SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)

DSM – 5 300.23 (F40.10)

• Social anxiety disorder, also known as social phobia.
• It involves discomfort around social interaction, and concern about being embarrassed and judged by
others.
• This discomfort will be experienced as fear and anxiety ,and accompanied by autonomic arousal.
• The discomfort can generalize to routine activities such a seating in front of others, or using a public
bathroom.
• Can lead to isolation, and either absence of development or stagnation of social skills.
 In a adult, this could include a first date, a job interview, meeting
someone for the first time, delivering an oral presentation, or speaking
in a class or meeting.
 In children, the phobic/avoidant behaviors must occur in settings with
peers, rather than adult interactions, and will be expressed in terms of
age appropriate distress, such as cringing, crying, or otherwise
displaying obvious fear or discomfort.
 Social interaction will consistently provoke distress.
ONSET
The onset can either be insidious, or sudden.

RISK FACTORS
• Temperamental qualities of fear of poor social evaluation and inhibition are risk factors for the
development for social phobia.
• Child maltreatment, (including peer abuse) is a risk factor for social phobia.
• Genetic basis.
• Learned behavior.
SOCIO- DEMOGRAPHIC INFORMATION
• Name : Arif
• Age : 22 years
• Sex : Male
• Address : Afghanistan
• Education: BBA
• Informants : The patient himself
• Occupation: Student
• Family Structure : Nuclear
• Language : English and Hindi
• Socio economic status : Middle class
• Informant’s Reliability : Reliable and Adequate

The 18 year old has stuttering issues with immense anxiety in public situations. He has had ongoing issues with his father
because of the reason being beaten up, even in the presence of guests which led to embarrassment, and a leading cause of
present public anxiety and low confidence.
CHIEF COMPLAINTS
• Stuttering speech in novel settings and under pressure
• Low confidence
• Issues with Father
• Getting angry easily

ONSET : Insidious
COURSE : Continuous
DURATION : 3 years
PRECIPITATING FACTOR : Issues with father and lacking confidence.
HISTORY OF PRESENT ILLNESS

The history of the illness presented by the client was reliable, and contributing to the current visible symptoms.
When 10 years old, father used to beat him for not completing his homework ow when teachers complained about
him. This caused fear and worsening of relationship of client with the father.
The scolding by father then began coming in front of guests at home that caused the client to feel ashamed and
embarrassed which is noted to be one of the major causes of current lack of confidence in him.
When on beginning with college years, client exclaimed experiencing extreme pressure to face new people and thus
there was stuttered speech. Due to this, he was not able to answer back to the teachers properly even when he knew
the answers.
Eventually, when there was improvement in relationship with father while growing up, there is still fear of father in
him. Besides, there are also mood fluctuations i.e., client gets angry easily on anything that is opposite to his
preferences and the state lasts for 2-3 minutes.
These factors are observed to be the cause of the experienced symptoms in the client which brought him to seek help.
PAST PSYCHIATRIC HISTORY
The client has experienced the symptoms of stuttering speech and lack in confidence, without any
self-harm behavior or substance use since 3 years but no treatment was taken.

FAMILY HISTORY
There are no problems between family members which contribute to the present
condition of the client except the fearful relationship that existed between the client and
his father few years earlier.
Also, there is stuttering in the mother and a younger sister which is not restricted to
public facing and is relatively low in frequency.
PERSONAL HISTORY
The development and functioning of the client since birth were observed to be normal but an adding
factor of physical abuse by father contributes effectively to the present symptoms and condition of
stuttering speech in public and low confidence in the client.
The growth through adolescent years was also normal functioning in educational area.
There is also appropriate functioning between friend circle and other people with whom he is once
comfortable.
There are no other problems observed in life activities such as attention, memory, attitudes, interests,
interpersonal relationships etc. though there is day dreaming with the content being anything that his
friends talk about.
PREMORBID PERSONALITY
The personality of the patient before the onset of current condition is not explained because
the patient was observed only after the full onset of the illness.

DRUG AND ALCOHOL HISTORY

There is no recorded history of drug/alcohol use.

SUICIDE RISK SCREENING

As recorded, there were no such ideations in the client.
DIAGNOSTIC IMPRESSION

All the symptoms consolidated indicate the presence of Social Anxiety Disorder with chief complaints being
stuttering speech in novel settings and under pressure with lack of confidence.
TREATMENT
1. SPEECH THERAPY
• Used as the treatment for stuttering speech.

Goals:
• Reducing the frequency of stuttering.
• Decreasing the tension and struggle of stuttering moments.
• Working to decrease word or situation avoidances.
• Using effective communication skills such as eye contact or phrasing.
EXERCISES USED:
1. BREATHING EXERCISES
• Regulating breathing may help reduce stuttering.
• One simple exercise used is diaphragmatic breathing.
• This breath technique can help become calm and relaxed, especially in social situations.
2. PROGRESSIVE RELAXATION
• Progressive relaxation exercises focus on relaxing the speech production muscles, such as the lips, tongue,
jaw and lungs helping reduce stuttering.
3. SLOW SPEECH EXERCISE
• Practicing beforehand about what to speak can help reduce stuttering, especially by slowing down vowels
and relaxing breath.
• In this technique, few sentences may be practiced slowly by stretching out the vowels for as long as
possible.
2. SUPPORTIVE PSYCHOTHERAPY
• Supportive psychotherapy is a dyadic treatment that uses direct measures to ameliorate symptoms and
to maintain, restore, or improve self-esteem, ego functions, and adaptive skills.
• A strong therapeutic alliance is fostered by conveying to the patient acceptance ,interest , respect, and
admiration for his/her accomplishments, thus supporting the patient’s self-esteem.

TECHNIQUES USED:
• Behavior goal setting
• Encouragement
• Positive reinforcement
• Modeling
OTHER EFFECTIVE TREATMENT
1. Medication including anti-anxiety medications.
2. Cognitive behavioral therapy: It teaches different ways of thinking, behaving, and reacting to
situations that help feel less anxious and fearful.
3. Social skills training: It is predicated on the notion that social anxiety is the result of impoverished or
underused social skills. Clients receive direct instruction in both verbal and nonverbal skills (for
example; eye contact, tone and volume of speech, conversational skills, and assertiveness training).
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