Social Anxiety Disorder - Questionnaire

Questionnaire: What Do You Know About Social Anxiety Disorder?

PHYSICIAN AND PATIENT SURVEY ABOUT SOCIAL ANXIETY DISORDER

Please take a moment to fill out the following brief questionnaire so that we can use your comments to help you in responding to this illness.

Name:

Address:

City/state/Zip:

E-Mail:

Phone:

Please check the appropriate response. Is your interest in social anxiety disorder that of a (an):

Psychiatrist

Family physician

Other health care professional

Individual/consumer

Patient diagnosed with depression, panic disorder

Family member

Friend

1. Which of the following symptoms do you most often associate as indications of social anxiety disorder? (Check as many as apply)

Excessive fear of scrutiny by others

Persistent fear of humiliation or embarassment in social or performance situations

Fear of speaking in public

Fear of eating, drinking or writing in public

Fear of using public restroom

Other (please describe)

2. Which of the following do you feel are barriers to effective identification and treatment of social anxiety disorder? Please rank the following with 1 representing the highest barrier and 8 the least.

Physician lack of recognition of social anxiety disorder symptoms

Insurance coverage/managed care

Lack of awareness that social anxiety disorder is a real, treatable medical condition

Difficulty of effectively communicating symptoms

Lack of available or effective medications

Presence of other conditions such as panic disorder, obsessive-compulsive disorder or depression

Stigma associated with mental disorders

3. What do you believe are the most important elements of support for the person suffering from social anxiety disorder? Please rank the following with 1 as most important; 8 the least.

Family support

Support groups

Medication

Psychotherapy

Combination of medication and psychotherapy

Insurance/managed care coverage

Other (please describe)

4. If you are a physician or health care professional, how frequently do you see patients with social anxiety disorder or the symptoms of social anxiety disorder?
very frequently
frequently
sometimes
infrequently
never

We welcome your comments, opinions, feelings and/or beliefs about this illness.

Return to Social Anxiety Disorder Index

Please check the appropriate response. Is your interest in social anxiety disorder that of a (an):
	Psychiatrist
	Family physician
	Other health care professional
	Individual/consumer
	Patient diagnosed with depression, panic disorder
	Family member
	Friend

1. Which of the following symptoms do you most often associate as indications of social anxiety disorder? (Check as many as apply)
	Excessive fear of scrutiny by others
	Persistent fear of humiliation or embarassment in social or performance situations
	Fear of speaking in public
	Fear of eating, drinking or writing in public
	Fear of using public restroom
Other (please describe)

	Physician lack of recognition of social anxiety disorder symptoms
	Insurance coverage/managed care
	Lack of awareness that social anxiety disorder is a real, treatable medical condition
	Difficulty of effectively communicating symptoms
	Lack of available or effective medications
	Presence of other conditions such as panic disorder, obsessive-compulsive disorder or depression
	Stigma associated with mental disorders

	Family support
	Support groups
	Medication
	Psychotherapy
	Combination of medication and psychotherapy
	Insurance/managed care coverage
Other (please describe)