Diagnostic anomalies in social phobia.

Social phobia has been recognized only recently as a clinical entity, and there is considerable overlap in diagnosis between agoraphobia, panic disorder, stress disorder and avoidant (anxious) personality disorder. In more severe cases there may also be some difficulty in differentiating the condition from schizophrenia. In reaching a correct diagnosis of social phobia it appears that the two essential elements of a phobic diagnosis, situational fear and avoidance, should be present prominently and that a distinction from agoraphobia can be made by paying close attention to the nature of the situations in which fear is shown. If this policy is followed, social phobia can be readily defined and is fairly easily distinguished from other neurotic disorders. There is considerable overlap with the anxious and fearful group of personality disorders, particularly avoidant (anxious) personality disorder and this is almost impossible to distinguish from chronic persisting social phobia. Data are presented on the incidence of primary and secondary social phobia occurring prospectively in patients with the most common neurotic disorders (dysthymia, panic and generalized anxiety disorder) seen over a 2-year period. Twelve per cent of the patients had secondary social phobia initially, but over the 2-year period 9% of the patients had social phobia as a primary or single psychiatric diagnosis on at least one occasion. This was most likely in those patients allocated to a benzodiazepine, diazepam, in the first phase of treatment (p < 0.05).