia in this context.40 It has been hypothesised that in modern day society these evolved tendencies can become more inappropriately activated and result in some of the cognitive 'distortions' or 'irrationalities' identified in cognitive-behavioural models and therapies41 Neurochemical and neurocognitive influences Some scientists hypothesize that social phobia is related to an imbalance of the brain chemical serotonin. A recent study report increased Serotonin and Dopamine transporter binding in psychotropic medication-naive patients with Generalized Social Anxiety Disorder.42 Sociability is also closely tied to dopamine neurotransmission. Low D2 receptor binding is found in people with social anxiety.43 The efficacy of medications which affect serotonin and dopamine levels also indicates the role of these pathways. There is also increasing focus on other candidate transmitters, e.g. Norepinephrine, which may be over-active in social anxiety disorder, and the inhibitory transmitter GABA. Individuals with social anxiety disorder have been found to have a hypersensitive amygdala, for example in relation to social threat cues e.g. someone might be evaluating you negatively, angry or hostile faces, and while just waiting to give a speech.44 Recent research has also indicated that another area of the brain, the 'Anterior cingulate cortex', which was already known to be involved in the experience of physical pain, also appears to be involved in the experience of 'social pain', for example perceiving group exclusion.45 Psychological factors Research has indicated the role of 'core' or 'unconditional' negative beliefs e.g. I am inept and 'conditional' beliefs nearer to the surface e.g. If I show myself, I will be rejected. They are thought to develop based on personality and adverse experiences and to be activated when the person feels under threat.46 One line of work has focused more specifically on the key role of self-presentational concerns.4748 The resulting anxiety states are seen as interfering with social performance and the ability to concentrate on interaction, which in turn creates more social problems, which strengthens the negative schema. Also highlighted has been a high focus on and worry about anxiety symptoms themselves and how they might appear to others.49 A similar model50 emphasises the development of a distorted mental representation of their self and over-estimates of the likelihood and consequences of negative evaluation, and of the performance standards that others have. Such cognitive-behavioral models consider the role of negatively-biased memories of the past and the processes of rumination after an event, and fearful anticipation before it. Studies have also highlighted the role of subtle avoidance and defensive factors, and shown how attempts to avoid feared negative evaluations or use 'safety behaviours' Clark Wells, 1995 can make social interaction more difficult and the anxiety worse in the long run. This work has been influential in the development of Cognitive Behavioural Therapy for social anxiety disorder, which has been shown to have efficacy. Treatment Arguably the most important clinical point to emerge from studies of social anxiety disorder is the benefit of early diagnosis and treatment. Social anxiety disorder remains under-recognized in primary care practice, with patients often presenting for treatment only after the onset of complications such as clinical depression or substance abuse disorders. Research has provided evidence for the efficacy of two forms of treatment available for social phobia: certain medications and a specific form of short-term psychotherapy called Cognitive-behavioral therapy CBT, the central component being gradual exposure therapy. Pharmacological treatments SSRIs Selective serotonin reuptake inhibitors SSRIs, a class of antidepressants, are considered by many to be the first choice medication for generalised social phobia. These drugs elevate the level of the neurotransmitter serotonin, among other effects. The first drug formally approved by the Food and Drug Administration was paroxetine, sold as Paxil in the US or Seroxat in the UK. Compared to older forms of medication, there is less risk of tolerability and drug dependency.51 However, their