Katherine Chemodurow Kelley, MD
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Katherine Chemodurow Kelley, MD
Social Phobia (Social Anxiety Disorder)
"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.”
“In any social situation, I felt fear. I would be anxious before I even left the house, and it would escalate as I got closer to a college class, a party, or whatever. I would feel sick in my stomach—it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else.”
“When I would walk into a room full of people, I’d turn red and it would feel like everybody’s eyes were on me. I was embarrassed to stand off in a corner by myself, but I couldn’t think of anything to say to anybody. It was humiliating. I felt so clumsy, I couldn’t wait to get out.”
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 affects about 15 million American adults. Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence. There is some evidence that genetic factors are involved. Social phobia is often accompanied by other anxiety disorders or depression. Substance abuse may develop if people try to self-medicate their anxiety.
Signs & Symptoms
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.
Social phobia is generally treated with psychotherapy, medication, or both.
Psychotherapy. A type of psychotherapy called Cognitive behavior 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. