Overview
Social phobia, also called social anxiety, is a disorder characterized by
overwhelming anxiety and excessive self-consciousness in everyday social
situations. People with social phobia have a persistent, intense, and
chronic fear of being watched and judged by others and of being
embarrassed or humiliated by their own actions. Their fear may be so
severe that it interferes with work or school - and other ordinary
activities. While many people with social phobia recognize that their fear
of being around people may be excessive or unreasonable, they are unable
to overcome it. 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 or drinking
in front of others - or, in its most severe form, may be so broad that a
person experiences symptoms almost anytime they are around other people.
Social phobia can be very debilitating - it may even keep people from
going to work or school on some days. Many people with this illness have a
hard time making and keeping friends.
Physical symptoms often accompany the intense anxiety of social phobia
and include blushing, profuse sweating, trembling, and other symptoms of
anxiety, including difficulty talking and nausea or other stomach
discomfort. These visible symptoms heighten the fear of disapproval 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 alcohol dependence.
How Common Is Social Phobia?
- About 3.7% of the U.S. population ages 18 to 54 - approximately 5.3
million Americans - has social phobia in any given year.
- Social phobia occurs in women twice as often as in men, although a
higher proportion of men seeks help for this 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
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 environment's 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
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 antidepressants such as selective serotonin
reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as
well as drugs known as high-potency benzodiazepenes. Some people with a
form of social phobia called performance phobia have been helped by
beta-blockers, which are 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 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 - 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 and depression. To try to reduce their
anxiety and alleviate depression, people with social phobia may use
alcohol or other drugs, which can lead to addiction. Some people with
social phobia may also have other anxiety disorders, such as panic
disorder and obsessive-compulsive disorder.
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For more information
National Institute of Mental Health
6001 Executive Blvd.
Room 8184, MSC
9663
Bethesda, MD 20892-9663
301-443-4513.
1-88-88-ANXIETY (1-888-826-9438)
http://www.nimh.nih.gov/
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