Social Phobia Follow-up

  • Author: Bettina E Bernstein, DO; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: Sep 14, 2011
 

Complications

  • Social phobia has a wide range of severity. It may be mild and associated with minimal distress or may be severe to the point of causing marked disability. Extreme avoidance behavior (ie, avoiding contact with others and being unable to maintain employment) sometimes complicates this condition.
  • Substance abuse, particularly the abuse of alcohol, sedatives, or narcotics, can also make treatment more difficult because benzodiazepines may not be appropriate or may need to be used with extreme caution in patients with substance dependency.
  • School refusal is a common complication of social anxiety disorder. A classic article highlights the importance of using cognitive behavioral therapy techniques for youth who are on an inpatient psychiatric unit to prevent school refusal.[43]
Next

Prognosis

  • Mild social phobia is associated with a good prognosis and may have a benign course.
  • Severe avoidance behavior and substance abuse are often associated with a guarded prognosis.
  • It is important to look for comorbid conditions (mood disorders, schizophrenia) in treatment-resistant or atypical presentations of social phobia.
Previous
Next

Patient Education

Previous
 
Contributor Information and Disclosures
Author

Bettina E Bernstein, DO  Clinical Assistant Professor, Department of Psychiatry, Philadelphia College of Osteopathic Medicine; Private Practice at the Wynnewood House; Outpatient Consultant, Clinical Affiliate, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia; Court Appointed Evaluator, Family Court of Philadelphia; Psychiatric Consultant, Intercommunity Action, Inc, Easttown Tredyffrin School District

Bettina E Bernstein, DO is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mohammed A Memon, MD  Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Eduardo Dunayevich, MD  Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories

Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor, Kiki D Chang, MD, to the development and writing of this article.

References

  1. Beidel DC. Social anxiety disorder: etiology and early clinical presentation. J Clin Psychiatry. 1998;59 Suppl 17:27-32. [Medline].

  2. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. Jan 1994;51(1):8-19. [Medline].

  3. Heimberg RG, Stein MB, Hiripi E, Kessler RC. Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades. Eur Psychiatry. Feb 2000;15(1):29-37. [Medline].

  4. Wiltink J, Haselbacher A, Knebel A, Tschan R, Zwerenz R, Michal M, et al. Social Phobia - An Anxiety Disorder Underdiagnosed in Outpatient and Consultation-Liaison Service?. Psychother Psychosom Med Psychol. May 18 2009;[Medline].

  5. Pöhlmann K, Döbbel S, Löffler S, Israel M, Joraschky P. [Social phobia - the blind spot: infrequently diagnosed, highly complex, and a predictor for unfavourable therapy outcomes?]. Z Psychosom Med Psychother. 2009;55(2):180-8. [Medline].

  6. Phan KL, Orlichenko A, Boyd E, Angstadt M, Coccaro EF, Liberzon I, et al. Preliminary evidence of white matter abnormality in the uncinate fasciculus in generalized social anxiety disorder. Biol Psychiatry. Oct 1 2009;66(7):691-4. [Medline].

  7. Stein MB. Neurobiological perspectives on social phobia: from affiliation to zoology. Biol Psychiatry. Dec 15 1998;44(12):1277-85. [Medline].

  8. Constable RT, Ment LR, Vohr BR, Kesler SR, Fulbright RK, Lacadie C, et al. Prematurely born children demonstrate white matter microstructural differences at 12 years of age, relative to term control subjects: an investigation of group and gender effects. Pediatrics. Feb 2008;121(2):306-16. [Medline].

  9. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Text Revision. 4th ed. Washington, DC: American Psychiatric Association; 2000.

  10. Amir N, Beard C, Burns M, Bomyea J. Attention modification program in individuals with generalized anxiety disorder. J Abnorm Psychol. Feb 2009;118(1):28-33. [Medline].

  11. Suveg C, Hudson JL, Brewer G, Flannery-Schroeder E, Gosch E, Kendall PC. Cognitive-behavioral therapy for anxiety-disordered youth: secondary outcomes from a randomized clinical trial evaluating child and family modalities. J Anxiety Disord. Apr 2009;23(3):341-9. [Medline].

  12. Titov N, Andrews G, Johnston L, Schwencke G, Choi I. Shyness programme: longer term benefits, cost-effectiveness, and acceptability. Aust N Z J Psychiatry. Jan 2009;43(1):36-44. [Medline].

  13. Suveg C, Sood E, Comer JS, Kendall PC. Changes in emotion regulation following cognitive-behavioral therapy for anxious youth. J Clin Child Adolesc Psychol. May 2009;38(3):390-401. [Medline].

  14. Berger T, Hohl E, Caspar F. Internet-based treatment for social phobia: a randomized controlled trial. J Clin Psychol. Oct 2009;65(10):1021-35. [Medline].

  15. Burstein M, He JP, Kattan G, Albano AM, Avenevoli S, Merikangas KR. Social phobia and subtypes in the national comorbidity survey-adolescent supplement: prevalence, correlates, and comorbidity. J Am Acad Child Adolesc Psychiatry. Sep 2011;50(9):870-80. [Medline]. [Full Text].

