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Social phobia: a clinical overview.

Mood disorders are characterized as the diseases of the 1980s, and anxiety disorders as the diseases of the 1990s. Of the anxiety disorders, social phobia is the least studied and most misunderstood. Recently, however, social phobia has been the focus of intense clinical investigation, and an increasingly clearer picture is emerging. The National Comorbidity Survey (NCS) data reveal a lifetime prevalence for social phobia of 13.3% in the adult population (15 to 54 years). First onset is early in life, usually before age 18, and the clinical course is chronic and unremitting. The central clinical feature is intense irrational fear in response to or in anticipation of feeling scrutinized and/or evaluated by others. This results in the severe or absolute avoidance of small social groups (57%), meeting strangers (42.1%), eating in public (24.7%), or even cashing checks or using public rest rooms. High lifetime comorbidity with other disorders is common: simple phobia (59%), agoraphobia (45%), major depression (17%), dysthymia (12%), alcohol abuse (19%), and drug abuse (13%). Despite the presence of significant disability (as many as 20% of social phobics are on welfare), there is a strong tendency by the public, and at times even for mental health professionals, to trivialize this disease.