Social phobia

On this page you will learn more about social phobia.

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Feeling nervous or shy around people is normal, especially if you’re meeting them for the first time. So is feeling self-conscious in certain social situations like introducing yourself to a large group or speaking in front of an audience. However, if daily encounters with people leave you feeling sick or give you a strong urge to flee, you may have social phobia.

People with social phobia or social anxiety feel extreme discomfort in any or a particular social situation. They may feel terrified about doing something embarrassing in front of other people, being examined or criticized, or they could be worried that their nervousness is visible. A person with this type of anxiety may exhibit a myriad of physical symptoms when they find themselves in a situation that they fear, and they may even try to escape. In more severe cases, an individual with social phobia will completely avoid being around people. 

A person with social phobia can be highly aware that their fear, anxiety, and reactions are out of proportion with the real risks; however, the knowledge of this does not help them calm themselves.

What is the difference between social anxiety, social phobia, and social anxiety disorder(SAD)?

None at all. What was once known as social phobia is now more commonly referred to as social anxiety. At times, the formal diagnosis may even read as social anxiety disorder or SAD. Despite the different names, they all refer to a person’s extreme anxiety towards social situations.

Symptoms of Social Phobia

Shyness or being particularly reserved in public doesn’t always indicate that a person has social phobia. Our personality traits and upbringing have a huge impact on how comfortable or uncomfortable we are in different situations. Some people are naturally quiet and restrained in their social interactions, while some are more outgoing or talkative. In the same vein, there are people who prefer to be alone and there are those who like being in the company of others.

However, when a person’s feelings of fear and anxiety towards being with others begin to interfere with their routines, work, school, enjoyment of life, or it causes them to isolate themselves, then there’s a strong likelihood that they have social anxiety disorder.

The symptoms of social anxiety disorder can be grouped into two: physical and emotional. 

The physical symptoms of social phobia are not too different from what a person with general anxiety might exhibit. These include:

  • Sweating.
  • Difficulty breathing.
  • Rapid heartbeat or heart palpitations.
  • Nausea.
  • Dizziness.
  • Blushing.
  • Shaking.
  • Stomach upset.
  • Vomiting.
  • Tense muscles.

On the other hand, the emotional symptoms of social anxiety are hidden in the public eye but they are equally exhausting to the individual:

  • Worrying about saying or doing something embarrassing in social situations.
  • Fearing situations where your appearance or manner of speaking may be examined or criticized.
  • Extreme fear of talking with people you don’t know, even if briefly.
  • Worrying that others will take note of how uncomfortable you feel in the situation.
  • Fearing that you would blush, sweat, or stutter when speaking. 
  • Wanting to avoid activities or speaking to people because you might embarrass yourself.
  • Feeling extremely anxious about an upcoming event or activity.
  • Spending an inordinate amount of time analyzing a past social interaction with particular focus on what you perceive to have done wrong.
  • Expecting the worst outcomes in every social interaction.
  • Wanting to or actually fleeing a social situation.
  • Extreme fear about speaking or performing in public.

Do I have social phobia?

If the symptoms enumerated above are starting to affect how you live your life and your relationship with others,  then you should consider seeking out help. More so if you are beginning to entertain thoughts of isolating yourself or have started actively avoiding social interactions.

What is the difference between generalized and specific social phobia?

Generalized social phobia refers to an individual’s anxiety and difficulty participating in almost all social situations. Specific social anxiety disorder, as the name implies, pertains to a person’s fear of a particular social situation. For example, a person may be comfortable being introduced to new people but may struggle with interacting with the staff at the supermarket. 

Causes and Risk Factors of Social Anxiety Disorder

Similar to other types of anxiety, there is no singular cause for social anxiety disorder. Mental health conditions are often born from a complex relationship between genetics and environment. Some of the factors that can impact a person’s inability to participate in various social situations include:

Trauma or negative experiences – A person who has experienced bullying in the past or has had a particularly embarrassing social encounter has a higher likelihood of developing social anxiety than someone who has not. 

Family history – Anxiety typically runs in the family. Moreover, a child whose parents exhibited symptoms of social anxiety disorder may grow up to develop the condition themself. Whether this is because of the family’s genetic makeup,  the child learning the behaviour from the parents, or because of upbringing, remains unclear.

Conditions that affect appearance, movement, or speech – People with a physical handicap, disfigurement, or speech impediment may feel especially self-conscious in social situations. A person with any of these conditions, paired with negative experiences may be more likely to develop social anxiety.

Other mental health conditions – Social anxiety disorder is closely linked to low self-esteem. Individuals who are diagnosed with depression are found to be more likely to develop social anxiety disorder and vice versa. Other types of anxiety can also co-occur with social phobia.

Social Phobia in Children

Children can also be diagnosed with social anxiety disorder, however, the source of their anxiety must be in the interaction with other children. It is normal for children to sometimes be afraid of adults that they don’t know. That said, it is also important to be attentive to children that fear particular adults that they do know.  

Signs of social phobia in children include crying, clinging to parents, temper tantrums, and refusing to speak in certain social situations around other children. 

Treatment for Social Anxiety Disorder

Your GP will examine you to rule out other possible causes of the physical symptoms. Once they have assessed you and agreed on a diagnosis of Social Anxiety Disorder they will refer you onwards to the most suitable mental health service. 

Psychotherapy such as CBT (cognitive behaviour therapy) and medication (SSRIs and SNRIs) are often used together in treating social anxiety, but can also be used separately or consecutively.  

Cognitive Behavioural Therapy for Social Phobia

Cognitive Behavioural Therapy can help an individual with social anxiety further understand their thoughts, feelings and behaviours towards social interactions and enable them to change them. 

CBT for social phobia begins with interviews and self-assessment so the therapist can glean information about the patient. In the next step, the therapist will guide the patient in identifying the thought patterns that give rise to the anxiety or fear that they feel and help them examine if these thoughts are real. 

In addition to the therapy itself, the therapist will also teach the patient techniques that will help them redirect their thoughts or challenge their beliefs when they are in the situation itself. The patient may be given homework that requires them to participate in a social situation where they can apply the techniques that they learned.

Group Therapy

Another possible treatment for social anxiety is cognitive behaviour group therapy or CGBT. This kind of therapy uses the same techniques as CBT for individuals with the added benefit that participants can simultaneously learn how to interact with other people. 

Video recording is sometimes used as a tool in CBGT so patients can examine their interactions with others more objectively.

Medication Used in Treating Social Anxiety

The specific medications that have been proven to be effective in treating the symptoms of social anxiety disorder are SSRIs and SNRIs. These drugs raise the levels of the neurotransmitter serotonin (and in some cases, norepinephrine) in the brain which helps relieve discomfort in many patients.

Another medication used by patients is Inderal (propranolol), a beta-blocker that slightly reduces adrenaline levels to relieve the symptoms. However, there is no strong scientific evidence that it is effective against social phobia. Inderal and similar medications seem to work best when used occasionally when the need arises. They should not be taken for preventive purposes.

Self-Help for Social Phobia

Given this type of anxiety, some people may try to treat their social anxiety disorder on their own. 

Utilising self help books such as: Overcoming Social Anxiety and Shyness Self Help Course, A 3 part programme based on Cognitive Behavioural Techniques by Gillian Butler. 

The Shyness Workbook, Transform Social Anxiety Using Your Compassionate Mind, by Lynne Henderson. 

The NHS also offers self help materials that can be accessed using the following link: https://web.ntw.nhs.uk/selfhelp/leaflets/Social%20Anxiety.pdf

Last updated on: 2022.03.07

Author: Monica Macaraeg

Reviewed by: Antigone Lanitis