"In school I was always afraid of being called on, even when I knew the answers. When I got a job, I hated to meet with my boss. I couldn't eat lunch with my co-workers. I worried about being stared at or judged, and worried that I would make a fool of myself. My heart would pound and I would start to sweat when I thought about meetings. The feelings got worse as the time of the event got closer. Sometimes I couldn't sleep or eat for days before a staff meeting.”
“In any social situation, I felt fear. I would be anxious before I even left the house, and it would escalate as I got closer to a college class, a party, or whatever. I would feel sick in my stomach—it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else.”
“When I would walk into a room full of people, I’d turn red and it would feel like everybody’s eyes were on me. I was embarrassed to stand off in a corner by myself, but I couldn’t think of anything to say to anybody. It was humiliating. I felt so clumsy, I couldn’t wait to get out.”
What is Social Phobia?
Social phobia is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of going to work or school or doing other everyday things.
Everyone has felt anxious or embarrassed at one time or another. For example, meeting new people or giving a public speech can make anyone nervous. But people with social phobia worry about these and other things for weeks before they happen.
People with social phobia are afraid of doing common things in front of other people. For example, they might be afraid to sign a check in front of a cashier at the grocery store, or they might be afraid to eat or drink in front of other people, or use a public restroom. Most people who have social phobia know that they shouldn't be as afraid as they are, but they can't control their fear. Sometimes, they end up staying away from places or events where they think they might have to do something that will embarrass them. For some people, social phobia is a problem only in certain situations, while others have symptoms in almost any social situation.
Social phobia affects about 15 million American adults. Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence. There is some evidence that genetic factors are involved. Social phobia is often accompanied by other anxiety disorders or depression. Substance abuse may develop if people try to self-medicate their anxiety.
Signs & Symptoms
People with social phobia tend to:
- Be very anxious about being with other people and have a hard time talking to them, even though they wish they could
- Be very self-conscious in front of other people and feel embarrassed
- Be very afraid that other people will judge them
- Worry for days or weeks before an event where other people will be
- Stay away from places where there are other people
- Have a hard time making friends and keeping friends
- Blush, sweat, or tremble around other people
- Feel nauseous or sick to their stomach when with other people.
Social phobia is generally treated with psychotherapy, medication, or both.
Psychotherapy. A type of psychotherapy called Cognitive Behavior Therapy (CBT) is especially useful for treating social phobia. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and fearful. It can also help people learn and practice social skills.
Medication. Our doctors may also prescribe medication to help treat social phobia. The most commonly prescribed medications for social phobia are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.
Antidepressants are used to treat depression, but they are also helpful for social phobia. They are probably more commonly prescribed for social phobia than anti-anxiety medications. Antidepressants may take several weeks to start working. Some may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time.
Another type of medication called beta-blockers, can help control some of the physical symptoms of social phobia such as excessive sweating, shaking, or a racing heart. They are most commonly prescribed when the symptoms of social phobia occur in specific situations, such as "stage fright."
Some people do better with cognitive behavior therapy, while others do better with medication. Still others do best with a combination of the two. Our doctors review the different treatment options that they feel are be best for each individual. If they feel that medication may be necessary, they will discuss the pros and cons of different medications as well as the possible side effects. We will work with you to tailor a treatment plan that is right for you. It is important that you feel thoroughly educated, have enough time to think about your options and feel that you and your doctor are working as collaborators.
More Resource Articles
COVID-19 Pandemic Fatigue
It’s hard to believe that we are nearly one year into the COVID-19 pandemic. The initial panic and hoarding of toilet paper have worn off, yet for many the psychological impacts of the pandemic are still very much present and may last longer than the pandemic itself.
Locus of Control and COVID-19
The COVID-19 pandemic is causing enormous stress for countless millions of people in all world regions. There has been no crisis of comparable magnitude within living memory. Individuals, communities, and entire populations are acutely aware of "loss of control" over their health, their finances, and their daily activities. The impact of "loss of control" on our mental health is made even worse by uncertainty over the future that is unprecedented in modern times...
Lifestyle Choices for Good Mental Health During COVID-19
Simple lifestyle choices can enhance mental health
Because of widespread unemployment and the closing of mental health clinics due to the pandemic, millions of individuals struggling with anxiety, depression, and insomnia do not have access to, or cannot afford psychotherapy or medications. These circumstances may continue for months or even years, depending on how soon effective antivirals and vaccines become available...
Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity)...
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time...
Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness...
An eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating. A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point, the urge to eat less or more spiraled out of control. Severe distress or concern about body weight or shape may also signal an eating disorder...
People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger...
Post-traumatic Stress Disorder
When in danger, it’s natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger...
Obsessive Compulsive Disorder
Everyone double checks things sometimes. For example, you might double check to make sure the stove or iron is turned off before leaving the house. But people with obsessive-compulsive disorder (OCD) feel the need to check things repeatedly, or have certain thoughts or perform routines and rituals over and over. The thoughts and rituals associated with OCD cause distress and get in the way of daily life...