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Social Anxiety Disorder and Social Phobia Explained

Social Phobia, which is commonly referred to as Social Anxiety Disorder, is an intense fear of being judged and embarrassed by others. The fear is so strong that it can interfere with in the way of going about everyday life, such as going to work or school. Feelings of embarrassment and self-consciousness are normal. Everyone has felt anxious or embarrassed at some point in their life. For most people, speaking in public or meeting new people can be anxiety-provoking. The difference is that people with Social Phobia worry about these things sometimes weeks before they occur.

Typically, individuals with Social Anxiety Disorder fear doing common things in front of others. They might be nervous about paying for things at a convenience store, or they might be overly self- conscious about eating or drinking in public, or they might completely avoid using a public restroom. Most people who have Social Phobia know their fear is excessive, but they have difficulty controlling it nonetheless . Oftentimes they ultimately avoid public situations where they might have to do something they think will humiliate them. For some people, Social Anxiety Disorder is a problem in a few, specific situations, while others have symptoms in any social encounter.

What Causes Social Anxiety Disorder/Social Phobia?

Social Anxiety Disorder can run in families, however, no one knows for sure why some people have it while others don't. Current research indicates several parts of the brain are involved in fear and anxiety. By learning more about fear and anxiety in the brain, researchers may be able to create better treatments. They are also looking for ways in which stress and environmental factors may play a role.

Symptoms of Social Anxiety Disorder/Social Phobia

People with Social Phobia can typically:

  • Be very anxious about being with other people and have a hard time talking to them, even though they wish they could
  • Be very self-conscious in front of other people and feel embarrassed
  • Be very afraid that other people will judge them
  • Worry for days or weeks before an event where other people will be
  • Stay away from places where there are other people
  • Have a hard time making friends and keeping friends
  • Blush, sweat, or tremble around other people
  • Feel nauseous or sick to their stomach when with other people.

Who Can Develop Social Anxiety Disorder/Social Phobia?

Social Anxiety Disorder affects about 15 million American adults. Women and men are equally likely to develop the disorder, usually beginning in childhood or early adolescence. Evidence suggests genetic factors are involved. Other anxiety disorders and depression frequently co-occur with Social Phobia. It is not uncommon for drug and alcohol abuse to develop in an attempt to self-medicate their anxiety.

Accurate Diagnosis of Social Anxiety Disorder/Social Phobia

Social Phobia typically starts during youth, and untreated, Social Anxiety Disorder can last for many years. Social anxiety can be limited to one situation, for instance, eating, etc. In other instances it may be so generalized (such as in generalized social phobia) that the individual feels intense anxiety around almost anyone other than very close relations.

Treatment for Social Anxiety Disorder/Social Phobia

Social phobia is best treated with Cognitive Behavioral Therapy (CBT), medication, or both. Cognitive behavior therapy is the treatment of choice for social phobia. Follow this link to a chart comparing the effectiveness of CBT to other treatments for Social Phobia. Through CBT, people learn different ways of reacting to thoughts and feelings, and behaving in situations that help them feel less fearful. CBT also helps people learn and practice social skills when there is a deficit.

A licensed psychologist typically provides psychotherapy. However, social workers and Marriage and Family Therapists (MFT) can also legally provide therapy, though their training is of shorter duration. Your psychologist should work with your psychiatrist to track your progress. Your unique treatment needs should determine the number and frequency of sessions. Following the doctor's instructions for any psychotherapy will likely provide the greatest benefit. 

Doctors also commonly prescribe medication to help treat Social Phobia. The most commonly prescribed medications for panic disorder are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods. The latest research suggests the relapse rate for individuals taking medications is much higher than that of individuals using only CBT. Interestingly, there is evidence to suggest the combination of medication and CBT also leads to high relapse rates, indicating CBT is the treatment of choice for Social Phobia.

Click for more information about What CBT is and How it Works

Antidepressants were originally designed to treat depression, but they can also be helpful short-term treatment helpful for social phobia. They are probably more commonly prescribed for social phobia than anti-anxiety medications. Antidepressants usually take several weeks to start working. Many cause side effects such as headache, nausea, or difficulty sleeping. They are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.

A type of antidepressant called monoamine oxidase inhibitors (MAOIs) can be more effective in treating social phobia. However, they are rarely used as a first line of treatment because when MAOIs are combined with certain foods or other medicines, dangerous side effects can occur, including death.

Although antidepressants can be safe and effective for many people, they can be dangerous for some, especially children, teens, and young adults. A "black box"—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Individuals taking antidepressants should be monitored closely, especially at the beginning of treatment.

Beta-blockers, another kind of medication, can help control some of the physical symptoms of social phobia such as excessive sweating, shaking, or a racing heart. Usually they are prescribed when symptoms of Social Anxiety is more akin to performance anxiety, also known as  stage fright.

This information is provided courtesy of the National Institute of Health.