Skip to main content
UC Davis Medical Center

UC Davis Medical Center

Social phobias involve more than shyness

Checkup on Health

couple on dinner date
Social anxiety disorder or social phobia is usually generalized to many social situations, and may include being introduced to new people, making small talk, eating out, or dating. Without treatment, the problem may affect a person’s life profoundly.

By Donald M. Hilty, M.D. 

Most people feel nervous when giving a speech or are excited in anticipation of a party. But for others, occasions like these can trigger agonizing anxiety and eventual avoidance of such situations altogether.

Dr. Hilty is an adult psychiatrist at UC Davis Medical Center in Sacramento. 

Social anxiety disorder, also known as social phobia, is a recognized psychiatric problem that affects some 13 percent of Americans over their lifetimes. About 10 to 20 percent of those affected have problems with very specific situations, such as performing in a concert or giving a presentation. But the more common problem is generalized to many social situations, and may include being introduced to new people, making small talk, eating out, or dating.

The disorder often appears during the teen years, though some sufferers feel that it was with them from early childhood. About half of those affected report that the problem began with a specific embarrassing incident.

Profound effect on daily life

People with social phobia feel an intense fear of being scrutinized or negatively evaluated by others. During or prior to a threatening situation, they may experience physical symptoms, such as a rapid heartbeat, sweating, blushing, a feeling of panic or — worst — feeling like they are having a heart attack.  Sufferers usually realize, on one hand that their fears are similar to those of others, but on the other hand, these are irrational, excessive or unreasonable, and uncontrollable.

Without treatment, the problem may affect a person’s life profoundly. One study found that nearly half of those with social phobia were unable to complete high school. Many drop out of college, are restricted in their professions, or have unsatisfying social lives. A large number turn to alcohol or drugs to ease their social difficulties and develop serious substance abuse problems.

Highly treatable

Fortunately, social anxiety disorder is highly treatable. But treatment is commonly delayed because of fear of asking for help with such a problem. And physicians or family members may not recognize the problem, blaming a drug or alcohol problem or attributing it to just a personality characteristic like shyness.

Physicians or family members may not recognize the problem, blaming a drug or alcohol problem or attributing it to just a personality characteristic like shyness.

Like other anxiety disorders, social anxiety disorder overlaps with depression, and medications that are effective against depression can work well in treating social phobias. Selective serotonin reuptake inhibitors (SSRIs) like Prozac, Paxil or Effexor XR, are approved for the treatment of social anxiety disorder.

Treating generalized social anxiety disorder with anti-anxiety medications like tranquilizers may mask certain symptoms but actually worsen depression, which is also commonly present, or make them tired.

For those with the less common social anxiety disorder that arises only in very specific situations, such as only before some kind of a performance, the occasional use of a beta blocker (a common heart medication) or a benzodiazepine (a tranquilizer) is highly effective for calming nerves.

Persistent social anxiety disorder can also be treated with counseling and psychiatric therapy. Therapy specifically aimed at treating social phobias typically involves about 20 sessions and covers:

  • managing anxiety by controlled breathing and other relaxation techniques;
  • training in social skills, such as how to initiate and maintain a conversation;
  • learning to change fearful thought patterns to more realistic thinking; and
  • gradual re-entry into social situations.

General supportive therapy can also be used as an adjunct but is not as effective alone.

Seeking help

Held annually, National Depression Screening Day raises awareness and screens people for depression and related mood and anxiety disorders. Click here for info 

If you or someone you love is plagued by anxiety, I urge you to seek help, which sometimes is the hardest step in the treatment of a mental illness. The national Anxiety Disorders Screening Day is scheduled for October 7-10, 2010.

Dr. Hilty has no conflicts of interest with regard to the statement above.