Social phobia is defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association [APA], 1994), as "a marked and persistent fear of social or performance situations in which embarrassment may occur" (p. 411). Rapee and Heimberg (1997) suggested that social phobia can best be understood on a continuum where shyness is at one end of the spectrum (indicating mild social anxiety), social phobia is in the middle (moderate social anxiety), and avoidant personality disorder is at the other end (severe social anxiety). However, the severity of social phobia should not be underestimated because evidence suggests that it is prevalent (Kessler et al., 1994), often considered chronic (Davidson, Hughes, George, & Blazer, 1993), and can be disabling to those who suffer from it (Wittchen, Stein, & Kessler, 1999). Approximately 60% of people with social phobia experience other troubling disorders, such as depression and obsessive-compulsive disorder (Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992), and are at greater risk of experiencing suicidal ideation and suicide attempts (Davidson et al., 1993).
Furthermore, despite the fact that those with social phobia report that it significantly interferes with their lives, less than 20% seek professional help (Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996; Wittchen et al., 1999), and only approximately 6% reported having used medications to treat their disorder (Schneier et al., 1992). The lack of information made available to people with social phobia about treatment options coupled with their fear of social interactions, including making contact with helping professionals, are cited as primary reasons for low treatment use.
The ramifications for those who must deal with social phobia are widespread and pervasive. When compared with people who had no psychiatric disorder, those with social phobia were less likely to marry and more likely to receive disability or welfare assistance (Schneier et al., 1992). In a study conducted by Wittchen et al. (1999), approximately one fifth of individuals with social phobia reported missing school and/ or work because of their condition, and 24% reported diminished work productivity. Thus, these individuals are likely to experience a wide range of psychological, emotional, and financial consequences from being isolated and underemployed.
Because of the prevalence of social phobia and the problems associated with the disorder, this article aims to create a better understanding of this condition and explore research related to the effective counseling and pharmacological treatments. Counseling implications are then discussed to obtain a holistic perspective of how to best treat those who have social phobia.
THE NATURE OF SOCIAL PHOBIA
For people with social phobia, exposure to a feared social situation can cause extreme anxiety and even panic. Symptoms can include, but are not limited to, trembling, twitching, dizziness, rapid heart rate, feeling faint, difficulty speaking or swallowing, and sweating. Commonly feared situations include eating in public places, giving and receiving compliments, unexpectedly bumping into someone you know, making eye contact, talking with unfamiliar people, and speaking to an audience (Wilson, 1996).
The early onset age for social phobia is 16 years (Magee et al., 1996; Ost, 1987); however, adolescents and children younger than 16 can be diagnosed with this disorder. For children, the duration of social phobia must exist for more than 6 months, and their capacity for age-appropriate peer interactions must be confirmed before the diagnosis of social phobia can be made (APA, 1994). The DSM-IV suggests that social phobia should not be diagnosed in children who exhibit social inhibition with adults only (p. 414). Nonetheless, there is a link between childhood inhibition and social phobia (Hayward, Killen, Kraemer, & Taylor, 1998), and it has been speculated that children who exhibit extreme shyness around other children or adults are at risk of developing social phobia later in life (Chavira & Stein, 1999). …