What is Social phobia?

Social anxiety disorder (social phobia), also known as social phobia, is a type of anxiety disorder in which a person experiences extreme anxiety in some social and public situations. It is among the most common mental disorders that affect adults. People with this disorder have an intense and chronic fear of embarrassing themselves or being perceived by others as anxious, weak, crazy or stupid. Such fears are so intense that they may prevent patients from performing their job duties or engaging in other day-to-day activities. A generalized type of social phobia is often a chronic and disabling condition that is characterized by a phobic avoidance of most social situations. This type of social phobia can be difficult to distinguish from avoidant personality disorder. Like panic disorder, social phobia is a common, frequently severe anxiety disorder that can cause significant work and social impairment.

About 15 million adult Americans ages 18 and older suffer from social anxiety disorder, according to the National Institute of Mental Health (NIMH). The disorder affects men and women equally. Social phobia should not be confused with shyness, stage fright or typical anxiety. These are normal emotions that people experience in situations that may be unusual, new or otherwise stressful. Social anxiety disorder causes anxiety that is especially intense and that is typically considered irrational given the social circumstances that are present. People fear what they perceive as the scrutiny and judgment of others who watch them in the anxiety-provoking situation.

Some people with social phobia may find that their symptoms only occur in certain situations. For example, a person may be at ease with people most of the time, but experience discomfort in certain situations such as eating in front of others or giving a presentation. Patients may fear using public restrooms or talking on the phone or writing while others watch. In other cases, people with social anxiety disorder will feel intense anxiety in almost any social situation.

People with social phobia will go to great lengths to avoid social situations that make them uncomfortable, or will find themselves worrying for days or weeks in advance of a dreaded social situation. Patients in an anxiety-provoking situation may experience symptoms related to panic attacks, sudden brief episodes of fear and anxiety.

Social anxiety disorder often begins in childhood or early adolescence, typically around age 13 and usually lasts throughout a person’s lifetime. Patients may find it difficult to make and maintain relationships, and may avoid school, work or other day-to-day situations. The type of social phobia that a patient suffers from may depend on gender. For example, fear of blushing may be more prevalent among women. In other cases, fears may be based on experience. Fear of eating in front of others is more likely in someone who has had a past embarrassing episode of choking in public.

How is it diagnosed?

Treatment may not be necessary in situations where social anxiety disorder is minor or where people are able to overcome their fears and do not limit their interactions. However, patients who find that anxiety brought on by social phobia is interfering with their ability to live or work should see a physician, preferably a mental health professional.

Before diagnosing social anxiety disorder, a physician should perform a complete physical examination and compile a thorough medical history. Patients will be asked to describe their symptoms and to explain what triggers them and how often they occur. Questions that a physician may ask a patient include:

• Do they feel intense fear in situations where they do not know people?
• Do they fear situations in which they may be judged?
• Do they fear being embarrassed or humiliated?
• Do they fear displaying physical signs of anxiety, such as sweating or trembling?
• Does anxiety disrupt their work, school or other activities?

There are no laboratory tests used to diagnose social phobia. However, a physician may also want to rule out other medical conditions that could be causing symptoms, such as a heart problem or an overactive thyroid gland. In such cases, blood tests or other procedures may be used to rule out a medical illness. Children may not be diagnosed with social anxiety disorder until they have experienced symptoms for at least six months.

A patient who appears to have social phobia may be referred to a psychiatrist or other mental health professional who can help make a specific diagnosis, and provide treatment and regular follow-ups. Patients may be asked to fill out questionnaires or self-assessments that can help pinpoint a diagnosis. In many cases, social anxiety disorder is accompanied by other anxiety disorders or mental illnesses such as depression, substance abuse or eating disorders.

How is Social phobia treated?

Treatment in its simplest form is the avoidance of the phobic situation. However, in the case of social phobia, it is often times impossible or not feasible to avoid the situation that causes the anxiety. Psychotherapy involves the use of insight-oriented therapy that enables the individual to seek healthy ways of dealing with the anxiety-provoking stimulus. Hypnosis, supportive (group therapy), and family therapy may be useful in the treatment of phobias in general.

The treatment for social phobia usually incorporates behavioral and cognitive methods. It has been reported that psychotherapy and pharmacotherapy used in combination have the best results compared to using either therapy alone. Pharmacotherapy for social phobia involving performance such as, stage fright and shy bladder involves the use of antiadrenergic and beta-adrenergic.

For the generalized type of social phobia, antianxiety agents may be useful. Various studies have shown serotonin-specific reuptake inhibitors (SSRIs) and benzodiazepine to be helpful.

Medications

Celexa (Citalopram), Prozac (Fluoxetine), BuSpar (Buspirone), Klonopin (Clonazepam), Xanax (Alprazolam), Ativan (Lorazepam)

Prevention methods for social phobia

Although there is no known method to prevent social anxiety disorder, individuals can use positive coping methods to help minimize symptoms. Getting enough sleep, engaging in exercise and eating a well-balanced diet can help people feel healthier and more relaxed. Relaxation techniques and other stress-management practices can also reduce anxiety levels.

Patients who feel anxious should also try to engage in hobbies and other pleasurable activities, and to reach out to others with whom they who feel comfortable. Patients should not use recreational drugs or alcohol to help them cope with uncomfortable social situations, as this is likely to have adverse consequences in the future.

Support groups can also help relieve anxiety. These are sessions in which people with social phobia share their experiences and offer encouragement and understanding to one another. Although the notion of sharing feelings with strangers can be intimidating, especially to those with social anxiety disorder, many patients find these groups to be extremely beneficial.

Finally, confronting situations that trigger anxiety can be one of the best techniques for successfully reducing symptoms. Exposure therapy allows patients to gradually work up to facing situations that have been causing them great fear. Although this approach may cause anxiety initially, patients who regularly face these types of situations will learn to use coping skills that eventually may significantly diminish symptoms related to their social phobia.

Predicted outcome

Only recently has social phobia been recognized as an important mental disorder. Available studies for the course and outcome of this disorder are limited.

Alternatives

It is important to differentiate social phobia from individuals who are normally shy and who have appropriate fears about certain social situations. The DSM-IV requires these symptoms must impair the individual's ability to function appropriately for a diagnosis of social phobia. Schizophrenics may exhibit social phobia and can be differentiated by the presence or absence of psychotic symptoms (delusions, hallucinations), and thought disorder. Individuals with social phobia will have some insight into their fears, often recognizing their phobia is irrational. Panic disorder with or without agoraphobia involves many of the same physiologic symptoms experienced by individuals with social phobia. These might include sweating, palpitation shortness of breath, and a fast pulse or pounding heart.

Appropriate specialists

Psychologist, psychiatrist, and licensed certified social worker.

Last updated 11 July 2015