In feared social or performance situations, social phobia can produce symptoms of anxiety, including heart palpitations, trembling, sweating, tense muscles, and a sinking feeling in the stomach Table 02. An important reason why social phobia often goes unrecognized is that social phobics and many doctors alike dismiss social phobia as a form of exaggerated shyness. It's also easy to blame impaired daily functioning on anything but social phobia. However, there are some very distinct and important differences between social phobia and simple shyness.
Social phobia is often mistaken for other anxiety disorders, including panic disorder and agoraphobia (fear of going outside the home) Table 03. One way to distinguish social phobia from other anxiety disorders is to examine the thoughts behind the fears. People with social phobia are afraid that they will be negatively judged, embarrassed, or humiliated in social situations; people with panic disorder fear having an unexpected panic attack in any situation—not just social situations. People with agoraphobia dread leaving a safe environment for fear that they will have an anxiety attack in a situation where they can't escape, or where familiar people are not present.
Table 2. Symptoms of Social Phobia
Heart palpitations Trembling Sweating Tense muscles Sinking feeling or butterflies in the stomach Dry mouth Hot or cold sinking sensation Blushing Increased urge to urinate or defecate Shortness of breath Headache/pressure in the head
Table 3. Symptoms of Social Phobia as Compared to Other Disorders
Disorder Key characteristics Social phobia Excessive fear of being negatively judged, embarrassed, or humiliated in social/performance situations Anxiety symptoms increase throughout a feared situation and become disabling Able to leave the house so long as assured not to run into others Knows that fears are unreasonable and would seek the company of others if anxiety was absent Shyness/performance anxiety Uneasiness about social or performance situations that quickly lessens/disappears as the situation is encountered Fears are not disabling Panic disorder Fear that unexpected anxiety attack will occur at any time Not limited to social situations Having familiar people around is comforting Agoraphobia Fear of leaving safe environments in case an anxiety attack occurs in a situation from which there is no escape Comforted by familiar faces Schizoid personality disorder Total lack of interest in interacting with others Depression Desire to withdraw from social situations as a result of depression Socialization is normal when not depressed. Feelings of inadequacy Body dysmorphic disorder Preoccupation with an imagined physical defect or a slight physical abnormality that leads to feelings of distress, interferes with daily functioning
Social phobia usually begins in childhood, but symptoms start to emerge around the middle to late teenage years. Symptoms that emerge before age 11 often predict more severe disease and poorer recovery. Social phobia is the third most common psychiatric disorder in the U.S. (following substance abuse and depression), affecting roughly 8% of the population each year.
Although social phobia may begin in childhood, its symptoms don't usually begin to emerge or peak until adolescence. Usually social phobia will worsen around age 15. This worsening may result from an especially humiliating experience, or may simply occur over time.
Because social phobia begins in childhood, family environment appears to play a role. Feeling safe and secure is important to children. When their world is disrupted by experiences they can't control or predict, certain fears can develop. Studies suggest that people whose parents were verbally abusive to one another may be at a higher risk for social phobia than the general population. Sexual abuse by a relative before the age of 12 can also increase the risk for social phobia in women.
Having a close relative (i.e., mother, father, sister, brother) with social phobia increases your risk for social phobia. Additionally, there's evidence that identical twins (which develop from a single egg) will have similar fears of doing things in front of others, whereas fraternal twins, developing from two different eggs, will not.
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