Social phobia: diagnosis, severity and implications for treatment.

Social phobia has a direct effect on the ability of the individual to interact with others in social or work situations and as a result is associated with a high level of dysfunction. The level of impairment is as severe as that found in other chronic disorders such as depression and is increased by a cascade of comorbidity, which complicates management. Efficacy in social phobia was reported with the MAOIs and this led to the investigation of reversible inhibitors of monoamine oxidase-A (RIMA) which offer a safer alternative. The efficacy of moclobemide has been shown in social phobia and the effect is more clear cut in patients with more severe symptoms. The better effect in severe social phobia has also been reported with the SSRI paroxetine. Effective treatment of social phobia appears to be able to overcome the substantial chronicity of illness which is frequent in sufferers. The introduction of these treatments should encourage people with social phobia to seek medical help for this hitherto much neglected disorder.