• a marked and persistent fear of social or performance situations where one is exposed to unfamiliar people or possible scrutiny

Epidemiology

• lifetime prevalence rate ~ 16%
• Female: Male = 1.5: 1
• Begins in early childhood and adolescence
• can lead to significant psychiatric comoribidy including depression, anxiety disorders, substance abuse and eating disorders
• often underrecognized by family practitioners

History

• fear of being humiliated or embarassed in social or performance situations
  • include: public speaking, eating, drinking, writing, public restrooms, speaking on the telephone, social gatherings
• the fear is recognized as excessive/unreasonable
• the avoidance, anticipation and distress interfere significantly with social and occupational functioning
• often presents with somatic complaints of insomnia, fatigue, palpitations, chest pain, shortness of breath, dizziness, trembling of hands, sweating, blushing and GI complaints

Physical

• hyperhidrosis, tremor, blushing, stuttering, hypertension and tachycardia
• must do a thorough mental status examination

Management

• cognitive behavioural therapy
• exposure therapy (most firmly established therapeutic maneuver)
• cognitive restructuring
• social skills training

References

Toronto Notes 2005