John, a 29-year-old single male, has been seeing you at your general medicine practice for many years, although he comes in very infrequently. If he wants to make an appointment to see a patient, he always asks you to be the first to see him after work. This time he comes back to see you and still asks you to see him before other patients come to the clinic. He tells you that he is eligible for a promotion at work, but his new position requires him to work with his colleagues. He says he can’t do the work with others. He comes and asks if you can help him. Keep yourself from feeling shy and blushing in public. John says he has a hard time “dealing with people. He could never speak in front of a large group of people; he felt uncomfortable around other people; he couldn’t go to restaurants. He recalls that even when he was in school, he was always afraid of teachers calling on him to answer questions in class. He never had a girlfriend, had few friends of the same sex, and rarely hung out with his friends. He had an okay job, his own office, and mostly communicated with others by email. He told you that he was worried that people would see him as an idiot and that he was afraid of people talking about him. So. He avoids any social situation where he might be looked down upon or talked about, except as a last resort. Mental Status Check: He is willing to talk to you, but seems very anxious when describing his problems. He denies that he feels depressed. His thoughts focus on his fear of what people will think of him, what they will say about him, and his fear of looking stupid. He blushes when people ask him questions or even when they look at him. There was no evidence of thought disorder, delusions, or paranoia. He has no perceptual disturbances (e.g., hallucinations). He has a good insight into his situation. What is the most likely diagnosis for John? The most likely diagnosis is social anxiety disorder (social anxiety disorder), also known as social phobia. Social phobia is the patient’s apparent fear of being exposed to strangers or being observed closely by others in social situations. Social phobia can manifest in a generalized form, although more commonly it manifests in a non-generalized form in situations that call for achievement . Generalized social anxiety disorder or generalized social phobia: Patients fear that they will embarrass themselves or embarrass themselves by their demeanor. Patients may exhibit shaking, blushing, and panic attacks. Anxiety occurs when the patient is exposed to the feared situation. If possible, the patient will try to avoid social situations. The patient himself or herself can recognize that the fear is excessive and unjustified. Often, the patient shows anxious anticipation of the planned social situation to occur, for example, the patient may begin to worry weeks before the planned social event and endure fear and anxiety during the event. Social terror often affects interpersonal relationships and job search.