A 21-year-old male college student is brought to the university health clinic by his concerned academic advisor. He is at risk of failing a mandatory course that requires an oral presentation, which he has repeatedly missed. The patient has been an enrolled student for three years and has consistently avoided classes requiring public speaking.

He describes an intense, persistent fear of being judged or scrutinized by others. This fear began in early adolescence but has become more impairing in college. He feels anxious when called upon in class, at social gatherings, or when meeting new people. In these situations, he experiences palpitations, sweating, trembling, blushing, and an upset stomach. He reports having only one close friend and actively avoids parties or group study sessions. He spends most of his free time at home with his parents. The patient acknowledges that his fear is excessive and irrational, but he feels unable to control it. He denies any history of panic attacks out of the blue.

His past medical history is unremarkable. He is not on any regular medications and has no known drug allergies. Family history is negative for any formal psychiatric disorders. He denies any use of alcohol, tobacco, or illicit substances. He reports difficulty sleeping the night before any anticipated social event.