Which statement would a client diagnosed with social phobia make in response to: 'What is most disruptive in your life?'

Which statement would a client diagnosed with social phobia make in response to: 'What is most disruptive in your life?'

• A. I feel like I can't breathe when I get in the elevator at work.
• B. Sometimes I feel like my heart is pounding so fast and the walls are closing in on me for no reason.
• C. I can't go into crowded stores or anywhere unless my sister is with me.
• D. I was just promoted at work and found out I will have to make presentation; I have never been able to speak in public.

Answer: (D)

In social phobia, the fear centers on being negatively evaluated in social or performance situations, so the person’s life is most disrupted by tasks that require others to judge them. The statement about being promoted and having to make a presentation captures a clear social-evaluative situation—speaking in front of others—that would cause intense anxiety and directly interfere with work duties. The other examples reflect different anxiety patterns. Breathing difficulties in an elevator and a rapid, pounding heartbeat with a sense of impending doom point to panic-type symptoms rather than a fear focused on social scrutiny. The person who avoids crowded places with a family member present suggests avoidance, but not the specific fear of being scrutinized or embarrassed in front of others that defines social phobia.

In social phobia, the fear centers on being negatively evaluated in social or performance situations, so the person’s life is most disrupted by tasks that require others to judge them. The statement about being promoted and having to make a presentation captures a clear social-evaluative situation—speaking in front of others—that would cause intense anxiety and directly interfere with work duties.

The other examples reflect different anxiety patterns. Breathing difficulties in an elevator and a rapid, pounding heartbeat with a sense of impending doom point to panic-type symptoms rather than a fear focused on social scrutiny. The person who avoids crowded places with a family member present suggests avoidance, but not the specific fear of being scrutinized or embarrassed in front of others that defines social phobia.