Dec 12 - 18, 20

Social phobia is a condition characterized by a marked and persistent fear of social or performance situations. Exposure to the social or performance situation almost invariably provokes an immediate anxiety response. It may begin in adolescence and may be associated with overprotective parents or limited social opportunities. Although adolescents and adults with this disorder recognize that their fear is excessive or unreasonable, this may not be the case in children.

Most often, the social or performance situation is avoided, although it is sometimes endured with dread. In individuals younger than 18, symptoms must have persisted for at least six months before the disorder is diagnosed.

This diagnosis should not be given if the fear is reasonable given the context of the stimuli (e.g. fear of being called on in class when unprepared). The disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. This disorder is not due to a medical condition, medication, or abused substance.

People with social phobia are at high risk for alcohol or other drug dependence because they may come to rely on drinks or drugs to relax in social situations.


The following situations are often stressful for people with social anxiety disorder:

* Meeting new people
* Being the center of attention
* Being watched while doing something
* Making small talk
* Public speaking
* Performing on stage
* Being teased or criticized
* Talking with "important" people or authority figures Being called on in class
* Going on a date
* Making phone calls
* Using public bathrooms
* Taking exams
* Eating or drinking in public
* Speaking up in a meeting
* Attending parties or other social gatherings

SYMPTOMS: People with social phobia become overwhelmingly anxious and self-conscious in everyday social situations. They have an intense, persistent, and chronic fear of being watched, and judged by others, and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends.

Social phobia can be limited to one situation such as talking to people, eating or drinking, or writing on a blackboard in front of others. Or, it may be so broad such as in generalized social phobia that the person experiences anxiety around almost everyone other than family members.


* Difficulty talking
* Profuse sweating or hot flashes
* Red face, blushing and shortness of breath
* Upset stomach, nausea (i.e. butterflies)
* Trembling or shaking (including shaky voice)
* Racing heart or tightness in chest
* Feeling dizzy or faint


* Excessive self-consciousness and anxiety in everyday social situations.
* Intense worry for days, weeks, or even months before an upcoming social situation
* Fear that you'll act in ways that that will embarrass or humiliate yourself
* Fear that others will notice that you're nervous


* Avoiding social situations to a degree that limits your activities or disrupts your life
* Staying quiet or hiding in the background in order to escape notice and embarrassment
* A need to always bring a buddy along with you wherever you go
* Drinking before social situations in order to soothe your nerves

Common fears of people with social phobia include:

* Attending parties and other social occasions
* Eating, drinking, and writing in public
* Meeting new people
* Speaking in public
* Using public restrooms


There is nothing abnormal about a child being shy, but children with social phobia experience extreme distress over everyday activities and situations such as playing with other kids, reading in class, speaking to adults, taking tests, or performing in front of others. Often, children with social phobia do not want to go to school.

COMPLICATIONS: Individuals with this disorder may develop hypersensitivity to criticism, negative evaluation, or rejection. They often have difficulty being assertive; and have a low self-esteem or have feelings of inferiority. They often fear indirect evaluation by others, such as taking a test. They may have poor social skills (e.g., poor eye contact) or observable signs of anxiety (e.g., cold clammy hands, tremors, shaky voice). They may underachieve at school due to test anxiety or avoidance of classroom participation. They may underachieve at work because of anxiety during, or avoidance of, speaking in groups, in public, or to authority figures and colleagues. They often have few friends and are less likely to marry. In more severe cases, individuals may drop out of school, be unemployed and not seek work due to difficulty interviewing for jobs, have no friends or cling to unfulfilling relationships, completely refrain from dating, or remain with their family or origin.

This disorder may be associated with other anxiety disorders, mood disorders, substance-related disorders, and bulimia nervosa and usually precedes these disorders. Avoidant personality disorder is frequently present in individuals with this disorder.

PREVALENCE: Community-based studies have reported a lifetime prevalence of social phobia ranging from three to 13 per cent. Most individuals with this disorder fear public speaking, whereas somewhat less than half fear speaking to strangers or meeting new people. Other performance fears (e.g., eating, drinking, or writing in public, or using a public restroom) appear to be less common.

In outpatient clinics, rates of social phobia have ranged between 10 and 20 per cent of individuals with anxiety disorders. Because of its prevalence, social anxiety has become a great concern for doctors, therapists, psychologists, psychiatrists, and other health workers.

