Social phobia (also social anxiety disorder) is a disorder characterized by an intense and persistent fear of a variety of social situations or situations in which the individual is expected to perform. Sufferers worry about their social interactions and fear entering into embarrassing situations where they may be judged, watched or humiliated. A patient is said to be suffering from social phobia when he/she avoids most social situations.
The most frequent social phobias relate to public speaking, engaging in conversation - particularly with a stranger - or speaking with an authority figure.
In men, common social phobias include a fear of using public toilets and of returning unwanted merchandise to a store.
Other social phobia sufferers experience difficulty with talking on the telephone, eating or drinking in front of strangers who may be looking at them, or participating in activities likely to include an audience, such as music concerts or sporting events.
Phobias can significantly impact the sufferer’s daily functioning and quality of life. For instance, a young man suffering from a social phobia may experience tremendous difficulty in finding employment because he feels unable to face the interview process, or he may refrain from having a satisfying love life due to his fear of approaching young women. Therefore, he may be confined to living in isolation, without any kind of social and emotional life.
Social phobia is described as “an illness marked by missed opportunities”. As it is often detected early, it hinders future social success, reducing the likelihood of domestic and professional success. Sufferers tend to be less educated, have a lower-than-average socioeconomic status and remain single.
Individuals suffering from social phobia rarely consult for symptoms related to anxiety. Most of the time, they seek medical attention for substance abuse, depression or other associated anxiety disorders common within this group.
The DSM-IV lists the characteristics of social phobia as follows:
- Marked and persistent fear of one or more social or performance situations in which the person is exposed to possible scrutiny by others or to unfamiliar people.
- Fear of embarrassment or humiliation.
- Exposure to a feared public situation or activity which may provoke anxiety (i.e. situational panic attack).
- The feared situations are avoided or endured with intense distress or impaired ability to function.
The avoidance or fear is not due to a medical or mental disorder.
A diagnosis of “generalized” social phobia is made when most public situations or activities are characterized by overwhelming fear.
Physical symptoms such as trembling, blushing, palpitations and sweating often accompany this excessive anxiety and fear of being judged by others.
This fear may drive sufferers to avoid going out or engaging in public activities, causing marked distress and interfering with the sufferer’s day-to-day life.
It may be difficult to distinguish between generalized social phobia and avoidant personality disorder, with the latter often presenting in childhood.
According to a Government of Canada report entitled The Human Face of Mental Health and Mental Illness in Canada 2006, anxiety disorders develop from a complex interplay of genetic, biological, cognitive, developmental and other factors, such as personal, socio-economic and workplace stress. A variety of theories has been proposed to explain how these factors contribute to the development of anxiety disorders.
The first is experiential: people may learn their fear from an initial experience, such as an embarrassing situation, physical or sexual assault, or the witnessing of a violent act. Similar subsequent experiences serve to reinforce the fear.
A second theory relates to cognition or thinking, in that people believe or predict that a specific situation will take an embarrassing or harmful turn. This may occur, for example, if parents are overprotective and continually warn against potential dangers.
A third theory focuses on a biological basis. Research suggests that the amygdala, a structure deep within the brain, signals the presence of a threat and triggers a fear or anxiety response. The amygdala also stores emotional memories, and may play a role in the development of anxiety disorders.
The children of adults with anxiety disorders are at much greater risk of developing an anxiety disorder than the general population, suggesting that genetic factors may play a role as well. Numerous studies have also confirmed that neurotransmitters in the brain such as serotonin and norepinephrine, as well as hormonal factors, can influence the onset and course of anxiety disorders.
Who is at risk?
Social phobia ranks among the most common anxiety disorders, affecting 750,000 adult Canadians (3% of the population) with a lifetime prevalence of 8-12%. This disorder is more common in women than in men. Early social phobia may present between the ages of 0-5 years and again between the ages of 11 to 15 years. It rarely appears past the age of 25 years.
Individuals suffering from social phobia are characterized by a number of personality traits, including lifelong timidity, fear of the unknown and low self-confidence and self-esteem.
Prevention and care
Good personal health practices may vastly reduce anxiety and allow it to return to tolerable levels.
Desirable health practices include:
- Proper balance between work, rest and leisure activities;
- Low consumption of alcohol, caffeine and nicotine;
- Good nutrition;
- Regular physical exercise.
Individual or group cognitive-behavioural therapy (CBT) and drug therapy are the two recommended treatments for social phobia. Some patients may receive both treatments simultaneously (combination treatment). Based on current studies, combination treatments are no more effective than other therapies, since both approaches boast nearly-identical rates of effectiveness. However, relapse rates have been shown to be lower with psychotherapy.
A study has concluded that CBT is more effective in patients treated individually than in group settings, as therapy may be adapted to target problem areas specific to each sufferer. Exposure therapy is particularly effective. Exposure may be provided through guided visualization, in vivo (real-life) situations, or role-play-based simulations which imitate situations likely to provoke social anxiety. This approach also includes the teaching of social skills, including eye contact, conversation skills, assertiveness, conflict management and relationship management.
- Medication therapy
Proven effective drugs include antidepressants and benzodiazepine, with the former considered the medication of choice. Benzodiazepines are more often recommended in cases where severe agitation and anxiety are present. Due to side effects and issues with addiction and weaning, these drugs are normally prescribed only for short-term use.
- Complementary approaches
Relaxation techniques: may improve emotional stability and reduce physical and psychological stress.
Bibliotherapy or self-directed therapy: supplementary reading effectively complements psychotherapy by encouraging patients to broaden their understanding of the disorder’s root causes, nature and treatment.
- C. André, P.Légeron : La peur des autres : trac, timidité et phobie sociale, Éditions Odile Jacob, Paris, 1998
- JM. Boisvert, M. Beaudry : S’affirmer et communiquer, Éditions de l’homme, Montreal, 1979.
Support and self-help groups: To help sufferers break out of their isolation, these groups allow participants to interact, share their experiences and receive support and additional information.
Association / Troubles Anxieux du Québec (Anxiety Troubles Association)
Canadian Network for Mood and Anxiety Treatments
L’Ordre des psychologues du Québec (Quebec’s Psychologists Order)
(514) 738-1881 ou 1-888-731-9420
Revivre (Association for people suffering from anxiety, bipolar disorder or depression)
Ligne d’écoute : (514) 738-4873 ou 1.866.REVIVRE
La Clé des Champs (Peer network for people living with an anxiety disorders)
Phobies-Zéro : (Help groups for youth and adults suffering from anxiety disorders – all around Quebec)
Ligne d’écoute et de soutien : (514) 276-3105 ou 1-866-0002
Groupe d’Entraide G.E.M.E. (Help group for better living)
(450) 462-4363, numéro sans frais : 1-866-443-4363
FFAPAMM (Friends and families of people suffering from mental illness)
Association québécoise de prévention du suicide (Suicide prevention)
24 heures/ jour, 7 jours/7 partout au Québec
1-866 APPELLE (277-3553)