efficacy and increased suicide risk has been subject to controversy. In a 1995 double-blind, placebo-controlled trial, the SSRI paroxetine was shown to result in clinically meaningful improvement in 55 percent of patients with generalized social anxiety disorder, compared with 23.9 percent of those taking placebo.52 An October 2004 study yielded similar results. Patients were treated with either fluoxetine, psychotherapy, fluoxetine and psychotherapy, placebo and psychotherapy, and a placebo. The first four sets saw improvement in 50.8 to 54.2 percent of the patients. Of those assigned to receive only a placebo, 31.7 percent achieved a rating of 1 or 2 on the Clinical Global Impression-Improvement scale. Those who sought both therapy and medication did not see a boost in improvement.53 General side-effects are common during the first weeks while the body adjusts to the drug. Symptoms may include headaches, nausea, insomnia and changes in sexual behavior. Treatment safety during pregnancy has not been established.54 In late 2004 much media attention was given to a proposed link between SSRI use and juvenile suicide. For this reason, the use of SSRIs in pediatric cases of depression is now recognized by the Food and Drug Administration as warranting a cautionary statement to the parents of children who may be prescribed SSRIs by a family doctor.55 Recent studies have shown no increase in rates of suicide.56 These tests, however, represent those diagnosed with depression, not necessarily with social anxiety disorder. However, it should be noted that due to the nature of the conditions, those taking SSRIs for social phobias are far less likely to have suicidal ideation than those with depression. Other drugs Although SSRIs are often the first choice for treatment, other prescription drugs are also commonly issued, sometimes only if SSRIs fail to produce any clinically significant improvement. In 1985, before the introduction of SSRIs, anti-depressants such as monoamine oxidase inhibitors MAOIs were frequently used in the treatment of social anxiety. Their efficacy appears to be comparable or sometimes superior to SSRIs or Benzodiazepines. However, because of the dietary restrictions required, high toxicity in overdose, and incompatibilities with other drugs, its usefulness as a treatment for social phobics is now limited. Some argue for their continued use, however, or that a special diet does not need to be strictly adhered to.57 A newer type of this medication, Reversible inhibitors of monoamine oxidase subtype A RIMAs inhibit the MAO enzyme only temporarily, improving the adverse-effect profile but possibly reducing their efficacy. Benzodiazepines are a short-acting and more potent alternative to SSRIs. The drug is often used for short-term relief of severe, disabling anxiety. Alprazolam and clonazepam are usual benzodiazepines for social fear. Although benzodiazepines are still sometimes prescribed for long-term everyday use in some countries, there is much concern over the development of drug tolerance, dependency and recreational abuse. Benzodiazepines augment the action of GABA, the major inhibitory neurotransmitter in the brain; effects usually begin to appear within minutes or hours. Some people with a form of social phobia called performance phobia have been helped by beta-blockers, which are more commonly used to control high blood pressure. Taken in low doses, they control the physical manifestation of anxiety and can be taken before a public performance. A novel treatment approach has recently been developed as a result of translational research. It has been shown that a combination of acute dosing of d-cycloserine DCS with exposure therapy facilitates the effects of exposure therapy of social phobia Hofmann, Meuret, Smits, et al., 2006. DCS is an old antibiotic medication used for treating tuberculosis and does not have any anxiolytic properties per se. However, it acts as an agonist at the glutamatergic N-methyl-D-aspartate NMDA receptor site, which is important for learning and memory Hofmann, Pollack, Otto, 2006. It has been shown that administering a small dose acutely 1 hour before exposure therapy can facilitate extinction learning that occurs during therapy. Psychotherapy Research has shown that a