Most people feel nervous in certain social situations, such as at a job interview, a high school reunion or giving a speech. Most of us worry about what we're going to say, do or even wear during events like these. These situations often become easier with some experience. However, for people who have social phobia (also called social anxiety disorder), these events and other social situations can be very frightening and disabling.
People who have social phobia usually begin to notice it when they are in their early teens, although some people have had it for as long as they can remember. For others, it develops later in life, as social demands increase. Social phobia often runs in families. Sometimes it leads to other problems, such as depression or substance abuse.
Some people have social phobia in only a few situations, such as performing in public or talking to an important person. Others will have it in many situations, which may include using a public bathroom, eating in a restaurant, talking on the telephone or signing their name in front of people (such as when writing and signing a check at the grocery store).
Most people who have social phobia have a strong fear of being judged or embarrassed in front of other people. They feel as though everyone is watching them and will see them blush, sweat or otherwise show their fear and anxiety. They often believe that showing anxiety is a sign of weakness or inferiority. They also believe other people are more confident and competent than they really are.
People who have social phobia usually know their fears are not completely rational, but they still find themselves dreading social situations. They may go out of their way to avoid going to some events. If people with social phobia do go to an event, they usually feel very nervous before the event and very uncomfortable during it. Physical symptoms include:
Afterward, the unpleasant feelings may linger as they worry about what other people at the event thought of them. Social phobia can make it difficult to go to work, school or take part in other daily activities.
Social phobia is an ongoing disorder that usually needs to be treated with medical care. It's not just shyness and usually does not go away on its own. Your family doctor can help you find ways to control your fears.
Cognitive behavioral therapy helps people think about social situations differently so they don't fear them. The therapy also involves learning how to reduce anxiety, as well as improving social and conversational skills.
Medicines called antidepressants and benzodiazepines can also help some people with social phobia. People who have a certain form of social phobia, called "performance anxiety," can take medicines called beta-blockers just before they perform to ease their anxiety.
Sometimes a combination of therapy and medicine works the best. Your doctor will know how to help treat your case of social phobia.
Social Anxiety Disorder: A Common, Underrecognized Mental Disorder by TJ Bruce, Ph.D. and SA Saeed, M.D. (American Family Physician November 15, 1999, http://www.aafp.org/afp/991115ap/2311.html)
Written by familydoctor.org editorial staff