Social phobia is a disorder characterized by overwhelming anxiety and excessive self-consciousness in social situations.  People with social phobia have a persistent, intense, and chronic fear of being scrutinized by others, and of being embarrassed or humiliated by their own actions.  Although it is common for many people to experience some anxiety before or during a public appearance, anxiety levels in people with social phobia can become so high that they begin to avoid social situations.  In addition, they often worry for days or weeks in advance of a dreaded situation.  While many people with social phobia recognize that the fear may be excessive or unreasonable, they are unable to overcome it.

Social phobia can be limited to only one type of situation (such as fear of speaking in formal or informal situations, or eating, drinking or writing in front of others) or, in its most severe form, may be so broad that a person experiences phobic symptoms in any social setting.  Social phobia can be very debilitating – people with this illness often avoid forming or maintaining close relationships or they turn down chances to advance their careers.  Some even become housebound.

Physical symptoms often accompany the intense anxiety of social phobia.  People with social phobia experience symptoms that include blushing, profuse sweating, trembling and other symptoms of anxiety, such as difficulty talking, or nausea or other stomach discomfort.  These visible symptoms may also heighten the fear of disapproval in social settings, and the symptoms themselves can become an additional focus of fear, creating a vicious cycle.

Co-Occurring Illnesses

• Social phobia can lower self-esteem and increase the risk of depression and suicide.
• In an attempt to reduce anxiety and alleviate depression, people with social phobia may use alcohol or other drugs, which can lead to addiction.
• Many people with social phobia may also develop other anxiety disorders, such as panic disorder or obsessive-compulsive disorder.  In particular, people with social phobia may become so anxious that they experience panic attacks (intense bursts of terror accompanied by physical symptoms) when in dreaded social situations.  As more situational panic attacks occur, people with social phobia may take extreme measures to avoid situations in which they fear another panic attack may occur or in which help may not be immediately available.  This avoidance, similar to that in many panic disorder patients, may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety.

Treatments

• Research has shown that there are effective forms of treatment available for social phobia, including medication, psychotherapy, or a combination of the two.
• A specific form of psychotherapy, called cognitive-behavioral therapy, has been found to be useful in treating social phobia.  One hallmark of this treatment involves exposure therapy, in which therapists gradually introduce patients to feared situations and help them become more comfortable in them.  Therapy for social phobia may also include anxiety management training—for example, teaching people such techniques as deep breathing to control their levels of anxiety. 
• Another important aspect of treatment is called cognitive restructuring, which involves helping individuals identify their misjudgments and develop more realistic expectations of the likelihood of danger in social situations.
• Supportive therapy, such as group therapy, or couple or family therapy, to educate significant others about the disorder is also helpful.

The content of this fact sheet was adapted from material published by the National Institute of Mental Health.