The essential feature of social phobia is a marked and persistent fear of performance situations when patients feel they will be the centre of attention and will do something humiliating or embarrassing. The situations that provoke this fear can be quite specific, for example public speaking, or be of a much more generalised nature involving fear of most social interactions, for example initiating or maintaining conversations, participating in small groups, dating, speaking to anyone in authority. Exposure to the feared situation almost invariably provokes anxiety with similar symptoms to those experienced by patients with panic attacks but some seem to be particularly prominent and difficult i.e. blushing, tremor, sweating and a feeling of 'drying up' when speaking.
Treatment. The drugs with established efficacy are the SSRI, paroxetine, the MAOI, phenelzine and
TABLE I9.S Relative effectiveness of pharmacological treatments for anxiety disorders
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