Distressing is Social Phobia?
I remember a college friend who’d blush, sweat, and tremble when required to speak in class. A few weeks before the
presentation, he’d be anxious and agitated, couldn’t sleep for at least five consecutive nights. As a naïve
student, I didn’t have any clue what he was going through. But I knew that something was terribly wrong.
A few years ago while in the airport, I noticed a man who’d wait for everyone to leave the washroom before he’d use
the urinal. He was too uncomfortable to address the call of nature with watchful eyes around.
In retrospect, I can say (now that I’m a psychiatrist) that those two individuals might have suffered from Social
Phobia or Social Anxiety Disorder (SAD). I just hope that they are doing well now but their symptoms at the time
were consistent with this overwhelming illness.
How distressing is Social Phobia or SAD?
Social Phobia is a type of anxiety disorder characterized by extreme fear, anxiety, or distress when in a social
situation or when performing before a crowd.
Public speaking is the most common situation that exposes a person’s social fears. Anyone with this disorder
develops significant anxiety symptoms such as sweating, fast heart beat, tremulousness, and restlessness when
presenting or giving a talk. Even small, friendly corporate or committee meetings can cause grave distress.
Urinating in public washrooms, eating in restaurants, writing or signing documents in front of people can also
trigger feelings of fear and discomfort. Individuals with this illness are preoccupied with being embarrassed or
criticized. In fact, some feel that others are so focused on them, just waiting for blunders to happen.
No wonder, they avoid social situations as much as possible. With prolonged unrecognized difficulties, some have
eventually lost their jobs, friends, and spouses.
How common is it? Describe its course.
Social Phobia has a lifetime prevalence ranging from 3% to 13%. Fear of public speaking appears to be the most
common. Meanwhile, performance anxiety such as writing in public or using the urinal is less frequent.
Social Phobia usually begins in the mid-teens but I’ve seen individuals who have suffered since childhood. It can
endure for life although some develop successful coping mechanisms that allow them to function well despite ongoing
Unfortunately, Social Phobia creates havoc especially if unrecognized. It is therefore vital that those who have
signs of social fears should be treated without delay. Is there any treatment for this illness?
Some newer antidepressants such as paroxetine and venlafaxine are known to work and have resulted in significant
relief. However, these medications don’t work right away. They need to be taken daily for a few weeks to see any
benefit. Moreover, the medications’ maximum effect may occur within 6-8 weeks or longer. To maintain stability
after feeling “normal,” afflicted individuals may have to be on medication for several months to a few years.
In addition to medications, cognitive-behavioral intervention also works well. By restructuring individuals’
thinking and by deliberately exposing them to dreaded situations, they eventually learn to face social situations
without horror and uncertainty.
The challenge lies among individuals who have Social Phobia associated with substance dependence, depression,
chronic nervousness, or other psychiatric disorders. In this case, the strategy is to treat all psychiatric
problems using appropriate medications combined with “talk” therapy.
Devastating as it is, Social Phobia can be treated. However, patience is a must since relief doesn’t always come as
by Michael G. Rayel, MD -
Dr. Michael G. Rayel - author, game inventor, and psychiatrist - has created the Oikos Game Series to promote
emotional health and has provided EQ Webinar for parenting, personal, and career success. For more info, visit
www.oikosglobal.com or www.psychedu.com.