2000 issue 4


Volume 16, issue 4


Fobia społeczna

Jacek Bomba1
1. Katedra Psychiatrii Collegium Medicum Uniwersytetu Jagiellońskiego
Farmakoterapia w Psychiatrii i Neurologii, 2000, 4, 321-331


ICD-l0 introduces social phobia as a separate dis order among anxiety disorders. The leading symptom is a fear of scrutiny by other people in relatively small groups accompanied by avoidance of social situations. This fear may be discrete to e.g. reddening in front of others, eating in public, visiting a public toiled, vomiting in social situation. May also be diffuse and concern all social situations outside family circle. A special form of social phobia is a fear speaking in public or performing. In specific cases a fear may be related to possible panic attack and so difficult to differentiate with agoraphobia.
Important differentiating factor is a primary character of fear, which is not related to delusional or obsessive thinking nor connected with real problems in functioning in groups (as in a case of stuttering).
The disorder has usually early beginning (before 18), sometimes in childhood. Not treated may result to underachievement’s, failures and incapacitation.
Comorbidity is quite often for patients with social phobia. Other anxiety disorders, depression and substance abuse and dependence (esp. on alcohol) are among the most often. Pathogenesis of social phobia is not clear. Psychodynamic interpretations emphasise symbolic character of symptoms and the role of ego defence mechanisms in development of phobias. Behavioural ones turn attention towards the conditioning of social experience. Cognitive approach accentuates a rigid scheme of self-esteem. Biological explanations led to three hypotheses: adrenergic, serotoninergic and dopaminergic.
The most effective in therapy appears to be integration of psychotherapy, especially cognitive-behavioural approach and pharmacotherapy. The last one has to take into account a type of anxiety and comorbid conditions. Benzodiazepines, buspiron, IMAO type A and SSRIs were found as effective. The last group has been recently suggested as the first choice medication in social phobia. In performance type of social phobia betablockers were found useful. In psychotherapy combination of behavioural exposure and cognitive restructuring are emphasised.