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Social phobia

A phobia is basically a fear. We all have fears, often about things such as heights and spiders but, for most of us, they don't interfere with the way we lead our lives.

These fears are only called phobias when they interfere with things we would otherwise enjoy, or do easily.

Many of us get worried before meeting new people, but we find that once we're with them, we can cope, and even enjoy the situation.

However, some of us become very anxious about these situations. At best, we can't enjoy them and, at worst, we might avoid them altogether. This is what doctors and psychologists call social phobia.

This fact sheet describes what it feels like to have social phobia, how you can help yourself, and what other kinds of help might be available.

There are two main sorts of social phobia.

General social phobia

If you suffer with a general social phobia, you'll tend to worry about becoming the centre of attention when you find yourself with other people. You will find yourself worrying that everybody's looking at you, and noticing what you're doing. You might be afraid of being introduced to other people and might even worry about eating or drinking in public.

It may be difficult for you to go into shops or restaurants. You may feel so embarrassed about undressing in public that you can't face going to the beach. It may also be difficult for you to confront your boss or your colleagues; even when you really should. Parties are likely to be particularly difficult.

Many of us will hesitate slightly before going into a room full of people. If you have a social phobia, you may tend to hover around the entrance or outer rooms - some people believe they are claustrophobic because of these feelings. When you finally get into the room with other people, it may feel as though everybody's looking at you. It can be tempting to use alcohol to help yourself cope, starting to drink before going to a pub or party, so that you can loosen up and relax enough to enjoy it.

Specific social phobia

This is a particular phobia that affects people who have to be the centre of attention as part of their way of life. It can affect anybody who has to perform or speak in front of other people. Salesmen, actors, musicians, teachers, or union representatives may all suffer from a specific social phobia. In spite of this, it doesn't seem to cause problems for them in ordinary social situations. If you do suffer from specific social phobia, you may find that you can mix and socialise with other people without any problems. However, when you have to get up and talk or perform in front of others, you become very anxious, perhaps stammering or even 'drying up' completely. It can even affect people who are experienced at speaking in public and who do it regularly. At its worst, it can make it impossible for the sufferer to speak in public at all, even to ask a question.

What does it feel like?

If you have a social phobia you might find yourself worrying a lot about making a fool of yourself in front of other people and you may feel very anxious before going into any of the social situations that worry you. You might find yourself going through, in great detail, all the embarrassing things that could happen to you. When you're actually with people, you may feel even more anxious, and may be unable to say, or do, what you want. In a way, it's a self-fulfilling prophecy.

You may worry so much about looking worried that you actually do begin to look worried! Your worry is your worst enemy. Once it is all over, you might find yourself worrying about how you handled the situation. You may go over, again and again, how you might have behaved or talked differently. People experiencing both of these types of social phobia have many of the same physical symptoms. You may get a very dry mouth, sweat a lot, have palpitations (the feeling that your heart is beating very fast and/or irregularly) and want to pass water or open your bowels. Other people may be able to see some of the signs of this anxiety, such as blushing, stammering, shaking and trembling.

Sometimes, you may breathe too fast, which can give you feelings of numbness or pins and needles in your fingers and toes. This can feel quite alarming and can make your anxiety even worse.

Panic attacks

At their worst, these feelings of fear and bodily symptoms can end in a panic attack. This is a short period, usually lasting only a few minutes, during which people feel overwhelmingly anxious, terrified of losing control, and may even feel they're going mad or even dying. These feelings tend to reach a peak and then pass rapidly, leaving the person feeling weak and exhausted. Although these attacks are very alarming, they eventually stop on their own and can't harm you physically.

How does it affect the way you think about yourself?

It can be very demoralising to suffer from a social phobia, because other people seem to easily do many of the things you find impossible. You may think that you are rather boring and may worry that others will think so too. It may make you over-sensitive and reluctant to bother other people, even when you perhaps should. It's easy to see how this can make you feel depressed and unhappy. This can make the social phobia even worse.

How can it affect people's lives?

