Facts About Social Phobia
From the National Institutes of Health
Social phobia is a disorder characterized by overwhelming
anxiety and excessive self-consciousness in social situations. People with
social phobia have a persistent, intense, and chronic fear of being scrutinized
by others and of being embarrassed or humiliated by their own actions. Although
it is common for many people to experience some anxiety before or during a
public appearance, anxiety levels in people with social phobia can become so
high that they begin to avoid social situations. While many people with social
phobia recognize that the fear may be excessive or unreasonable, they are unable
to overcome it. In addition, they often worry for days or weeks in advance of a
dreaded situation.
Social phobia can be limited to only one type of situation (such as a fear of
speaking in formal or informal situations, or eating, drinking, or writing in
front of others) or, in its most severe form, may be so broad that a person
experiences phobic symptoms in any social setting. Social phobia can be very
debilitating û people with this illness often avoid forming or maintaining
close relationships or they turn down chances to advance their careers. Some
even become housebound.
Physical symptoms often accompany the intense anxiety of social phobia. People
with social phobia experience symptoms that include blushing, profuse sweating,
trembling, and other symptoms of anxiety, including difficulty talking and
nausea or other stomach discomfort. These visible symptoms heighten their fear
of disapproval in social settings and the symptoms themselves can become an
additional focus of fear. Fear of symptoms can create a vicious cycle: as people
with social phobia worry about experiencing the symptoms, the greater their
chances of developing the symptoms.
Social phobia often runs in families and may be accompanied by depression or
alcoholism.
How Common Is Social Phobia?
At least 7.2 million Americans experience clinically significant phobias in a
given year, many having social phobia.
Social phobia occurs in women twice as often as in men, although a higher
portion of men seek help for this particular disorder.
The disorder typically begins in childhood or early adolescence and rarely
develops after age 25.
What Causes Social Phobia?
Research to define causes of social phobia is ongoing.
Some investigations implicate a small structure in the brain called the amygdala
in the symptoms of social phobia. The amygdala is believed to be a central site
in the brain that controls fear responses.
Animal studies are adding to the evidence that suggests social phobia can be
inherited. In fact, researchers supported by the National Institute of Mental
Health (NIMH) recently identified the site of a gene in mice that affects
learned fearfulness.
One line of research is investigating a biochemical basis for the disorder.
Scientists are exploring the idea that heightened sensitivity to disapproval may
be physiologically or hormonally based.
Other researchers are investigating the environmentÆs influence on the
development of social phobia. People with social phobia may acquire their fear
from observing the behavior and consequences of others, a process called
observational learning or social modeling.
What Treatments Are Available for Social Phobia?
Research supported by NIMH and other institutions has shown that there are two
effective forms of treatment available for social phobia: certain medications
and a specific form of short-term psychotherapy called cognitive-behavioral
therapy. Medications include selective serotonin reuptake inhibitors (SSRIs),
monoamine oxidase inhibitors (MAOIs), and high-potency benzodiazepenes. Some
people with a form of social phobia called performance phobia have been helped
by beta-blockers more commonly used to control high blood pressure.
Cognitive-behavior therapy is also very useful in treating social phobia. The
central component of this treatment is exposure therapy, which involves helping
patients gradually become more comfortable with situations that frighten them.
The exposure process often involves three stages. The first involves introducing
people to the feared situation. The second level is to increase the risk for
disapproval in that situation so people build confidence that they can handle
rejection or criticism. The third and final stage involves teaching people
techniques to cope with disapproval. In this stage, people imagine their worst
fear and are encouraged to develop constructive responses to their fear and
perceived disapproval.
Cognitive-behavior therapy for social phobia also includes anxiety management
training û for example, teaching people techniques such as deep breathing to
control their levels of anxiety. Another important aspect of treatment is called
cognitive restructuring, which involves helping individuals identify their
misjudgments and develop more realistic expectations of the likelihood of danger
in social situations.
Supportive therapy such as group therapy or couples or family therapy to educate
significant others about the disorder is also helpful. Sometimes people with
social phobia also benefit from social skills training.
What Other Illnesses Co-Occur with Social Phobia?
Social phobia can cause lowered self-esteem, depression, and in extreme
situations, suicide attempts. To try to reduce their anxiety and alleviate
depression, people with social phobia may use alcohol or other drugs, which can
lead to addiction.
National Institutes of Health