What is Social Phobia (Social Anxiety Disorder)?

Social phobia, also referred to as social anxiety disorder, is a common mental health condition. It is a type of anxiety disorder. Those affected by it experience fear and anxiety in specific or all social situations, due to a fear of being judged or humiliated. Learn more about social phobia in this overview.

Definition

Social phobia is a mental health condition that causes someone to experience intense and persistent fear and anxiety in specific or all social situations, as well as sometimes everyday tasks like eating or drinking in front of others. The anxiety is caused by a fear of being judged or humiliated by others.

Social phobia is referred to in the most recent edition of the "Diagnostic and Statistical Manual for Mental Disorders" (DSM-5), the book used by mental health professionals to diagnose conditions, as Social Anxiety Disorder, and it is classified as a type of anxiety disorder.

Some people may not have anxiety in social situations, but they experience it when they need perform or do something in front of a group. This is called performance anxiety, and it can occur when giving a speech, dancing, playing an instrument, etc.

Symptoms

People with social anxiety disorder experience physical and mental signs and symptoms when in social situations or performing in front of others.

Physicals signs and symptoms include:

• Pounding or faster heart rate 
• Shortness of breath
• Sweating
• Tremors or shaking
• Headaches
• Fatigue and difficulty sleeping
• Nausea or diarrhea
• Frequent urination

Emotional and mental symptoms include:

• Feeling apprehension or dread
• Feeling tense or jumpy
• Restlessness
• Irritability
• Anticipating the worst 
• Watching for signs of danger
  

Diagnosis

If you are experiencing these symptoms, it is important to discuss them with a doctor or other healthcare professional. They will perform a physical exam and take a history to determine if it is caused by a physical problem. Once this is ruled out, they likely will refer you to a mental health professional who has more training in diagnosing mental health conditions, like a psychiatrist, psychologist, or therapist.

The symptoms must be persistent and present for at least 6 months and cause impairment in the person's ability to function in daily life. In children, the social setting must also be with peers and not just adults to classify as social anxiety.

Causes and Risk Factors

Several parts of the brain are involved in social phobia, and it seems that it is affected by both genetic and environmental factors. Regarding genetics, social phobia sometimes occurs in families, but there is no known reason why some family members have it and others do not. Temperamental risk factors include behavioral inhibition, and environmental factors can sometimes include childhood adversity or maltreatment.

A person with social phobia is also an increased risk for other mental illnesses, such as depression and substance use disorders. It often begins early in life, with an average age of onset of 13 years, and also lasts a long time.

Treatment

Social phobia is treated with psychotherapy, also called “talk” therapy, medication, or a combination of the two. Often psychotherapy is started first, with medications added if needed. Research has shown that while there is typically a more immediate effect of medication, the effects of therapy last longer.

Psychotherapy

Typically, the form of therapy used for social phobia is cognitive-behavioral therapy (CBT). Someone being treated with CBT will learn different ways of thinking, reacting, and behaving in situations that cause distress, ideally leading to an improvement in anxiety and fear. It can also help them learn and develop better social skills. CBT is often done in individual sessions, but it can also be helpful in the group setting. 

While not an official form of psychotherapy, sometimes people with social phobia utilize support groups, which provides them a way to encourage and learn from each other. This should not replace the standard treatment of therapy and/or medications, but they are a good supplement.

Medications

The most commonly used medications for social phobia that are considered first-line treatment are selective serotonin reuptake inhibitors (SSRIs). This class of medications is considered an antidepressant, but they are used for many other conditions, including social phobia. The selective serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) has also been shown to help in social phobia.

Occasionally, benzodiazepines may be used, which are anti-anxiety medications that work quickly to reduce anxiety. However, they can also cause dependency and withdrawal, so they are used in situations when symptoms are disabling and require rapid relief.

For performance anxiety specifically, beta-blockers, like Inderal (propranolol), are often utilized. These are often used for heart conditions and blood pressure, but in this case, they are helpful in reducing specific physical symptoms like fast heart rate, sweating, and tremors.

A Word from Verywell

It is difficult to live with anxiety, especially when it is in social situations. However, if you are experiencing symptoms that seem like social phobia, it is important to discuss them with your doctor or healthcare provider. They will be able to rule out any physical causes, get more information about your symptoms, and provide you with resources and referrals, allowing you to live your life the way you would like.