Fears that make prisoners of more than a million

Social phobia: Treatment often denied to sufferers
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More than a million people - three per cent of the adult population - are suffering from social phobia, but only 10 per cent receive treatment, according to the Royal College of Psychiatrists.

Social phobia - the fear of scrutiny by others - generally begins in mid-teenage years when it causes a great deal of damage.

A further seven per cent of people avoid certain social situations and 40 per cent consider themselves shy.

Sufferers display a marked and persistent fear of social or performance situations, which provoke a panic attack, even though they realise the fear is excessive or unreasonable.

Typical fears include being introduced to strangers, eating or drinking in a public place, writing in front of others or being teased.

Those who suffer from social phobia, or social anxiety disorder, as it is also known, have common symptoms. Seventy-nine per cent said they suffered from palpitations, 75 per cent from trembling and 74 per cent sweating. Other symptoms included a sinking stomach, tense muscles, dry mouth and blushing.

In addition, social phobia is seen as being responsible for the onset of other serious conditions, such as depression, agoraphobia and, most particularly, alcoholism and drug abuse. The logic is that social phobics will drink or take drugs in order to muster Dutch courage to socialise, but by doing so they cause more harm to themselves. Suicide attempts are also significantly higher among social phobics.

The causes of social phobia are not known but may stem back to childhood. Dr Malcolm Lader, professor of clinical psychopharmocology at the Institute of Psychiatry in London, said: "Every child is fearful of strangers but usually develops through this by parental example and biological maturation to become a social animal." However, in some children, this does not happen.

"This can be long-term lifetime behaviour which doesn't tend to get better" he added.

At present there are two main means of treating social phobics - either through psychology or prescribed drugs.

Dr David Clark, of Oxford University, said that if social phobics were given 12 weeks cognitive behaviour therapy, 70 per cent of patients would make a marked improvement, which would be still apparent up to five years later.

The treatment involves the patients facing their fears - such as writing a cheque in public. Conversational skills are also taught.

The other option is drug treatment and so far the most effective treatments have been the use of anti-depressants. Fifty to sixty per cent of patients treated with either mono-amine oxidase inhibitors or reversible inhibitors of mono-amine oxidase showed significant improvement after 16 weeks. The Royal College of Psychiatrists is launching a free leaflet, Help Is At Hand, which explains treatments and symptoms of social phobia.

Dr Lader called for GPs to be more aware of those suffering from social phobia and for combined drug and psychological treatments to be given.

In the US, where the condition is already treated as an anxiety disorder, studies show that about 1.5 per cent of the male population and 3 per cent of the female population will experience symptoms of social phobia for up to six months.

A further study found that just over 11 per cent of US men and 15 per cent of US women will have to cope with the condition permanently.