In response to Dr Ostow's comments on our article1, I would like to make the following comments. Dr Ostow is right in asserting that not every aversion is a phobia. Some individuals may be averse to performance or social contacts for reasons that have nothing to do with anxiety. According to most up-to-date psychiatric epidemiological data,2 however, between 1% and 3% of adult Americans suffer severe performance or social dread or avoidance secondary to anxiety that is sufficient to warrant a diagnosis of social phobia. These individuals can be differentiated from those with schizoid personality disorders who lack a strong interpersonal drive or from schizophrenic individuals for whom close interpersonal contact often leads to psychotic decompensation. The differentiation is easy to make for individuals with "discreet" social phobias (who are otherwise well-compensated individuals), who simply feel extreme jitters when they have to give a speech, audition, eat in a
Liebowitz MR. Social Phobia-Reply. Arch Gen Psychiatry. 1986;43(6):614–615. doi:10.1001/archpsyc.1986.01800060108017
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