Humans are social animals, and their ability to relate comfortably in social situations affects many important aspects of their lives, including family, education, work, leisure, dating, and relationships.
Phobias are a type of anxiety disorder in which certain situations or objects make people fearful, anxious and cause them to avoid those things. The fear and anxiety are out of proportion to the actual threat. There are many specific phobias.
Although some anxiety in social situations is normal, people with social phobia have so much anxiety that they either avoid social situations or endure them with distress. About 13% of people have social phobia sometime in their life. The disorder affects about 9% of women and 7% of men during any 12-month period.
Some adults with social phobia were shy as children, while others did not develop significant anxiety symptoms until after puberty.
People with social phobia are concerned that their performance or actions will seem inappropriate. Often, they worry that their anxiety will be obvious—that they will sweat, blush, vomit, or tremble or that their voice will quaver. They also worry that they will lose their train of thought or that they will not be able to find the words to express themselves.
Some social phobias are tied to specific performance situations, producing anxiety only when the people must perform a particular activity in public. The same activity performed alone produces no anxiety. Situations that commonly trigger anxiety among people with social phobia include the following:
A more general type of social phobia is characterized by anxiety in many social situations.
In both types of social phobia, people fear that if they fail to meet other people's expectations or are scrutinized in social interactions, they will feel embarrassed, humiliated, or rejected, or will offend others.
People may or may not recognize that their fears are irrational and excessive.
Doctors diagnose social phobia when people have fear or anxiety that involves all of the following:
Is intense and has been present for 6 months or longer
Concerns one or more social situations
Nearly always occurs in the same situation or situations
Involves fear of a negative evaluation by others
Leads the person to avoid the situation or uncomfortably endure it
Is out of proportion to the actual danger
Causes significant distress or significantly impairs functioning
Social phobia often persists if left untreated, causing many people to avoid activities that they would otherwise like to do.
Exposure therapy is usually effective. But arranging for exposure to last long enough to allow people to get used to the anxiety-provoking situation and grow comfortable in that situation may not be easy. For example, people who are afraid of speaking in front of their boss may not be able to arrange a series of speaking sessions in front of that boss. Substitute situations may help, such as joining Toastmasters (an organization for those who have anxiety about speaking in front of an audience) or reading a book to nursing home residents.
Cognitive-behavioral therapy may also help. With this therapy, people learn to do the following:
Antidepressants, such as SSRIs, and benzodiazepines (antianxiety drugs) can often help people with social phobia. SSRIs are usually preferred because they, unlike benzodiazepines, are unlikely to interfere with cognitive-behavioral therapy. Benzodiazepines affect the central nervous system (brain and spinal cord) and can cause sleepiness and memory problems.
Beta-blockers may be used to reduce the increased heart rate, trembling, and sweating experienced by people who are distressed by performing in public, but these drugs do not reduce anxiety itself.