Clinical features and treatment response in social phobia: axis II comorbidity and social phobia subtypes

se fear of one or more social situations in which the individual is exposed to the observation of others. The individual fears that he/she will behave in a way that will be humiliating. Exposure to those stimuli provokes an immediate anxiety response that can lead to the avoidance of those situations or to the endurance of them with intense anxiety (DSM-IV, APA, 1994). The clinical features of this diagnostic category include a wide number of situations, from specific fears such as eating, writing or speaking in public, to more generalized fears which appear in all or almost all social situations (Heimberg, Holt, Scheneier, Spitzer & Liebowitz, 1993). This variability has opened up a discussion on the necessity of distinguishing among different social phobia subtypes. As a background, we can take the Öst, Jerremalm & Johansson (1981) study. This authors, using the performance in a role-play, distinguished between «behavioral reactors» (behavioral disruption without cardiac acceleration) and «physiological reactors» (cardiac acceleration without behavioral disruption). Later, they considered another subtype, «cognitive reactors» (predominance of irrational thoughts) (Jerrelmalm, Jansson & Öst, 1986). DSM-IIIR (APA, 1987) specifies the generalized social phobia subtype when the individual fears «most» social situations. This subtype is maintained by DSM-IV (APA, 1994). Heimberg distinguished three social phobia subtypes: generalized social phobia, which includes fear across almost all domains of social situations; non-generalized social phobia, which includes individuals who fear multiple social situations, but who report no problems in at least one social domain; and finally, discrete social phobia, which includes individuals with fear in only one or two circumscribed social siClinical features and treatment response in social phobia: axis II comorbidity and social phobia subtypes