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How 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 struggles.

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 expected.

by Michael G. Rayel, MD -

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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 or