Comorbidity and differential diagnosis

Social phobia may increase the risk for other psychiatric disorders. (9,2 21.> In the National Comorbidity Survey (NCS), 81 per cent of persons with primary social phobia met the criteria for at least one other lifetime psychiatric disorder.(22) Odds ratios for other DSM-IIIR disorders given social phobia were 7.75 for simple phobia, 7.06 for agoraphobia, 4.83 for panic disorder, 3.77 for generalized anxiety disorder, 2.69 for post-traumatic stress disorder, 3.69 for major depression, 3.15 for dysthymia, and 2.01 for substance abuse/22) In persons with comorbid diagnoses in the Epidemiological Catchment Area Study (ECA), social phobia preceded the comorbid disorder in 76.8 per cent and onset in the same year in 7.2 per cent of cases.(9)

Differential diagnosis is complicated by the fact that certain Axis I disorders both resemble and co-occur with social phobia. However, the distinction among disorders is clinically important because pharmacological and psychological treatments may be differentially efficacious.

Panic disorder with agoraphobia (PDA) can be differentiated from social phobia in several ways. While many individuals with social phobia experience panic attacks, their anxiety occurs in anticipation of being evaluated negatively by others; for persons with panic disorder, panic attacks are often unexpected, may not be associated with specific cognitions, and can be nocturnal.(5) The age of onset for social phobia tends to be earlier than that for PDA.(23) Persons with social phobia presenting for treatment either show an equal gender distribution or are slightly more likely to be male; (24,25) those with PDA presenting for treatment are substantially more likely to be female/,5,26 Persons with social phobia are more likely to experience blushing and muscle twitches, while individuals with PDA are more likely to experience symptoms such as blurred vision, headaches, chest pain, and ringing in the ears and to fear that they will die or go crazy. (5,,26) Finally, persons with social phobia report feeling more comfortable when alone, while persons with PDA may feel more comfortable in the presence of others. (23)

Individuals with generalized anxiety disorder endorse higher levels of social anxiety than individuals with anxiety disorders other than social phobia. (24) Although individuals with either social phobia or generalized anxiety disorder may devote excessive amounts of time to worrying and ruminating, the focus of the worries in social phobia is specific to social or performance situations, while the hallmark feature of worry in generalized anxiety disorder is a heightened focus on possible catastrophic consequences across several domains of life. Patterns of anxiety symptoms also differentiate the two. Sweating, flushes, and breathing problems are more common in social phobia, while headaches, insomnia, and fear of dying are more common in generalized anxiety disorder. (2 28>

Social phobia and depression may share the characteristic of withdrawal from social situations.(26 In differentiating between social phobia and depression, one must consider the reason for the withdrawal. Persons with depression do so because they fail to experience pleasure in or lack the energy for social engagement. Persons with social phobia fear the negative evaluation they believe is associated with such situations. Persons with depression may be indifferent about engaging in social situations, while persons with social phobia often have a strong desire to affiliate with others which is hampered by anxiety.

Schizophrenia spectrum disorders are also characterized by symptoms that may resemble those of social phobia. For example, persons with schizophrenia, schizotypal personality, and schizoid personality are socially avoidant. However, they do not typically desire social relationships. (26) Similarly, persons with paranoid personality disorder may avoid others because they are suspicious of and fear harm from other persons.

Headache Happiness

Headache Happiness

Headache Happiness! Stop Your Headache BEFORE IT STARTS. How To Get Rid Of Your Headache BEFORE It Starts! The pain can be AGONIZING Headaches can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows. And just think of how unwelcome headaches are while you're trying to work.

Get My Free Ebook


Post a comment