  16. Fichter MM, Kohlboeck G, Quadflieg N, Wyschkon A, Esser G. From childhood to adult age: 18-year longitudinal results and prediction of the course of mental disorders in the community. Soc Psychiatry Psychiatr Epidemiol. Sep 2009;44(9):792-803. [Medline].

  17. Kuusikko S, Pollock-Wurman R, Jussila K, Carter AS, Mattila ML, Ebeling H, et al. Social anxiety in high-functioning children and adolescents with Autism and Asperger syndrome. J Autism Dev Disord. Oct 2008;38(9):1697-709. [Medline].

  18. Weinstock LS. Gender differences in the presentation and management of social anxiety disorder. J Clin Psychiatry. 1999;60 Suppl 9:9-13. [Medline].

  19. Lau AS, Fung J, Wang SW, Kang SM. Explaining elevated social anxiety among Asian Americans: emotional attunement and a cultural double bind. Cultur Divers Ethnic Minor Psychol. Jan 2009;15(1):77-85. [Medline].

  20. Hsu L, Alden LE. Cultural influences on willingness to seek treatment for social anxiety in Chinese- and European-heritage students. Cultur Divers Ethnic Minor Psychol. Jul 2008;14(3):215-23. [Medline].

  21. Guntheroth W. Link among mitral valve prolapse, anxiety disorders, and inheritance. Am J Cardiol. May 1 2007;99(9):1350. [Medline].

  22. Bögels SM, Alden L, Beidel DC, et al. Social anxiety disorder: questions and answers for the DSM-V. Depress Anxiety. Feb 2010;27(2):168-89. [Medline].

  23. Letamendi AM, Chavira DA, Hitchcock CA, Roesch SC, Shipon-Blum E, Stein MB. Selective Mutism Questionnaire: Measurement Structure and Validity. J Am Acad Child Adolesc Psychiatry. Aug 8 2008;[Medline].

  24. van Peer JM, Spinhoven P, van Dijk JG, Roelofs K. Cortisol-induced enhancement of emotional face processing in social phobia depends on symptom severity and motivational context. Biol Psychol. May 2009;81(2):123-30. [Medline].

  25. Mazeh D, Bodner E, Weizman R, Delayahu Y, Cholostoy A, Martin T, et al. Co-morbid social phobia in schizophrenia. Int J Soc Psychiatry. May 2009;55(3):198-202. [Medline].

  26. Evans KC, Wright CI, Wedig MM, Gold AL, Pollack MH, Rauch SL. A functional MRI study of amygdala responses to angry schematic faces in social anxiety disorder. Depress Anxiety. 2008;25(6):496-505. [Medline].

  27. Stein MB, Goldin PR, Sareen J, Zorrilla LT, Brown GG. Increased amygdala activation to angry and contemptuous faces in generalized social phobia. Arch Gen Psychiatry. Nov 2002;59(11):1027-34. [Medline].

  28. Bögels SM, Perotti EC. Does Father Know Best? A Formal Model of the Paternal Influence on Childhood Social Anxiety. J Child Fam Stud. Apr 2011;20(2):171-181. [Medline]. [Full Text].

  29. Maeda F, Nathan JH. Understanding taijin kyofusho through its treatment, Morita therapy. J Psychosom Res. Jun 1999;46(6):525-30. [Medline].

  30. Blair K, Shaywitz J, Smith BW, Rhodes R, Geraci M, Jones M, et al. Response to emotional expressions in generalized social phobia and generalized anxiety disorder: evidence for separate disorders. Am J Psychiatry. Sep 2008;165(9):1193-202. [Medline].

  31. Miller G. Society for Neuroscience meeting. Pills and games help conquer fear. Science. Nov 21 2003;302(5649):1321. [Medline].

  32. Victor AM, Bernstein GA. Anxiety disorders and posttraumatic stress disorder update. Psychiatr Clin North Am. Mar 2009;32(1):57-69. [Medline].

  33. Davidson JR. Pharmacotherapy of social anxiety disorder: what does the evidence tell us?. J Clin Psychiatry. 2006;67 Suppl 12:20-6. [Medline].

  34. Katzelnick DJ, Kobak KA, Greist JH, et al. Sertraline for social phobia: a double-blind, placebo-controlled crossover study. Am J Psychiatry. Sep 1995;152(9):1368-71. [Medline].

  35. Pande AC, Davidson JR, Jefferson JW, et al. Treatment of social phobia with gabapentin: a placebo-controlled study. J Clin Psychopharmacol. Aug 1999;19(4):341-8. [Medline].

  36. Guastella AJ, Richardson R, Lovibond PF, Rapee RM, Gaston JE, Mitchell P, et al. A randomized controlled trial of D-cycloserine enhancement of exposure therapy for social anxiety disorder. Biol Psychiatry. Mar 15 2008;63(6):544-9. [Medline].