form of psychotherapy that is effective for several anxiety disorders, particularly panic disorder and social phobia58 is cognitive-behavioral therapy CBT. It has two main components. The cognitive component helps people become aware of and to change thinking patterns that keep them from overcoming their fears. A person with social phobia might be helped to question how they can be so sure that others are continually watching and harshly judging him or her. The behavioral component of CBT seeks to change people's reactions to anxiety-provoking situations. It also serves as a logical extension of cognitive therapy where people are shown proof in the real world that their dysfunctional thought processes are unrealistic. A key element of this component is gradual exposure, in which people confront the things they fear in a structured, sensitive manner. Gradual exposure is an inherently unpleasant technique. It involves four components, duration, frequency, graded and focused. Ideally the person should be exposed to a feared social situation that is anxiety provoking but bearable graded for as long as possible duration, two to three times a day frequency, and the person must endure the anxiety until it declines focused. A hierarchy of feared steps is constructed and the patient is exposed to each step. The aim is also to learn from acting differently and observing reactions behavioral 'experiments'. This is intended to be done with support and guidance when the therapist and patient feel they are ready. Cognitive-behavior therapy for social phobia also includes anxiety management training, which may include techniques such as deep breathing and muscle relaxation exercises, which may be practiced 'in-situ'. CBT may also be conducted partly in group sessions Cognitive behavioral group therapy, facilitating the sharing of experiences, a sense of acceptance by others and undertaking behavioral challenges in a trusted environment Heimberg. Some studies have suggested social skills training can help with social anxiety59. Whether specific social skills techniques and training are required, rather than just support with general social functioning and exposure to social situations, does not seem to be clear60. Interpersonal Therapy has been shown to have efficacy for depression and a small study of the therapy in the treatment of social phobia suggests it may also work with social phobia61. History Literary descriptions of shyness can be traced back to the days of Hippocrates around 400 B.C. Hippocrates described someone who 'through bashfulness, suspicion, and timorousness, will not be seen abroad; loves darkness as life and cannot endure the light or to sit in lightsome places; his hat still in his eyes, he will neither see, nor be seen by his good will. He dare not come in company for fear he should be misused, disgraced, overshoot himself in gesture or speeches, or be sick; he thinks every man observes him'. Charles Darwin wrote about the physiology and social context of blushing and shyness. The first mention of a psychiatric term, social phobia phobie des situations sociales, was made in the early 1900s. Psychologists used the term social neurosis to describe extremely shy patients in the 1930s. After extensive work by Joseph Wolpe on systematic desensitization, research in phobias and their treatment grew. The idea that social phobia was a separate entity from other phobias came from the British psychiatrist, Isaac Marks in the 1960s. This was accepted by the American Psychiatric Association and was first officially included in the third ion of the Diagnostic and Statistical Manual of Mental Disorders. The definition of the phobia was revised in 1989 to allow comorbidity with avoidant personality disorder, and introduced generalized social phobia. 