Review Question - QID 217052

This patient presents with palpitations in the setting of marked fear of being observed in a social situation out of concern for being negatively evaluated and is avoiding social situations due to this fear. Therefore, this patient most likely has social anxiety disorder.

Social anxiety disorder is characterized by marked fear or anxiety about social situations in which the individual is open to scrutiny by others, such as in social interactions, being observed in public, or during public performance. The individual is primarily afraid of being negatively evaluated by others and avoids social situations where they can be scrutinized by others, causing impairment in social/occupational function. When the fear is limited to public speaking or performing, the performance only specifier is used. The first-line treatment for social anxiety disorder is either pharmacotherapy or cognitive behavioral therapy. Pharmacotherapy is with either a selective serotonin reuptake inhibitor (SSRI) like paroxetine or a serotonin and norepinephrine reuptake inhibitor (SNRI) like venlafaxine. For the performance only subtype, beta-blockers prior to the anxiety-provoking situation or as needed benzodiazepines may be helpful.

Canton et al. review the treatment options for social anxiety disorder. They state that SSRIs and SNRIs are first-line pharmacologic therapies and that combined psychotherapy and pharmacotherapy are most effective.

Incorrect Answers:
Answer 1: Agoraphobia can present with anxiety and avoidance of certain public situations, but the fear is centered on being trapped and not having the ability to escape the situation rather than being negatively evaluated.

Answer 2: Antisocial personality disorder is characterized by a pervasive pattern of disregard for the rights of others and/or social norms, such as illegal behavior, deceitfulness, recklessness, and lack of remorse.

Answer 3: Normal shyness should always be considered to avoid the over-pathologizing of illness, but this patient's behavior is affecting her social function. She rarely leaves the house due to her fear of negative evaluation; therefore, this is pathologic.

Answer 4: Panic disorder can cause social anxiety because patients are afraid that their panic attacks are seen by others. However, because this patient's fear is primarily of negative evaluation of her chewing as opposed to anticipation of a panic attack, social anxiety disorder is more appropriate.

Bullet Summary:
In social anxiety disorder, patients have a primary fear of being negatively evaluated by others, which leads to social anxiety and avoidance behavior.