Social Phobia, also known as Social Anxiety Disorder, is a psychiatric disorder characterized by a marked and persistent fear of social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. The exposure to the feared situation almost invariably provokes anxiety, which may take the form of a panic attack (intense fear, trembling, sweating, palpitations, chest pain). The person recognizes that the fear is excessive, and the feared situations are avoided or else are endured with intense distress. Social phobia, by definition, interferes significantly with the person’s functioning.

It is estimated that 15 million adults in the USA have Social Phobia. The lifetime prevalence is approximately 2–7 %, and the estimated male to female ratio is 2:3.

Social phobia can be circumscribed (anxiety over engaging in specific activities such as public speaking or eating in public), or generalized (fear includes most social situations).

Like many other mental health conditions, social phobia is chronic and likely arises from a complex interaction of genes and environment. Circumscribed social phobia has complications only when avoidance of the phobic situation interferes with the patient’s life (e.g., a public speaking phobia in a politician). Generalized social phobia may leave patients isolated and housebound. It is not unusual for people with social phobia to abuse alcohol or sedative–hypnotic medications to cope with the symptoms or to try to escape them.

Treatment of social phobia consists of medications and psychotherapy. Antidepressants like the SSRIs (selective serotonin reuptake inhibitors), the SNRIs (serotonin– norepinephrine reuptake inhibitors) and the MAOIs (monoamine oxidase inhibitors) are the most commonly prescribed medications. Benzodiazepines (e.g., alprazolam or clonazepam) are effective to reduce the anxiety symptoms; however, they should be used for short periods of time to prevent withdrawal. Circumscribed social phobia, especially when tremor is prominent, may be treated with propranolol (inderal) 1–2 hours before the anticipated public exposure. Cognitive behavioral therapy is an effective approach, and it is based on the idea that your own thoughts—not other people or situations—determine how you behave or react.

Social Phobia can be disabling and debilitating. With appropriate treatment, patients affected by this condition can become confident in social situations and live normal productive lives. Like in other anxiety disorders, early diagnosis and treatment are crucial predictors of success.

Ana C Posada Diaz, MD Psychiatrist