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“Social Anxiety Disorder” by Schneier Franklin

The article, “Social Anxiety Disorder,” by Schneier Franklin, was published in 2006, in the New England Journal of Medicine. The writer outlines what he considers the main causes of social anxiety disorder and proposes two solutions, namely, therapy and medication.

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He deconstructs the condition using an anecdotal example of a 28-year-old man, who finds it impossible to feel comfortable around other people. Schneier uses this case study as a basis from which to study the condition starting from its origin in adolescence. He examines its development over the years as it gradually worsens, reinforced by the patient’s inability to confront it due to fear and shame.

The problems facing people suffering from the condition are briefly examined, after which he moves to possible solutions. He proposes cognitive behavior therapy to be the most effective method, citing empirical studies that have shown improvement rates of over 80% (Schneier, 2006). He also discusses several pharmacological solutions such as Serotonin-Reuptake Inhibitors, which he claims are highly effective if administered consistently.

The challenges of treating the conditions, such as resistance to treatment, are also discussed, and finally, the writer concludes by recommending either therapy or medication. However, he suggests that therapy should come first in view of its projected long-term benefits. He also admits that the condition is markedly difficult to diagnose and treat in children and teens because its symptoms can be easily mistaken for age-related awkwardness (Schneier, 2006).

The topic addressed is especially important since, social anxiety disorder, also known as social phobia, is reportedly one of the most common anxiety disorders in the United States (Andrade, Sandarsh, Chethan & Nagesh, 2010). According to Hofmann and Smit (2008), Cognitive Behaviour therapy is indeed one of the most effective ways of treating the condition. Many other experts in the field have echoed this inference, although there appears to be a consensus in that medication is also relatively effective.

However, in most cases, a doctor will only prescribe a pharmacological intervention, either to supplement therapy or if the patient is unwilling or unable to commit to it (Hofmann & Smits, 2008). Despite the fact that they are a major reason why patients fail to adhere to their regimens, Schneier does not address the possible side effects of the drugs he proposes.

For instance, Serotonin-Reuptake Inhibitors have been reported to cause a broad range of symptoms such as nausea, dizziness, agitation, and even sexual dysfunction, especially among men (Andrade et al., 2010). Consequently, even when patients opt for this, many end up not completing the prescribed dosage because of the side effects.

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In as far as diagnosing and treating children is concerned, the writer raises a crucial issue, but one needs to be extensively researched before a reliable solution can be determined. In many cases, social awkwardness is a common characteristic among teens, especially in the early years, and it can be confused for social phobia (Schneier, 2006).

Consequently, this creates a paradox since it is during this time that the phobia emerges, yet it is sometimes almost impossible to isolate the symptoms from normal teen behavior. Nevertheless, although his recommendations are clinically sound according to the existing literature on the subject, they can be contested on the basis that they do not provide practitioners or patients with concrete directions. In addition, critics will note that, even with knowledge of the side effects of pharmacological interventions, he neither addresses them nor suggests how they can be mitigated.


Andrade, C., Sandarsh, S., Chethan, K. B., & Nagesh, K. S. (2010). Serotonin reuptake inhibitor antidepressants and abnormal bleeding: a review for clinicians and a reconsideration of mechanisms. The Journal of clinical psychiatry, (71), 1565-75.

Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of clinical psychiatry, 69(4), 621.

Schneier, F. R., M.D. (2006). Social anxiety disorder. The New England Journal of Medicine, 355(10), 1029-1036. Web.

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