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Social Phobia

(Social Anxiety Disorder)

By John H. Greist, MD, Clinical Professor of Psychiatry;Distinguished Senior Scientist, University of Wisconsin School of Medicine and Public Health;Madison Institute of Medicine

Social phobia is fear of and anxiety about exposure to certain social or performance situations. These situations are often avoided or endured with much distress.

Humans are social animals, and their ability to relate comfortably in social situations affects many important aspects of their lives, including family, education, work, leisure, dating, and relationships.

Social phobia is a type of anxiety disorder. Although some anxiety in social situations is normal, people with social phobia have so much anxiety that they either avoid social situations or endure them with distress. About 13% of people have social phobia sometime in their life. The disorder affects about 9% of women and 7% of men during any 12-month period. Men are more likely than women to have the most severe form of social anxiety, avoidant personality disorder.

Some people are shy by nature and, early in life, show timidness that later develops into social phobia. Others first experience anxiety in social situations around the time of puberty (see Social Anxiety Disorder in Children and Adolescents).

People with social phobia are concerned that their performance or actions will seem inappropriate. Often, they worry that their anxiety will be obvious—that they will sweat, blush, vomit, or tremble or that their voice will quaver. They also worry that they will lose their train of thought or that they will not be able to find the words to express themselves.

Some social phobias are tied to specific performance situations, producing anxiety only when the people must perform a particular activity in public. The same activity performed alone produces no anxiety. Situations that commonly trigger anxiety among people with social phobia include the following:

  • Public speaking

  • Performing publicly, such as reading in church or playing a musical instrument

  • Eating with others

  • Meeting new people

  • Having a conversation

  • Signing a document before witnesses

  • Using a public bathroom

A more general type of social phobia is characterized by anxiety in many social situations.

In both types of social phobia, people's anxiety comes from the belief that if their performance falls short of expectations, they will feel embarrassed, humiliated, or rejected or will offend others.

People may or may not recognize that their fears are irrational and excessive.


  • A doctor's evaluation, based on specific criteria

Doctors diagnose social phobia when people have fear or anxiety that is all of the following:

  • Is intense and has been present for 6 months or longer

  • Concerns one or more social situations

  • Nearly always occurs in the same situation or situations

  • Involves fear of a negative evaluation by others

  • Makes them change their behavior to avoid the situation

  • Is out of proportion to the actual danger

  • Causes significant distress or significantly impairs functioning

Also, doctors rule out other mental disorders that can cause similar symptoms, such as agoraphobia, panic disorder, or body dysmorphic disorder.


  • Exposure therapy

  • Cognitive-behavioral therapy

  • Antidepressants, usually selective serotonin reuptake inhibitors

Social phobia often persists if left untreated, causing many people to avoid activities that they would otherwise like to do.

Exposure therapy (see What Is Exposure Therapy?) is effective. But arranging for exposure to last long enough to allow people to get used to the anxiety-provoking situation and grow comfortable in that situation may not be easy. For example, people who are afraid of speaking in front of their boss may not be able to arrange a series of speaking sessions in front of that boss. Substitute situations may help, such as joining Toastmasters (an organization for those who have anxiety about speaking in front of an audience) or reading a book to nursing home residents.

Cognitive-behavioral therapy may also help. With this therapy, people learn to do the following:

  • Recognize when their thinking is distorted

  • Control the distorted thinking

  • Modify their behavior accordingly

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), and benzodiazepines (antianxiety drugs) can often help people with social phobia. SSRIs are usually preferred because they, unlike benzodiazepines, are unlikely to interfere with cognitive-behavioral therapy. Benzodiazepines affect the central nervous system (brain and spinal cord) and can cause sleepiness and memory problems.

Beta-blockers may be used to reduce the increased heart rate, trembling, and sweating experienced by people who are distressed by performing in public, but these drugs do not reduce anxiety.

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