Disorder of the Decade

SOCIAL PHOBIA

EVERYONE FEELS SELF-CONSCIOUS occasionally. Many folks would rather
die than give a speech or introduce themselves to a stranger. But a
number of Americans harbor an irrational fear that their social
performance is being carefully monitored and criticized by others all the
time. As a result, these shy-meisters will go to great lengths to avoid
eating, drinking, speaking, or even writing in public.

The condition, social phobia, affects about 2% of the population
and is "one of the worst neglected disorders of our time," insists
psychologist Barry Wolfe, Ph.D., of the National Institute of Mental
Health. He is one of a pack of researchers and clinicians across the
country paying heightened attention to the disorder, encouraged by the
results of new behavioral and drug therapies.

The condition has been ignored in the past primarily because
extreme social phobics rarely seek help, so embarrassed are they by
behavior that society deems "trivial" or "outgrowable." Typically,
concerned parents notice that their abnormally anxious teenagers or
twenty-something stay-at-homes are avoiding classes or job
responsibilities and drag them off to therapy.

Accurate diagnosis and treatment are difficult because the disorder
manifests itself in many ways. Some fear simply using a public toilet,
while others believe any interaction with strangers will lead to public
ridicule. In addition, many suffer more from secondary symptoms such as
depression, suicide ideation, and agoraphobia, complicating
diagnosis.

No one knows for sure what sets off social phobia, but it may
result from a combination of biological vulnerability-an inborn
predisposition to shyness - and some embarrassing event during childhood
or adolescence. And though social phobia appears to be passed down from
generation to generation, it's not child-raising skills that are at
fault.

For those brave enough to come forward, treatment does exist. In
behavioral therapy, participants identify self-destructive thinking
patterns, compare notes with fellow sufferers, and role-play
uncomfortable situations, such as cocktail parties, that force them to
face - and ultimately master-the initial stages of anxiety they feel in
real life.

Drugs such as the betablocker propranolol, phenelzine, and the
antidepressant Prozac also alleviate symptoms, says NIMH's Wolfe, who
predicts that a combination of drug and cognitive therapy may ultimately
prove most effective.

PHOTO: A man biting his fingernails (PHOTO:INDEX/BLACK BOX)