Physical disability and social phobia.

The DSM-III-R excludes persons with socially phobic symptoms secondary to axis III conditions from the diagnostic category of social phobia. This exclusion exists without empirical basis. A series of eight clinical cases is presented in which patients suffered from excessive levels of secondary social anxiety relative to their disfiguring or disabling physical conditions. All subjects had a good response to the monoamine oxidase inhibitor phenelzine, which enabled them to live in a less-inhibited and less-restrictive manner. Their medication response to monoamine oxidase inhibitors parallels the psychopharmacologic response patterns of generalized or DSM-III-R social phobics. This study suggests a novel application of the drug phenelzine for a patient group formerly overlooked with regard to treatment options. The similarity of this group's psychopharmacologic responsivity and clinical characteristics to those of DSM-III-R social phobics also lends support to the relaxation of the axis III exclusion in DSM-IV's definition of social phobia.