Causes, incidence, and risk factors

People with social phobias fear and avoid situations in which they may be subject to the scrutiny of others. It may begin in adolescence and may be associated with overprotective parents or limited social opportunities. Males and females are affected equally with this disorder.

People with social phobia are at high risk for alcohol or other drug dependence, because they may come to rely on drinks or drugs to relax in social situations.

Symptoms

People with social phobia become overwhelmingly anxious and self-conscious in everyday social situations. They have an intense, persistent, and chronic fear of being watched and judged by others, and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends.

Although many people with social phobia realize that their fears about being with people are excessive or unreasonable, they are unable to overcome them on their own.

Social phobia can be limited to one situation (such as talking to people, eating or drinking, or writing on a blackboard in front of others). Or, it may be so broad (such as in generalized social phobia) that the person experiences anxiety around almost everyone other than family members.

Physical symptoms that often occur with social phobia include:

• Blushing
• Difficulty talking
• Nausea
• Profuse sweating
• Trembling

Social phobia is different from shyness. Shy people are able to participate in social functions. People with social phobia are constrained by their condition to the point that it affects their ability to function in work and relationships.

Some of the most common fears of people with social phobia include:

• Attending parties and other social occasions
• Eating, drinking, and writing in public
• Meeting new people
• Speaking in public
• Using public restrooms

Signs and tests

The health care provider will look at your history of phobia, and will get a description of the behavior from you, your family, and friends.

Signs include:

• Elevated blood pressure
• Rapid heart rate

Treatment

The goal of treatment is to help you function effectively. The success of the treatment usually depends on the severity of the phobia.

Anti-anxiety and antidepressant medications are sometimes used to help relieve the symptoms associated with phobias. See Panic Disorder for more information about medications.

Behavioral treatment appears to have long-lasting benefits.

• Cognitive behavioral therapy helps you understand and change the thoughts that are causing your condition, as well as learn to recognize and replace panic-causing thoughts.
• Systematic desensitization or exposure therapy may be used to treat phobias. You are asked to relax, then imagine the things that cause the anxiety, working from the least fearful to the most fearful. Gradual exposure to the real-life situation has also been used with success to help people overcome their fears.
• Social skills training may involve social contact in a group therapy situation to practice social skills. Role playing and modeling are techniques used to help you become more comfortable relating to others in a social situation.

Lifestyle changes may help reduce how often the attacks occur.

• Get regular exercise, adequate sleep, and regularly scheduled meals.
• Reduce or avoid the use of caffeine, some over-the-counter cold medicines, and other stimulants.

Expectations (prognosis)

The outcome is generally good with treatment, and antidepressant medications have been shown to be very effective.

Complications

• Alcohol use to combat anxiety
• Alcohol or other drug dependence
• Loneliness and social isolation

Calling your health care provider

Call your health care provider or mental health professional if fear is affecting your work and relationships with others.

Prevention

Taking measures to improve your self-esteem and getting training in social skills may be helpful.

References

1. Stein MB, Stein DJ. Social anxiety disorder. Lancet. 2008;371:1115-1125. [PubMed]
2. Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders: Panic, social anxiety, and generalized anxiety. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 32.

Review Date: 2/14/2010.Reviewed by: Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.