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Social Phobia (Social Anxiety Disorder): Always Embarrassed

Introduction

Are you afraid of being judged by others or of being embarrassed all the time? Do you feel extremely fearful and unsure around other people most of the time? Do these worries make it hard for you to do everyday tasks like run errands, or talk to people at work or school?

If so, you may have a type of anxiety disorder called social phobia, also called social anxiety disorder.

What is social phobia?

Social phobia is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of going to work or school or doing other everyday things.

Everyone has felt anxious or embarrassed at one time or another. For example, meeting new people or giving a public speech can make anyone nervous. But people with social phobia worry about these and other things for weeks before they happen.

People with social phobia are afraid of doing common things in front of other people. For example, they might be afraid to sign a check in front of a cashier at the grocery store, or they might be afraid to eat or drink in front of other people, or use a public restroom. Most people who have social phobia know that they shouldn't be as afraid as they are, but they can't control their fear. Sometimes, they end up staying away from places or events where they think they might have to do something that will embarrass them. For some people, social phobia is a problem only in certain situations, while others have symptoms in almost any social situation.

Social phobia usually starts during youth. A doctor can tell that a person has social phobia if the person has had symptoms for at least 6 months. Without treatment, social phobia can last for many years or a lifetime.

What are the signs and symptoms of social phobia?

People with social phobia tend to:

  • Be very anxious about being with other people and have a hard time talking to them, even though they wish they could
  • Be very self-conscious in front of other people and feel embarrassed
  • Be very afraid that other people will judge them
  • Worry for days or weeks before an event where other people will be
  • Stay away from places where there are other people
  • Have a hard time making friends and keeping friends
  • Blush, sweat, or tremble around other people
  • Feel nauseous or sick to their stomach when with other people.

What causes social phobia?

Social phobia sometimes runs in families, but no one knows for sure why some people have it, while others don't. Researchers have found that several parts of the brain are involved in fear and anxiety. Some researchers think that misreading of others’ behavior may play a role in causing social phobia. For example, you may think that people are staring or frowning at you when they truly are not. Weak social skills are another possible cause of social phobia. For example, if you have weak social skills, you may feel discouraged after talking with people and may worry about doing it in the future. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.

How is social phobia treated?

First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that an unrelated physical problem isn’t causing the symptoms. The doctor may refer you to a mental health specialist.

Social phobia is generally treated with psychotherapy, medication, or both.

Psychotherapy. A type of psychotherapy called cognitive behavioral therapy (CBT) is especially useful for treating social phobia. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and fearful. It can also help people learn and practice social skills.

Medication. Doctors also may prescribe medication to help treat social phobia. The most commonly prescribed medications for social phobia are anti- anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.

Antidepressants are used to treat depression, but they are also helpful for social phobia. They are probably more commonly prescribed for social phobia than anti-anxiety medications. Antidepressants may take several weeks to start working. Some may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.

A type of antidepressant called monoamine oxidase inhibitors (MAOIs) are especially effective in treating social phobia. However, they are rarely used as a first line of treatment because when MAOIs are combined with certain foods or other medicines, dangerous side effects can occur.

It’s important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens, and young adults. A “black box”—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts.

Anyone taking antidepressants should be monitored closely, especially when they first start treatment.

Another type of medication called beta-blockers can help control some of the physical symptoms of social phobia such as excessive sweating, shaking, or a racing heart. They are most commonly prescribed when the symptoms of social phobia occur in specific situations, such as “stage fright.”

Some people do better with CBT, while others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.

What is it like having social phobia?

"In school I was always afraid of being called on, even when I knew the answers. When I got a job, I hated to meet with my boss. I couldn't eat lunch with my co-workers. I worried about being stared at or judged, and worried that I would make a fool of myself. My heart would pound and I would start to sweat when I thought about meetings. The feelings got worse as the time of the event got closer. Sometimes I couldn't sleep or eat for days before a staff meeting."

"I'm taking medicine and working with a counselor to cope better with my fears. I had to work hard, but I feel better. I'm glad I made that first call to my doctor."

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
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NIH Publication No. TR 10-4678
Revised 2013