Characteristics of Social Phobia Among Persons With Essential Tremor
J Clin Psychiatry 2001;62(5):367-372
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Background: Social phobia symptoms have been
reported to be common among patients with essential tremor, but
characteristics of this comorbidity have not been systematically
Method: Cases with essential tremor (N = 94) and
controls without essential tremor (N = 85), ascertained from
movement disorder clinic and community samples, were evaluated
for social phobia symptoms (using the social phobia module of the
Structured Clinical Interview for DSM-IV Axis I Disorders and the
Liebowitz Social Anxiety Scale), characteristics of tremor, and
associated disability (via videotaped examination, performance
test, and disability questionnaire).
Results: Lifetime combined prevalence of primary
social phobia and clinically significant social phobia symptoms
occurring secondary to essential tremor was 32.7% (16/49) among
essential tremor patients in the clinic sample. Essential tremor
cases with secondary social phobia symptoms reported a markedly
later age at onset of clinically significant social phobia
symptoms than essential tremor cases with primary social phobia
(51.0 vs. 8.8 years). Cases with secondary social phobia also
reported greater fear and avoidance of eating, drinking, and
writing in public than essential tremor cases with primary social
phobia and control subjects with social phobia. Essential tremor
cases with secondary social phobia symptoms also demonstrated
more severe tremor and tremor-related disability than essential
tremor cases with primary social phobia and essential tremor
cases without social phobia. Among all essential tremor cases,
severity of social phobia symptoms and tremor independently
contributed to disability.
Conclusion: Social phobia appears to occur in a
substantial minority of essential tremor patients, and severity
of social phobia symptoms is associated with disability,
independent of tremor severity. Persons with social phobia
symptoms secondary to essential tremor evidence clinical
characteristics that differ from those of persons with primary
social phobia. Further research is needed to determine the
efficacy of treatment of social phobia in essential tremor
patients with significant social phobia symptoms.