TREATMENT: The goal of treatment is to help you function effectively. The success of the treatment usually depends on the severity of the phobia. Anti-anxiety and antidepressant medications are sometimes used to help relieve the symptoms associated with phobias.

The first step to finding a social anxiety treatment that works is to understand the mental condition. There is no better way to understand this mental health than learning the symptoms associated with it. Some of the most common manifestations of social anxiety are excessive sweating, difficulty in speaking to the point of stuttering, aloofness, irrational shyness, and timidity.

Other symptoms-triggering situations are attending social events such as parties, being called up in class, being vilified in front of colleagues at work, and meeting persons in authority. When a person experiences fear and shyness in these situations in a regular basis, then those people most likely need help.

There are many ways to get the best help. The type of treatment for social anxiety would depend on the severity of the symptoms and how the disorder affects the patient. The more severe the symptoms, the more aggressive the help should be.

One way to seek treatment is by entering social anxiety treatment centers where the patients are treated with behavioral therapy treatments to control the social anxiety/phobia.

Undergoing treatment in a center can either be individual or group therapy. In addition, other centers may also provide actual exposure to social situations that trigger anxiety to help individuals face the problem head-on with the help of a therapist.


* Cognitive behavioral therapy helps you understand and change the thoughts that are causing your condition, as well as learn to recognize and replace panic-causing thoughts.

* Systematic desensitization or exposure therapy may be used to treat phobias. You are asked to relax, and then imagine the things that cause the anxiety, working from the least fearful to the most fearful. Gradual exposure to the real-life situation has also been used with success to help people overcome their fears.

* Social skills training may involve social contact in a group therapy situation to practice social skills. Role-playing and modeling are techniques used to help you become more comfortable relating to others in a social situation.

Cognitive-behavioral therapy for social phobia typically involves:

* Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises.

* Challenging negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views.

* Facing social situations you fear in a gradual, systematic way, rather than avoiding them.

Lifestyle changes may help reduce how often the attacks occur. The following lifestyle tips will help you reduce your overall anxiety levels and set the stage for successful treatment:

* Avoid or limit caffeine, over-the-counter cold medicines, and other stimulants. Coffee, tea, caffeinated soda, energy drinks, and chocolate act as stimulants that increase anxiety symptoms.

* Drink only in moderation. You may be tempted to drink before a party or other social situation in order to calm your nerves, but alcohol increases your risk of having an anxiety attack.

* Quit smoking. Nicotine is a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety.

* Get adequate sleep. When you are sleep deprived, you are more vulnerable to anxiety. Being well rested will help you stay calm in social situations.

* Get regular exercise and regularly scheduled meals.

An effective self-help social anxiety treatment is by applying the so-called social strategies method. These strategies are basically a series of mental calisthenics that help a person suffering from social anxiety deal with an uncomfortable situation. The key with this type of social anxiety treatment is to guide the mind in a way that it will react positively to anxiety-inducing social cues. Actively seeking out and joining supportive social environments is another effective way of tackling and overcoming social anxiety disorder or social phobia. The following suggestions are good ways to start interacting with others in positive ways:

* Take a social skills class or an assertiveness training class. These classes are often offered at local adult education centers or community colleges.

* Volunteer doing something you enjoy, such as walking dogs in a shelter, or stuffing envelopes for a campaign - anything that will give you an activity to focus on while you are also engaging with a small number of like-minded people.

* Work on your communication skills. Good relationships depend on clear, emotionally-intelligent communication. If you find that you have trouble connecting to others, learning the basic skills of emotional intelligence can help.

A breathing exercise to help you keep your calm in social situations

* Sit comfortably with your back straight and your shoulders relaxed. Put one hand on your chest and the other on your stomach.

* Inhale slowly and deeply through your nose for four seconds. The hand on your stomach should rise, while the hand on your chest should move very little.

* Hold the breath for two seconds.

* Exhale slowly through your mouth for six seconds, pushing out as much air as you can. The hand on your stomach should move in as you exhale, but your other hand should move very little.

* Continue to breathe in through your nose and out through your mouth. Focus on keeping a slow and steady breathing pattern of 4-in, 2-hold, and 6-out.

* In addition to deep breathing exercises, regular practice of relaxation techniques such as meditation, yoga, and progressive muscle relaxation will also help you get control over the physical symptoms of anxiety.