Course and Consequences

The clinical course of SP is chronic, unremitting, and life-long. Patients often enter treatment later in life, frequently reporting suffering from severe symptoms for many years before seeking treatment. As already mentioned, the presence of a comorbid disorder in SP has important implications in term of prognosis. The combination of a very early onset together with a chronic lifetime course indicates that SP is responsible for many years of disability and life distortion for patients. Compared with sufferers of other mood and anxiety disorders, SP sufferers experienced a worse quality of life in the domains of work, friendship, and partnership.

The consequences of this impairment include academic under achievement, inability to work, under performance at work, and thus financial dependency; moreover, there is evidence that more than half of all SP are single, divorced, or separated. Utilisation of treatment (morbidity) is increased in SP patients: SP overall is associated with significantly elevated rates of seeking any outpatient treatment for emotional problems and of psychiatric outpatient treatment. In the Florence Psychiatric Survey (Faravelli et al., 1989), 78.4% of SP patients sought help from their general practitioner, 21% were referred to a public psychiatrist, 14.9% underwent psychotherapy and 13.5% used other outpatient facilities.

However, a consistent portion of the long-term consequences and burden of SP seems to be due to the association with other disorders. The ECA study reports that only 5.4% of patients with uncomplicated SP sought help from a mental health specialist.

The socio-economic impact of SP is no less significant. By disrupting schooling in adolescence, the disorder limits educational attainment and career progression. Throughout the working lives of sufferers, continuing functional impairment has an economic impact, reflected in the loss of working days to illness and reduced work performance. The NCS study also found that patients with complex (generalised) SP, compared with patients with speaking-only SP, were more likely to report that their phobia interfered with their lives, more likely to have received treatment for phobia, more likely to have seen a mental health specialist, and more likely to have taken medication for their phobia.

Although many sufferers may organise their working and social lives to accommodate the condition, and thus may not perceive an actual deterioration in quality of life, they are clearly not realising their full potential. Thus, as well as the considerable personal burden of SP, the condition also places a burden on society as a whole.

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