What is social phobia

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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
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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?

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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
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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?

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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

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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
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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

Original work copyright Royal College of Psychiatrists
(RCP) 1998, adapted with permission from RCP, in
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collaboration with the Service User Steering Group.
Flesch-Kincaid level 8.4. Date written: October 2006 Date
for review: October 2009.

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