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Social anxiety or social phobia may be one of the least diagnosed conditions amongst children and adults in the United States today. It is estimated that as many as 13% of the population suffers from social anxiety disorder. The vast majority of persons fear more than one type of social situation. The most prevalent fear is public speaking followed by fear of speaking to strangers and meeting new people. Other performance fears can include eating, drinking, writing in public or using public rest rooms. Social anxiety disorder is also prevalent within the population diagnosed with more generalized anxiety disorders.

It is a life long disorder that often begins around the age of eight when children’s aware-ness of others in relationship to themselves becomes a developmental milestone. It typically has an onset during mid-teens, sometimes emerging out of a childhood history of social inhibition or shyness. Onset may follow a stressful will humiliating experience that most teenagers are exposed to in social settings. Some clinicians believe it a more rare disorder “Elective Mutism” in children by is a precursor to Social Anxiety/Social Phobia (SA/SP).

It is of interest that social anxiety has become of increasing interest to the clinical community in the past few years. This occurrence may be a product of a number of factors;

The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), 1 describes social phobia as an intense, irrational and persistent fear of being scrutinized or negatively evaluated by others. In patients with this disorder, feared social or performance situations typically provoke an immediate anxious reaction ranging from diffuse apprehension to situational panic. The types of fears and avoidance commonly associated with social phobia are, to some degree, experienced by most people. However, to meet the i-agnostic criteria for this disorder, the symptoms must be severe enough to cause significant distress or disability. Social phobia can be generalized, meaning that the patient fears many or most social interactions or it can be limited to one or a few situations, such as public speaking or performing.

While the onset is most common in adolescents and young adulthood, many people often enter treatment after suffering their 15-25 years after the onset of symptoms. Social anxiety disorder occurs equally amongst males and females. When females enter treatment they are more likely to report the symptoms of social anxiety whereas males are more likely to seek treatment describing more phobic like behaviors. According to DSM-IV, 69% of those with the disorder believed that their anxiety interfered significantly with their social relationships. 92% felt it significantly interfered with occupational performance and 85% with their academic functioning.

Clearly, social anxiety disorder or social phobia has a major impact on an individual’s capacity to function to their potential either socially or in the workplace. Of some inter-est, due to the chronic nature of the disorder, 72 to 80% of the cases are complicated by a co-morbid conditions such as panic disorder, Agoura phobia, school phobia, generalized anxiety disorder, depression, avoid into personality disorder, alcoholism, drug use, and/or depression.

In most clinical settings, especially under HMO guidelines, the co-morbid condition be-comes the focus and is the one likely to be recognized and treated. Social anxiety disorder is treated in a number of ways. The best combination seems to be medication and cognitively oriented behavior therapy.

Overall, social anxiety disorder or social phobia lives deep within our culture. Untreated, talented people never realize their potential. Untreated, a phobic teenager becomes de-pressed and self medicates with alcohol or drugs to reduce the anxiety. Untreated, the assembly worker never makes manager, or the middle manager is never promoted. And, for those whose co-morbid symptoms are treated, the underlying anxiety continues to erode their lives.

Therefore, it is important for clinicians to be aware of the insidious nature of social anxiety disorder and to unmask it within the clinical setting by looking past the co-morbid symptoms and seeking out causative events.