Clinical features
Effective treatment is dependent on accurate diagnosis. The symptoms of social phobia should be asked about when patients present with depression, panic attacks restricted to social situa- tions, or alcohol misuse. Patients may avoid eye contact, intro- duce themselves awkwardly or self-consciously, and offer weak handshakes.1 Other patients may give no signs during the consul- tation but will reveal anxiety when talking about specific feared situations.1
The symptoms of social phobia can be categorized as somatic, cognitive and behavioural.1 The most common somatic symp- toms are blushing and excessive perspiration, with palpitations, trembling, abdominal distress and muscular tension being less frequent.1 Common cognitive and emotional symptoms include unpleasant thoughts about the situation and blocked thoughts with difficulty thinking or concentrating. Patients fear their symptoms will be noticed and judged by those around them, and may display characteristic behaviours such as difficulty in speaking, becoming silent or avoiding eye contact. Complete avoidance of feared situations can have severe consequences on the development of the affected person and further reduce social confidence. Patients with social phobia are often unable to marry or have enduring relationships because of their anxiety in social encounters, and this causes long-lasting personal distress.1 After avoiding or on leaving a feared situation, individuals often experience significant self-reproach, decreased self-esteem and depressed mood.8