5 Social phobia had been largely ignored prior to 1985. After a call to action by psychiatrist Michael Liebowitz and clinical psychologist Richard Heimberg, there was an increase in research and attention on the disorder. The DSM-IV gave social phobia the alternative name Social Anxiety Disorder. Research in to the psychology and sociology of everyday social anxiety continued. Cognitive Behavioural models and therapies were developed for social anxiety disorder. In the 1990s, paroxetine became the first prescription drug in the US approved to treat social anxiety disorder, with others following. Criticisms Some argue that inherent problems with society such as a competitive culture, power imbalances, lack of care and poor social education in families cause social anxiety; they feel the diagnostic boundaries have been stretched too far and that clinical and media work is promoting the idea that any problems with shyness or social worries are a pathological medical condition requiring medical treatment. Some see this as being driven by pharmaceutical companies, either by direct advertising to the public or their financial influence on psychiatry.62 This view can be associated with anti-psychiatry. See also Agoraphobia Anxiety Anxiety Disorders Association of America Asperger syndrome Avoidant personality disorder Fear Generalized anxiety disorder Hikikomori Hypervigilance Hypoglycemia Introversion and extroversion Liebowitz social anxiety scale LSAS Love-shyness Major depressive disorder Mean world syndrome mindfulness Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder Selective mutism Social anxiety Social control Social rejection Taijin kyofusho Timidness References ^ Webmd. Mental Health: Social Anxiety Disorder ^ Webmd. Mental Health: Social Anxiety Disorder ^ p. 29-30. Social Phobia: Diagnosis, Assessment, and Treatment. Richard G. Heimberg. Guilford Press ^ Shyness Social Anxiety Treatment Australia Social Phobia ^ a b c d e Furmark, Thomas. Social Phobia - From Epidemiology to Brain Function. Retrieved February 21, 2006. ^ eNotes. Social phobia - Causes. 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Hirirpi E.V.A. and Kessler R.C. 2000, Trends in the prevalence of social phobia in the United States: A synthetic cohort analysis of changes over four decades. European Psychiatry 15 pp. 29-37 ^ Baumeister R, Leary M 1995. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull 117 3: 497-529. doi:10.1037/0033-2909.117.3.497. PMID 7777651. ^ Gilbert, P. 2001. Evolution and social anxiety - The role of attraction, social competition, and social hierarchies. Psychiatric Clinics of North America ^ Gilbert, P. 1998. The evolved basis and adaptive functions of cognitive distortions. British Journal of Medical Psychology, 71, 447-463. ^ van der Wee et al. May 2008. Increased Serotonin and Dopamine Transporter Binding in Psychotropic Medication-Naïve Patients with Generalized Social Anxiety Disorder Shown by 123I-β-4-Iodophenyl-Tropane SPECT. The Journal of Nuclear Medecine 49 5: 757-763. doi:10.2967/jnumed.107.045518 inactive 2008-06-25. PMID 18413401. ^ Murray B. Stein, MD; Jack M. Gorman, MD. Journal of Psychiatry Neuroscience Volume 26. Unmasking social anxiety disorder 2001. Retrieved March 1, 2006. ^ Davidson, Marshall, Tomarkenc Henriquesa 2000 While a phobic waits: regional brain electrical and autonomic activity in social phobics during anticipation of public speaking. Biological Psychiatry, 472, 85-95 ^ Eisenberger, N.I., Lieberman, M.D. Williams, K.D. 2003. Does rejection hurt? An fMRI study of social exclusion. Science, 302: 290-292 ^ Beck AT, Emery G, Greenberg RL 1985 Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books. ^ Leary, M.R., Kowalski, R.M. 1995 Social Anxiety. London: Guildford Press ^ Leary, M.R., Kowalski, R.M, Campbell, C.D. 1988. Self-presentational concerns and social anxiety: the role of generalised impression expectancies. Journal of Research in Personality, 22, 308-321. ^ Clark, D. M., Wells, A. 1995. A cognitive model of social phobia. In. R. G. Heimberg, M. R. Liebowitz, D. A. Hope, F. R. Schneier Eds., Social phobia: Diagnosis, assessment, and treatment pg 41-68. Guilford Press: New York. ^ Rapee, R.M., Heimberg, R.G. 1997 A cognitive-behavioral model of anxiety in social phobia, Behaviour Research and Therapy, 35, pp. 741-756 ^ SSRIs in Depression and Anxiety. John Wiley and Sons, 109-111. ^ Murray B. Stein, MD; Michael R. Liebowitz, MD; R. Bruce Lydiard, PhD, MD; Cornelius D. Pitts, RPh; William Bushnell, MS; Ivan Gergel, MD. Paroxetine Treatment of Generalized Social Phobia Social Anxiety Disorder April 1995 - February 1996. Retrieved February 24, 2006. ^ Jonathan R. T. Davidson, MD; Edna B. Foa, PhD;Jonathan D. Huppert, PhD; Francis J. Keefe, PhD; Martin E. Franklin, PhD; Jill S. Compton, PhD; Ning Zhao, PhD; Kathryn M. Connor, MD; Thomas R.Lynch, PhD; Kishore M. Gadde, MD Fluoxetine, Comprehensive Cognitive Behavioral Therapy, and Placebo in Generalized Social Phobia October 2004. Retrieved February 24, 2006. ^ Chang, Kiki D March 28, 2006. Social Phobia. eMedicine. Retrieved on 2006-05-14. ^ Federal Drug and Administration. Class Suicidality Labeling Language for Antidepressants. 