By asking a few brief questions, the physician can determine whether a patient meets the DSM-IV criteria for social phobia. These criteria are: (1) persistent fear of social situations in which the person is exposed to unfamiliar people which includes a specific fear of humiliation or embarrassment; (2) exposure to the situation almost invariably provokes anxiety; (3) the fear is recognized as unreasonable; (4) the feared situations are avoided or endured with intense distress; and (5) the symptoms result in impairment and/or marked distress.1 Social phobia is common among those with substance abuse disorders. A recent study of patients receiving substance abuse treatment found that social phobia was the second most common comorbid psychiatric diagnosis, occurring in 31% of subjects.2 A psychiatric referral is not necessary to evaluate social phobia, and the remaining answers are not appropriate in this clinical scenario.
- Evaluate for social phobia.
2. Adamson SJ, Todd FC, Sellman JD, et al. Coexisting psychiatric disorders in a New Zealand outpatient alcohol and other drug clinical population. Aust N Z J Psychiatry 2006;40:164-70.
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