Basics
Social phobia is a common psychiatric disorder. People with social phobia have an intense fear of performance or social situations where they may be judged, embarrassed, or humiliated Table 01. Feeling shy or anxious when meeting new people or speaking in front of a group of strangers can cause anxiety in just about anyone at one time or another. Unlike shyness or stage fright, however, social phobia causes intense anxiety and distress that increases to the point of causing impairment. Even though social phobics are aware that these responses are excessive and unreasonable, they will avoid feared situations. If a particular situation is unavoidable, they will approach it with anxious anticipation that can start weeks before the actual event.
Table 1. Situations That Lead to Social Phobia Symptoms
Being introduced to unfamiliar people Speaking/performing in public Speaking with people in important positions Eating/writing while being observed in public Using a public lavatory Using the telephone Initiating a conversation or small talk Asking questions in groups Refusing unreasonable requests Attending social gatherings Dating Receiving visitors There are two subtypes of social phobia: nongeneralized, in which you may fear only one or two situations (usually performance-related), and generalized, in which you fear three or more situations. If you have nongeneralized social phobia, you will be most fearful of situations that require performing in front of others. This category includes such things as public speaking, acting, or writing in public.
Generalized social phobia is more severe and disabling than nongeneralized social phobia, and tends to run in families. Generalized social phobics fear multiple situations, including many of the same situations that are feared by nongeneralized social phobics.
With social phobia, fears can persist even when stressful situations are avoided. If left untreated, social phobia can progress to the point where it interferes with academic achievement, employment success, income, and personal relationships.
Causes
While experts are unsure about the exact causes of social phobia, certain biological imbalances appear to cause symptoms. Social phobia has long gone unrecognized as a major illness, thus delaying serious research into its cause. Various theories have been raised, most of them pointing to the importance of key biological imbalances in the body.
For example, in most people a fearful situation will trigger a chemical "fight or flight" response that wanes as the person adjusts to the situation. In people with social phobia, however, the fight or flight response does not naturally diminish, but rather mounts to the point where it causes total impairment.
An imbalance in the brain chemical serotonin may also play a role in social phobia. Serotonin is involved in modulating mood, emotions, sleep, and appetite, and is involved in the transmission of impulses between nerve cells. It is believed that people with social phobia may possess receptors that are extra-sensitive to serotonin, which then leads to fluctuations in nerve impulses.
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I'm Shereen A. Gharbia, PharmD. Welcome to PDR Health!
