Social phobia (American Psychiatric Association, 1994) is characterised by a marked or persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to the possible scrutiny of others (American Psychiatric Association, 1994). The individual fears that he or she will act in a way or show anxiety symptoms that will be humiliating or embarrassing. For example, some patients with hyperhydrosis and rosacea often perspire or blush more prominently in embarrassing situations and may develop a social phobia as a result. Exposure to the feared social situation almost always provokes anxiety, which may take the form of a situationally bound panic attack, which in turn also results in an exaggerated autonomic reactivity of the skin. In social phobia the individual recognises that the fear is excessive or unreasonable; however, intense anxiety results if the feared situation is not avoided. The anxious anticipation or distress of the feared social or performance situation interferes significantly with the individual's overall functioning. Social phobia is also encountered in patients with cosmetically disfiguring skin disorders (Kent & Keohane, 2001) such as psoriasis and acne (Gupta & Gupta, 1996; Woodruff et al., 1997), especially those who have been teased or ridiculed about their skin disorder at some time earlier in their lives. Some patients with chronic acne whose acne had interfered with their socialisation during their adolescence continue to experience social anxiety in later life when they no longer have the acne, because of the long-term impact of having to live with acne during developmentally critical periods of life such as adolescence (Kellett & Gawkrodger, 1999). Patients with social phobia are typically underdiagnosed because the very nature of their disorder prevents them from attending clinics and doctors offices where they have to face large numbers of relatively unfamiliar people.
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