  37. Rapee RM, Gaston JE, Abbott MJ. Testing the efficacy of theoretically derived improvements in the treatment of social phobia. J Consult Clin Psychol. Apr 2009;77(2):317-27. [Medline].

  38. Stangier U, Schramm E, Heidenreich T, Berger M, Clark DM. Cognitive Therapy vs Interpersonal Psychotherapy in Social Anxiety Disorder: A Randomized Controlled Trial. Arch Gen Psychiatry. Jul 2011;68(7):692-700. [Medline].

  39. Maric M, Heyne DA, de Heus P, van Widenfelt BM, Westenberg PM. The Role of Cognition in School Refusal: An Investigation of Automatic Thoughts and Cognitive Errors. Behav Cogn Psychother. Jun 29 2011;1-15. [Medline].

  40. Heyne D, Sauter FM, Van Widenfelt BM, Vermeiren R, Westenberg PM. School refusal and anxiety in adolescence: Non-randomized trial of a developmentally sensitive cognitive behavioral therapy. J Anxiety Disord. Apr 28 2011;[Medline].

  41. Knijnik DZ, Salum GA Jr, Blanco C, Moraes C, Hauck S, Mombach CK, et al. Defense style changes with the addition of psychodynamic group therapy to clonazepam in social anxiety disorder. J Nerv Ment Dis. Jul 2009;197(7):547-51. [Medline].

  42. Midgley N. Re-reading "Little Hans": Freud's case study and the question of competing paradigms in psychoanalysis. J Am Psychoanal Assoc. Spring 2006;54(2):537-59. [Medline].

  43. Walter D, Hautmann C, Rizk S, et al. Short term effects of inpatient cognitive behavioral treatment of adolescents with anxious-depressed school absenteeism: an observational study. Eur Child Adolesc Psychiatry. Nov 2010;19(11):835-44. [Medline].

  44. Altamura AC, Pioli R, Vitto M, Mannu P. Venlafaxine in social phobia: a study in selective serotonin reuptake inhibitor non-responders. Int Clin Psychopharmacol. Jul 1999;14(4):239-45. [Medline].

  45. Bailey JE, Papadopoulos A, Lingford-Hughes A, Nutt DJ. D-Cycloserine and performance under different states of anxiety in healthy volunteers. Psychopharmacology (Berl). Sep 2007;193(4):579-85. [Medline].

  46. Connor KM, Davidson JR, Potts NL, et al. Discontinuation of clonazepam in the treatment of social phobia. J Clin Psychopharmacol. Oct 1998;18(5):373-8. [Medline].

  47. Hofmann SG, Pollack MH, Otto MW. Augmentation treatment of psychotherapy for anxiety disorders with D-cycloserine. CNS Drug Rev. Fall-Winter 2006;12(3-4):208-17. [Medline].

  48. Nutt DJ, Bell CJ, Malizia AL. Brain mechanisms of social anxiety disorder. J Clin Psychiatry. 1998;59 Suppl 17:4-11. [Medline].

  49. Schmidt NB, Richey JA, Buckner JD, Timpano KR. Attention training for generalized social anxiety disorder. J Abnorm Psychol. Feb 2009;118(1):5-14. [Medline].

  50. Stallard P, Simpson N, Anderson S, Goddard M. The FRIENDS emotional health prevention programme: 12 month follow-up of a universal UK school based trial. Eur Child Adolesc Psychiatry. Aug 2008;17(5):283-9. [Medline].

  51. Stein DJ, Westenberg HG, Yang H, et al. Fluvoxamine CR in the long-term treatment of social anxiety disorder: the 12- to 24-week extension phase of a multicentre, randomized, placebo-controlled trial. Int J Neuropsychopharmacol. Dec 2003;6(4):317-23. [Medline].

  52. Stein MB, Chavira DA. Subtypes of social phobia and comorbidity with depression and other anxiety disorders. J Affect Disord. Sep 1998;50 Suppl 1:S11-6. [Medline].

  53. Stein MB, Liebowitz MR, Lydiard RB, et al. Paroxetine treatment of generalized social phobia (social anxiety disorder): a randomized controlled trial. JAMA. Aug 26 1998;280(8):708-13. [Medline].

  54. Velosa JF, Riddle MA. Pharmacologic treatment of anxiety disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am. Jan 2000;9(1):119-33. [Medline].

  55. Weeks JW, Heimberg RG, Fresco DM, Hart TA, Turk CL, Schneier FR, et al. Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychol Assess. Jun 2005;17(2):179-90. [Medline].

  56. Westenberg HG. The nature of social anxiety disorder. J Clin Psychiatry. 1998;59 Suppl 17:20-6. [Medline].

  57. White M, Dorman SM. Receiving social support online: implications for health education. Health Educ Res. Dec 2001;16(6):693-707. [Medline].

  58. Zaider TI, Heimberg RG. Non-pharmacologic treatments for social anxiety disorder. Acta Psychiatr Scand Suppl. 2003;72-84. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.