Social anxiety disorder

Question 1

Screening questions for social phobia

Answer 1

Do you ever feel anxious in certain social situations or in situations where you might be watched (e.g eating in front of others, writing in front of others, asking a question in a group of people, meetings, parties.public speaking)?
- What worries you about these situations?
-Whenever you’re in these situations what do you feel like? (?blushing, palpitations, sweating, panic attack)

o Do you worry that you might say or do something that embarrassing or make people think badly of you?

o How often do you get anxious
- Do you think you are more worried and afraid than you should be?
o How long has this been going on? (> 6 months)

o Do you try and avoid such situations? To what degree?
– if not avoiding then how bad does the anxiety get?

Question 2

What is additional questions to screening, what are the comorbidities

Answer 2

• Functional impact
• “What problems has it caused in your life?”
• Marriage, job/school, friendships, leisure activities
• “How much does it bother you that you have this fear?”
• Comorbid depression, alcohol/drug abuse in 40%

Question 3

What is the DSM criteria for social phobia (social anxiety disorder)

Answer 3

A. Marked fear or anxiety about ≥1 social situation in which the person is exposed to possible scrutiny by others e.g. social
interactions (having a conversation, meeting
unfamiliar people), being observed (e.g. eating or drinking), performing in front of others
- Nb. In children this must occur in peer settings and not just in interactions with adults

B. Fear of acting in a way or showing anxiety symptoms that will be negatively evaluated e.g. humiliation or embarrassment,
rejection

C. Social situations almost always provoke fear/anxiety
- In children this may be expressed as crying,
tantrums, freezing, clinging etc.

D. Social situations are either avoided or endured with intense fear/anxiety

E. Fear or anxiety out or proportion to the actual threat posed by the social situation
and to the sociocultural context

F. Fear/anxiety/avoidance persistent for ≥6 months

G. Fear/anxiety/avoidance causes clinically significant distress or impairment in social/
occupational/other important areas of functioning

H. Fear/anxiety/avoidance not attributable to a substance (drug of abuse, medication) or
medical condition

I. Fear/anxiety/avoidance not better explained by another psychiatric disorder e.g. panic disorder, body dysmorphic disorder, autism spectrum disorder

J. If another medical condition (e.g. Parkinson’s disease, obesity) is present the fear/anxiety/avoidance is unrelated or excessive

Question 4

What is ddx of social phobia and ix

Answer 4

o Schizoid
o Autism spectrum
o Performance anxiety
o Hyperthyroidism, parkinson’s

Ix
o Safety
o Exclude medical causes –bloods, urine tox

Question 5

What is management of social phobia

Answer 5

o Meds
1st line = SSRI / SNRI
2nd line = long acting benzos eg. clonazepam
/ MAOi - eg. Phenelzine - If no/partial response to SSRI and hx of substance use disorder

Other = propranolol PRN or clonazepam prn for performance only SAD - taken 30-60m before event.

Psych
o Psychoeducation
o CBT
- Systematic desensitisation