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Social phobia has been described for centuries in the literature, but it has only recently been recognized as a discrete and treatable psychiatric condition rather than excessive shyness or a personality disorder. Conceptualizing social phobia as a neurobiological entity with reliable diagnostic features has greatly facilitated epidemiological and treatment research. As has been discussed earlier in this issue, social phobia may be much more common in the general population than was previously believed. The National Comorbidity Survey conducted by Kessler and colleagues1 is a recently published US community survey that employed structured psychiatric interviews to generate DSM-III-R diagnoses. After major depression (17.1%) and alcohol dependence (14.1%), social phobia was the third most frequent lifetime psychiatric disorder in the United States at 13.3%; 12-month prevalence was 7.9%. Even if these most recent figures overestimate the true prevalence of social phobia, it is clear that the previous estimates have been too low. Because of the significant potential for impairment in work and social functioning, academic difficulties, depression, and substance abuse often associated with social phobia, effective and practical treatments are clearly needed.
The generalized subtype of social phobia is a more pervasive, severe, and less responsive condition than nongeneralized/discrete social phobia. It should be remembered that improvement of social phobia (especially generalized social phobia) may continue for months and years after acute treatment is completed. This is, in part, due to the typical interruption in normal psychosocial development that occurred at a relatively early age for many of these patients. For many patients, social competence can be achieved only after the individual has been allowed to continue normal social development that was prevented by pathological social fear and avoidance.
This article will present a brief overview of the current evidence for efficacy of the available pharmacological and standardized behavioral and cognitive-behavioral treatments. Suggestions for optimizing treatment of social phobia will be presented. Finally, remaining questions and directions for further investigation will be reviewed briefly.
PHARMACOLOGICAL TREATMENTS FOR SOCIAL PHOBIA
The efficacy of pharmacological treatments for social phobia has now been documented for monoamine oxidase inhibitors (MAOIs), benzodiazepines, and selective serotonin reuptake inhibitors (SSRIs). Beta blockers (atenolol and others) have shown less consistent results.
Monoamine Oxidase Inhibitors
Similarities between symptoms in individuals experiencing rejection sensitivity as a symptom...