Definitions of the specific and social phobias are as follows:

• Specific - Clinically significant anxiety induced by exposure to a specific situation or object, often resulting in avoidance.

• Social - Clinically significant anxiety induced by exposure to certain social or performance situations, often resulting in avoidance.

Causes of the specific and social types of phobias are as follows:

• Specific - For some patients, phobias start early in life and disappear in time without treatment, while other phobic conditions may progress later in life. The condition may be familiar.

• Social - Social phobias appear to occur more frequently among first-degree biological relatives of those with disorders as compared with the general population. Men are more likely to experience the more serious type of social anxiety known as avoidant personality disorder. In this disorder the patient has feelings of inadequacy and inhibition, and is hypersensitive to criticism.

Signs and symptoms of the specific and social types of phobias are as follows:

• Specific - Some persons with this type of phobia experience very little difficulty; however, some phobias of this type interfere greatly with normal performance, e.g., fear of closed places. Persons with fear of blood, or injections, or injury may possibly experience fainting episodes due to a vasovagal response that produces bradycardia and orthostatic hypotension. In addition, many may experience hyperventilation and a feeling of fainting (pre-syncope) due a change in their blood gas levels.

• Social - A limited amount of anxiety in social situations is normal. However, most persons with social phobia are extremely anxious in social situations. They try to avoid situations in which anxiety phobia occurs. A generalized type of social phobia may produce anxiety in a variety of social situations, but specific social phobias usually produce anxiety only when the person must execute an activity in a public setting.

In most cases, the diagnostic criteria noted for specific and social anxiety are as follows:

• Specific

  • Constant, extreme fear that occurs due to the presence or anticipation of a particular object or situation. (E.g., fear of closed places, flying, the dark, animals etc.)

  • An instant anxiety response to the provoking object or situation which may lead to panic attack in some persons.

  • Recognition by the patient that he or she experiences extreme fear.

  • Avoidance of the stimulus causing the phobic reaction or demonstrating severe anxiety when it occurs.

  • Interference with the person's daily life style by the anxiety reaction, or demonstration of significant distress by the having the phobia.

  • Continuance of the condition for more than six months in persons under 18 years of age.

  • The phobic, panic or anxiety reaction to the stimulus is best attributed to a specific phobic disorder as opposed to other disorders.

• Social the criteria for social phobia are basically the same as for specific phobia with the following exceptions:

  • In addition to the criteria noted, the disorder cannot be attributed to effects of substances or medical conditions if other mental or medical conditions exist.

  • The fear or anxiety should not be limited to the degree of upset caused by the social implications of the condition.

Management of specific and social anxiety is as follows:

• Specific - Since the stimuli that cause the anxiety are specific, staying away from the stimuli is often adequate to avoid the disorder. However, if treatment is indicated, exposing the person to the stimuli is the usual treatment of choice. Regulated contact with the object or situation is most effective when consistency is maintained. This type of therapy has also shown positive responses in persons with a phobia of blood, injections, or injury. Medications are usually not given because they usually are not helpful in overcoming specific phobias. However, anxiety-reducing medications may be helpful in managing the disorders on a short-term basis.

• Social - Exposure to the situation that causes the phobic reaction is usually effective. The difficulty comes with planning exposure of the proper duration to establish habituation. Antidepressant medications have been noted to be effective.

Residuals for the specific and social types are as follows:

• Specific - Generally, phobias that continue into adulthood have a relatively low rate (20%) of remittance.

• Social - In most cases, this disorder is a life-long experience. However, the intensity may vary during adulthood as the person is faced with different pressures and burdens.