Many sufferers cope by arranging their lives around their symptoms. This means that they (and their families) have to miss out on things they might otherwise enjoy. They can't visit their children's school, can't do the shopping or go out with friends. They may avoid promotion at work, even though they're quite capable of doing a more demanding and more financially rewarding job. About half of those with a severe phobia, particularly men, will find it difficult to make long-term relationships.

How common is it?

About one or two in a hundred men, and about two or three in every hundred women suffer from a social phobia.

Are there any complications?

Some people become so upset by their social phobia that they develop depression. This may need treatment in its own right, quite apart from the social phobia. If somebody constantly avoids places where people meet, they may in the end develop a fear of those places - even when there is nobody there. They may then find themselves unable to go out - this is called agoraphobia.

Others may use alcohol, drugs or medication prescribed by doctors to cope with their symptoms and may come to rely on them. However, in spite of their anxiety and panic attacks, people with social phobia don't seem to have any more heart attacks than anybody else.

What are the causes?

We really don't know for sure. Some experts think that it might be due to people getting 'stuck' at the normal stage of shyness that all children go through between the ages of three and seven, but there are lots of different theories.

Can it be helped?

There are several different ways of helping people with social phobia. These may be used on their own or together, depending on the individual's needs.

Self-help: If you're naturally shy, you might find it helpful to join a self-confidence or assertiveness course at an Adult Education Centre. Relaxation exercises may help you feel generally less anxious - you can get details of these from many G.P. surgeries.

Psychological treatments

Social Skills Training: This helps to make people feel more relaxed and confident in company. It does this by teaching some of the simple social skills that we tend to take for granted, like how to start a conversation with a stranger. There's a lot of practice with other people and so-called `feedback' - people might watch themselves practising on video to get an idea of what they're doing and how they appear to other people.

Exposure Therapy: This involves helping a person to relax while in the situation that they find frightening. It can be done in stages, each time making the situation a little more intense and challenging. Another way is called `flooding'. The patient is first taught how to relax in a frightening situation and is then put into a situation that would normally worry them, such as a crowded room. They are then helped to relax and wait for their anxiety to disappear, which it will after a while.

Cognitive Therapy: We can often make ourselves anxious by the way we think about things. This treatment helps people change the way they think about themselves and other people. Take the situation where a conversation dries up: Someone with a social phobia may tend to think that it is their fault, and so will start to feel anxious. In cognitive therapy, the therapist will remind them that it is just as likely that the other person has run out of things to say - a much more realistic and less worrying way to think about the situation.

Drug Treatments

Beta-Blockers: These drugs are usually used to treat high blood pressure. In low doses, they help control the rapid heartbeat and physical shaking of anxiety - which can be a symptom of the social phobia - and can be taken shortly before meeting people or before speaking in public.

Anti-depressants: A particular type, called MAOIs, have been found to help, and sometimes to stop the anxiety and panic, although it often takes a few weeks for the treatment to work. There are drawbacks though. They tend to lower the blood pressure, which can make people feel faint. Some foods, such as cheese, yeast extract and fermented soya bean products may produce dangerous reactions with these drugs, so people taking an MAOI have to follow a special diet which leaves out these foods.

Some cough medicines can produce similar reactions to these foods. There are now some new MAOI drugs called RIMA. These don't seem to produce the above reactions and so the user can mostly eat what he or she likes, although some precautions are still necessary.

Other types of traditional anti-depressants don't seem to work very well in social phobia. More recently developed anti-depressants, known as SSRIs, have been found to be helpful in social phobia, but can sometimes cause headaches and dizziness in the first few weeks. You can, however, eat what you like if you're taking these drugs.

Anxiolytics: drugs like Valium were used in the past to treat all sorts of anxiety. We now know that they're addictive and that they don't help in the long run. They shouldn't usually be used to treat people with a social phobia.

Original work copyright Royal College of Psychiatrists (RCP) 1998, adapted with permission from RCP, in collaboration with the Service User Steering Group.
Flesch-Kincaid level: 8.4
Date written: May 2007
Date for review: November 2015
Page last updated: 21.11.2013