Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Anxiety Disorders
Social Phobia
Children with social phobia (also called social anxiety disorder) have a
persistent fear of being embarrassed in social situations, during a performance,
or if they have to speak in class or in public, get into conversation with
others, or eat, drink, or write in public. Feelings of anxiety in these
situations produce physical reactions: palpitations, tremors, sweating,
diarrhea, blushing, muscle tension, etc. Sometimes a full-blown panic attack
ensues; sometimes the reaction is much more mild. Adolescents and adults are
able to recognize that their fear is unreasonable or excessive, although this
recognition does not prevent the fear. Children, however, might not recognize
that their reaction is excessive, although they may be afraid that others will
notice their anxiety and consider them odd or babyish.
Young children do not articulate their fears, but may cry, have tantrums,
freeze, cling, appear extremely timid in strange social settings, shrink from
contact with others, stay on the side during social events, and try to stay
close to familiar adults. They may fall behind in school, avoid school
completely, or avoid social activities among children their age. The avoidance
of the fearful situations or worry preceding the feared event may last for weeks
and interferes with the individual’s daily routine, social life, job, or school.
They may find it impossible to speak in social situations or in the presence of
unfamiliar people (for review of social phobia, see DSM-IV; Black et al., 1997).
Social phobia is common, the lifetime prevalence ranging from 3 to 13 percent,
depending on how great the fear is and on how many different situations induce
the anxiety (DSM-IV; Black et al., 1997). In survey studies, the majority of
those with the disorder were found to be female (DSM-IV). Often the illness is
lifelong, although it may become less severe or completely remit. Life events
may reassure the individual or exacerbate the anxiety and disorder.
Back to the Mental Health: The Surgeon General's Report Table of Contents