2004. Retrieved February 24, 2006. ^ Group Health Cooperative. Study refutes link between suicide risk, antidepressants January 1, 2006. Retrieved February 24, 2006. ^ Crozier, page. 475-477. ^ Jonathan R. T. Davidson, MD; Edna B. Foa, PhD; et al. Fluoxetine, Comprehensive Cognitive Behavioral Therapy, and Placebo in Generalized Social Phobia 1998. Retrieved March 1, 2006. ^ Mersch et al., 1991 ^ Stravynski Amado, 2001 ^ Lipsitz et al, 1999 ^ Koerner, Brendan I. July/August 2002. Disorders Made to Order. Mother Jones. Retrieved on 2006-05-14. Further reading American Psychiatric Association. 2000. Anxiety disorders. In Diagnostic and statistical manual of mental disorders 4th ed., text rev., pp. 450-456. Washington, D.C.: American Psychiatric Association. Belzer, K. D., McKee, M. B., Liebowitz, M. R. 2005. Social Anxiety Disorder: Current Perspectives on Diagnosis and Treatment. Primary Psychiatry, 1211, 40-53. Bruch, M. A. 1989. Familial and developmental antecedents of social phobia: Issues and findings. Clinical Psychology Review, 9, 37-47. Burns, D. D. 1999. Feeling good: The new mood therapy Rev. ed.. New York: Avon. ISBN 0-380-81033-6. Crozier, W. R., Alden, L. E. 2001. International Handbook of Social Anxiety: Concepts, Research, and Interventions Relating to the Self and Shyness. New York: John Wiley Sons, Ltd. ISBN 0-471-49129-2. Hales, R. E., Yudofsky, S. C. Eds.. 2003. Social phobia. In Textbook of Clinical Psychiatry 4th ed., pp. 572-580. Washington, D.C.: American Psychiatric Publishing. Hofmann, S. G., Meuret, A. E., Smits, J. A. J., Simon, N. M., Pollack, M. H., Eisenmenger, K., Shiekh, M., Otto, M. W. 2006. Augmentation of exposure therapy for social anxiety disorder with d-cycloserine. Archives of General Psychiatry, 63, 298-304. Hofmann, S. G., Pollack, M. H. Otto, M. O. 2006. Augmentation treatment of psychotherapy for anxiety disorders with d-cycloserine. CNS Drug Reviews, 12, 208-217. Okano, K. 1994. Shame and social phobia: A transcultural viewpoint. Bulletin of the Menninger Clinic, 583, 323-38. Samson, A. 2002. Psychiatric conceptions of social phobia: A comparative perspective. Swiss Journal of Sociology, 283, 505-527. Stein, M. B., Kean, Y. M. 2000. Disability and quality of life in social phobia: Epidemiologic findings. American Journal of Psychiatry, 157, 1606-1613. Van Ameringen, M. A., et al. 2001. Sertraline treatment of generalized social phobia: A 20-week, double-blind, placebo-controlled study. American Journal of Psychiatry, 1582, 275-281. Wagstaff, A. J., et al. 2002. Spotlight on paroxetine in psychiatric disorders in adults. Drugs, 62, 655-703. Garcia-Lopez et al. 2006. Efficacy of three CBGT treatments: A 5-year follow-up. Journal of Anxiety Disorders, External links Listen to this article info/dl Play sound Spoken This audio file was created from a revision dated 2006-06-27, and does not reflect subsequent s to the article. Audio help More spoken articles This is a spoken version of the article. Click here to listen. Social Anxiety at the Open Directory Project Anxiety Disorders Association of America - Help for people with anxiety disorders, including social anxiety disorder v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering Retrieved from http://en..org/wiki/Social_phobia Categories: Spoken articles | Anxiety disorders | PhobiasHidden categories: Pages with DOIs broken since 2008 | Accuracy disputes from June 2008 | All articles with statements | Articles with statements since August 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages ÄŒesky Dansk Deutsch Español Français Italiano עברית Lietuvių Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий СрпÑ?ки / Srpski Suomi Svenska Türkçe ייִדיש ä¸æ–‡ This page was last modified on 23 August 2008, at 19:48
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