100 Chapter 9
Treatment
It is often possible to enlist the help of parents and teachers to reduce
avoidable stresses in the young person’s life. It may also be helpful to
teach the young person (and perhaps the rest of the family) cognitive-
behavioural strategies for managing the remaining anxieties. Selective
serotonin reuptake inhibitors (SSRIs) may reduce symptoms for as long
as medication is taken. For the present, the most promising long-term
approach seems to be a combination of stress reduction and cognitive-
behavioural work.
Course
The disorder often persists for years, and may continue into adult life,
sometimes combined with depression.
Social anxiety disorder and social phobia
ICD-10 has a category calledsocial anxiety disorder of childhoodthat has no
exact counterpart in DSM-IV, though there was an equivalent category
calledavoidant disorderin DSM-III-R. What this category describes is an
exaggerated and persistent version of the normal developmental phase of
stranger anxiety that is commonly prominent up to the age of 30 months
in ordinary children. Affected children have good social relationships
with family members and other familiar individuals but show marked
avoidance of contact with unfamiliar people, resulting in social impairment
(for example, in peer relationships). They may remain unassertive and
socially impaired into adolescence, or they may improve spontaneously.
It is not clear how useful it is to think of these children as having an
anxiety disorder as opposed to extremely shy personalities. In practice,
many affected children also meet the criteria for other anxiety disorders,
most commonly generalised anxiety disorder.
The sort of social anxiety described in the previous paragraph is clearly
not exactly the same condition associal phobia, with the latter typically
starting in the mid-teens and involving fear of public scrutiny and humil-
iation. Nevertheless, social phobia can arise from a background of long-
standing childhood shyness and inhibition. Thus the distinction between
early-onset social anxiety and later-onset social phobia may not be clear-
cut. The relationship with avoidant personality disorder in adulthood is
unknown.
Panic disorder
The key feature of panic disorder, which may or may not be accompanied
by agoraphobia, is the presence of discrete panic attacks, at least some of
which occur unexpectedly without any obvious precipitant. The peak age
of onset is 15–19 years. Panic attacks are rare or non-existent in prepu-
bertal children. During an attack, the individual experiences an intense
fear of impending danger, disaster or death, accompanied by a mixture of
somatic symptoms such as sweatiness, a racing heart, or hyperventilation.
Treatment options include cognitive therapy and tricyclic antidepressants.