Social Phobia

By Dr. Cheryl Lane, PhD

As human beings, we are naturally social creatures. While most of us get nervous in certain social situations, such as public speaking or meeting new people. However, for anyone with an anxiety disorder known as Social Phobia, social interactions and events can be very distressing or even debilitating.

Social phobia – also known as “social anxiety disorder” - affects millions of people. It causes significant anxiety and extreme self-consciousness. You deeply fear doing something that might cause humiliation or embarrassment. Talking and making eye contact with others is often very difficult.

With social phobia, you may go to great lengths to avoid any social or performance situation that makes you anxious. Unfortunately, avoidance perpetuates the problem. Sadly, this can significantly limit you in terms of jobs and careers, not to mention the activities you can truly enjoy.

Social phobia can develop at a very young age. However, the onset usually occurs during adolescence. It may start abruptly, e.g. following an event that caused a lot of embarrassment, or it may develop gradually.

As a general rule, social phobia should not be confused with normal stage fright, performance anxiety, or shyness. However, if the anxiety causes an unusual degree of distress or impairment, then social phobia may be present.

Symptoms

Typical symptoms of social phobia include irrational fear or anxiety:

• Of many or most social or performance situations
• That you’ll be scrutinized or unfavorably judged by others
• That your anxiety will be obvious
• Of unfamiliar people or social situations
• That you’ll embarrass yourself
• Of being in the spotlight

Additional symptoms include:

• Avoidance of the feared situation if possible
• Anticipating or being in the feared situation causes significant anxiety, which may include panic attacks
• The anxiety interferes with important aspects of your life, making it difficult to function normally or causing a significant degree of distress
• You realize that the fear is excessive or unreasonable (may not apply to children)

Physical symptoms of anxiety almost always occur while in the feared situation. They may include:

• Sweating
• Blushing
• Shaking
• Pounding or racing heart
• Shallow breathing
• Upset stomach or nausea
• Confusion
• Dizziness
• Cold, clammy hands
• Feeling flushed
• Tense muscles

Risk Factors

Some people are more vulnerable to developing social phobia than others. Risk factors for this disorder include:

• Having a biological sibling or parent with social phobia or another anxiety disorder
• Being female
• Being shy as a child
• Having overly protective or controlling parents
• Having to perform publicly or face a challenging new social situation
• A childhood history that includes bullying, abuse, or a conflicted home environment
• Social phobia may also develop in someone with a disability or condition that others often notice (e.g. having a speech impediment or a large facial scar).

Causes

The exact cause of social phobia is not clear. However, it is likely due to some combination of genetics, environmental factors (particularly in childhood), brain chemistry, and biological factors.

Treatment

Although social phobia is often a lifelong condition, appropriate treatment can be very helpful in terms of managing the disorder and, in some cases, overcoming it altogether. Psychotherapy is generally the most effective treatment for social phobia. Medication can be very beneficial in treating specific symptoms. However, if used as the sole treatment, the symptoms typically return if the medication is discontinued. Medication is usually more effective when used in conjunction with psychotherapy.

Psychotherapy

Many different types of therapy can be beneficial for social phobia. However, one of the most effective is a specific type of therapy known as Cognitive Behavioral Therapy (CBT). CBT is especially effective because it addresses the irrational thoughts and maladaptive behaviors (such as avoidance) that play a primary role in all anxiety disorders. A skilled therapist can help you identify and change these negative thought patterns and unhealthy behaviors.

Learning and using relaxation techniques can also be very helpful to manage symptoms of anxiety, particularly the panic attacks that often accompany social anxiety disorder.

Medication

The medications that are most often used to treat symptoms of social anxiety disorder include:

• Antidepressants
  • SSRIs (selective serotonin reuptake inhibitors) including Zoloft®, Paxil®, Prozac®, and Luvox®, are the most commonly prescribed medications for social phobia.
  • Effexor, which impacts both serotonin and norepinephrine, has also been shown to be effective for social anxiety.
• Benzodiazepines, such as Klonopin, Ativan, and Xanax, can provide quick relief of anxiety symptoms. Since extended use or overuse can lead to tolerance and addiction, they should not be used for more than a few weeks and should be taken exactly as prescribed.
• Beta blockers, such as Inderal, may be prescribed for specific situations. They help reduce the uncomfortable adrenaline surge that often occurs in performance situations.

Hypnotherapy

Some people with social phobia and other types of anxiety have benefited from hypnotherapy. It can be particularly effective when used in conjunction with psychotherapy because hypnosis makes most individuals more open to suggestion.

Image detail from "The open door" by Peter Ilsted