Social Phobia

Children with social phobia (also called social anxiety disorder) have a persistent fear of being embarrassed in social situations, during a performance, or if they have to speak in the class or in public, get into conversation with others, or eat, drink or write in public.

Feelings of anxiety in these situations produce physical reactions; palpitations, tremors, sweating, diarrhea, blushing, muscle tension, etc.  Sometimes a full blown panic attack ensues.  Sometimes the reaction is more mild.

These children exhibit excessive fear in situations where they have to perform in front of unfamiliar people or in situations where they may be observed or scrutinized by others.  The anxiety that is experienced must be experienced in situations where children have to perform in the presence of other children, as well as in situations where they have to perform in front of adults.  The child either avoids the feared social or performance situation, or he or she endures it with intense anxiety or distress.

To reach diagnostic criteria for this disorder, the child's avoidance, anxious anticipation, or distress in the feared social or performance situation needs to be excessive, and interfere significantly with the child's normal routine, academic performance, or social activities or relationships. 

Adolescents and adults are able to recognize that their fear is unreasonable or excessive, although this recognition does not prevent the fear.  Children, however, might not recognize that their reaction is excessive, although they may be afraid that others will notice their anxiety and consider them odd or babyish.

Young children do not articulate their fears, but may cry, have tantrums, freeze, cling, appear extremely timid in strange social settings, shrink from contact with others, stay on the side during social events, and try to stay close to familiar adults.

Children with this disorder may fall behind in school, avoid school completely, or avoid social activities among children their age.  They may find it impossible to speak in social situations or in the presence of unfamiliar people.

A. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. NOTE: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.

B. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. NOTE: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.

C. The person recognizes that the fear is excessive or unreasonable. NOTE: In children, this feature may be absent.

D. The feared social or performance situations are avoided or else are endured with intense anxiety or distress.

E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

F. In individuals under age 18 years, the duration is at least 6 months.

Specify if:

GENERALIZED: if the fears include most social situations (eg, initiating or maintaining conversations, participating in small groups, dating, speaking to authority figures, attending parties). NOTE: Also consider additional diagnosis of Avoidant Personality Disorder.