Social Phobia (Social Anxiety Disorder)

• Do you live in fear of certain social situations?
• Do you avoid these situations so that you won’t feel embarrassed?
• When you are forced to experience a social situation that you fear, do you experience intense anxiety?
• Are you one of the 15 million Americans who experience social phobia?

Social Anxiety Disorder (also sometimes known as Social Phobia) makes people feel great anxiety or self consciousness at the thought of ordinary social encounters. Social anxiety produces a great fear of feeling embarrassed or “rejected” in public.

This disorder can be tied to specific activities, such as public speaking, for example, or can be more generalized, whereby people get anxious about the thought of a whole range of social situations.

While it’s quite normal for people to feel some degree of apprehension prior to making a speech, for example, someone with a social anxiety disorder will feel powerful anxiety when thinking about an upcoming speech for weeks or months, may try to get out of doing it by calling in sick, or may find that the anxiety experienced compromises his or her ability to perform normally. While some degree of apprehension about a public speaking event is normal, anxiety experienced at a level that interferes with normal everyday life is not.

Do You Have Social Phobia?

The diagnostic criteria for adult social anxiety disorder (APA) are as follows.

A person with social phobia (adult):

1. Has a significant and enduring fear of social situations in which she will meet and possibly be judged by strangers. She fears that her actions or obvious anxiety will prove embarrassing.

2. When she must attend a social situation (that has been provoking worry) she feels anxiety (or possibly experiences a panic attack).

3. Knows that her fears are not normal or healthy

4. Tries to avoid social situations that produce anxiety

5. Avoiding social situations, worrying about social situations or anxiety felt during social situations interferes with job or school performance, relationships or social life; or the person feels very concerned about their social phobia.

6. The anxiety is not produced as a result of another mental or physical health condition or as a result of medication or drug or alcohol use or abuse.

To reach a diagnosis of social phobia in children, the symptoms must occur for 6 months or longer, and children do not need to recognize that their anxiety is out of the ordinary. Read signs of social phobia in children for more information.

Generalized Social Phobia

A diagnosis of social phobia is segregated as either generalized, or non-generalized.

• People with generalized social phobia feel anxiety when thinking about or experiencing a wide range of (or most) social situations.
• People with non generalized social phobia feel anxiety when thinking about or experiencing a specific kind of social activity, such as public speaking, using a public bathroom, or attending a social gathering of strangers.

Some examples of social activities that are sometimes associated with social phobia include:

• Talking with a person in authority, such as your boss
• Eating in a restaurant
• Giving a speech
• Using a public bathroom
• Going shopping
• Talking with strangers (small talk)
• Calling a stranger on the phone
• Going to a party
• Standing in a line

Who Gets Social Phobia?

The reported prevalence rates vary greatly, depending on the criteria used, and range from a lifetime occurrence in 3% of the population, to 13%. Both women and men are equally at risk of the condition. The disorder most typically begins in the mid teen years, although it can begin earlier in childhood. In some cases, a particularly humiliating and stressful social experience at any point in life can trigger the disorder.

People with social phobias are at an increased risk of other anxiety disorders and depression and since many try to self medicate with drugs or alcohol, they are also at an elevated risk of substance abuse.

The disorder generally endures for a lifetime, although the symptoms can be managed with treatment. Many people find that the intensity of the symptoms will differ at different points in life, depending on environmental conditions.

There is likely a genetic link to this disorder; people with very close relatives who have social anxiety disorder are more likely to experience the condition as well.

Getting Treatment for Social Phobia

People with social phobia disorder will generally have it for life – but although certain social situations may always present challenges, treatment can help a lot to minimize the severity of symptoms and so lessen the impact the disorder has on your quality of life.

Psychotherapy (talk therapy) and or certain medications are the most commonly used treatments for the disorder.

Psychotherapy

Cognitive behavioral therapy (CBT) is an evidence based treatment that has been proven to help people control symptoms of social phobia. CBT teaches ways to control or change thoughts and negative thinking patterns to reduce the anxiety produced by certain forms of thinking. Exposure therapy, a subset of CBT, may be used to help people gain confidence in their ability to deal with social situations, and relaxation techniques are often taught, to help people control their physiological response to anxiety.

CBT focuses on the here and now (as opposed to past traumas, for example) it is proven to work and it works relatively quickly – most people report some improvements within a few weeks.

Medication

SSRI anti depressants are FDA approved for use in controlling the symptoms of social phobia, and are often a first-line choice of medication. SSRIs are not FDA approved for use in the treatment of social phobia for children under the age of 18.

Anti-anxiety drugs, such as benzodiazepines, work quickly, but are addictive and recommended only for short term symptoms control. Beta blockers (a cardiac medication) can help to control the symptoms of anxiety by reducing the effects of adrenaline. Beta blockers are not recommended for long duration symptoms control, but are sometimes prescribed for transient use, such as to help control symptoms of anxiety while public speaking.

No single medication works well for all people with social phobia, and so your doctor may need to try out a few medications before getting a “good fit”. Social phobia is a long lasting disorder and there are no overnight cures. Treatment takes time, but it can and does work and it is worth it.

Lifestyle Changes

In addition to CBT and or medication for symptoms control, certain lifestyle changes can help to reduce the intensity of social phobia symptoms.

• Avoid caffeine, nicotine and stimulant drugs or medications. Stimulants can worsen anxiety levels.

• Avoid alcohol, particularly excessive alcohol levels. Alcohol can help temporarily to reduce anxiety, but the regular use of alcohol actually worsens anxiety disorders.

• Get enough sleep – fatigue increases anxiety and decreases coping abilities

• Practice communication skills by giving people compliments

• Practice mind-body activities, such as meditation or yoga, than can induce calm

• Eat a nutritious diet

• Join a support group

• Love yourself and think good thoughts about yourself!

• Exercise