Social anxiety explains a common yet frequently hidden condition affecting many individuals. It can range from an uneasy feeling in social settings, to extreme fear of being scrutinized in public. Social phobia is the clinical term for an unbearable fear of being negatively judged, leading to mortification and embarrassment. With social phobias, individuals are sensitive to evaluative or performance situations including public speaking and job interviews and test taking, although eating, drinking or writing in public also fall into this category. Social interactions, notably with strangers and people in authority also cause significant uneasiness. The individual’s extreme discomfort in these situations may provoke a panic attack.
While it’s common for many individuals to be shy, those diagnosed with social phobia recognize that their reaction is extreme, excessive, and unwarranted. Stage fright, apprehension in meeting authority figures, and other forms of anxiety are common, normal experiences for most people, and do not fall under the severity of social phobia. To fall within the diagnosis of social phobia, the anxiety must be extreme, with serious negative consequences in the individual’s life. Signs that anxiety may be boarding on a social phobia and not quite "normal":
- Social phobia can be a debilitating condition. Individuals will often do everything possible to avoid the dreaded situations, causing people to drop out of school, quit jobs, never date or never gain employment. Other times individuals will endure the anxiety provoking situation with considerable distress. Individuals with social phobias are frequently fearful of several situations.
- Individuals diagnosed with social phobias fear they might embarrass or humiliate themselves with awkward actions or speech. They selectively remember and focus upon all the embarrassing moments in their life and disregard any instances of successful social interaction. They may refuse to speak in public for fear of sounding inarticulate. They often fear others will view them as stupid or crazy. If they experience a slight trembling of hands, they believe everyone will see this and harshly judge them.
- Individuals who suffer from social phobias, or extreme social anxiety, often experience the physical symptoms of anxiety, such as racing heart, shaking, sweating, stomach aches or bowel dysfunction, tense muscles, facial blushing, and a sense of confusion. These symptoms may escalate into a full-blown panic attack, which is a debilitating condition that often leads to isolation, depression and substance abuse.
Social phobias are believed to be learned behavior occurring after a stressful, traumatic encounter (either a direct traumatic experience or through seeing others traumatized, hearing stories or seeing photos of others’ trauma). However there is evidence that some individuals may be genetically predisposed to more fearful life-long characteristics. Social phobias can also make a midlife appearance, if life and work require participation in performance and social events.
Most people with social phobias were fearful as children, and without treatment this condition continues, worsening in times of stress. Children and adolescents may frequently exhibit temporary or transient social anxiety as they learn to manage new social arrangements. A traumatic event may result in children refusing to speak or refusing to attend school. However, these behaviors must be ongoing for at least six months before mental health professionals make a diagnosis of social phobias. When school age children have global worries, such as anxiety about natural disasters and war, they may have generalized anxiety disorder rather than social phobias. Both of these anxiety disorders can begin in childhood, but the scope of worry is the differentiating factor.
Those with social anxiety may be highly reluctant to seek treatment, however, good treatment options abound. Unlike other anxiety disorders, social phobia can be successfully addressed without the need for a highly structured group program. Individual therapists who display warmth and patience can offer a much needed safe place, while groups for social anxiety can help individuals practice their social skills. A combination of both group and individual treatment may yield the most success.
Therapists use many treatment modalities to reduce fear and develop social skills, including relaxation techniques such as deep breathing and visualization. Therapists may teach a form of self-hypnosis which the individual is expected to practice at home. Cognitive therapy is used to challenge people’s thoughts and improve their perception of themselves. For example, individuals with social phobias may erroneously believe that they garner more attention than they actually do. They may not be able to objectively rate their social competence skills, believing that even acceptable interactions are a disaster. In a group setting, social skills training may include rehearsal and practice in maintaining eye contact or offering a handshake. While those with social anxiety may become highly averse to the thought of group therapy, members are often relieved to find other individuals who experience the same discomfort and build a social support network.
While medications are not able to cure social phobias, they may be used to alleviate symptoms of anxiety or other disorders such as mood disorders.