Social anxiety disorder: common, disabling, and treatable.

BACKGROUND Social anxiety disorder (also known as social phobia) is characterized by extreme fear, avoidance, or both of one or more social or performance situations, such as making a presentation, meeting new people, or eating in front of others. This condition is common, with a lifetime prevalence of up to 13%, and one third of affected persons have major dysfunction. METHODS The English-language literature on social anxiety disorder indexed on MEDLINE was searched using the phrases "social phobia" or "social anxiety disorder;" this search was supplemented with other data sources, such as recent textbooks, to determine common clinical symptoms, differential diagnosis, and management in the primary care setting. RESULTS Recognition and treatment of social anxiety disorder is poor; only a small minority of patients with this condition have it appropriately diagnosed or treated. Primary care physicians should suspect social anxiety disorder in patients who have specific symptoms and signs (such as hyperhidrosis, flushing, tremor, and white-coat hypertension), in patients who have symptoms of anxiety (such as chest pain, palpitations, or dizziness), or in patients who have another known anxiety disorder, depression, or substance abuse. Drug treatment consists of serotonin-reuptake inhibitors, monoamine oxidase inhibitors, or high-potency benzodiazepines. A specific type of psychotherapy called cognitive behavioral therapy is another effective treatment, but it is not acceptable or accessible to most patients. CONCLUSIONS Because social anxiety disorder is common, disabling, and treatable, primary care physicians should intensify their efforts to recognize it.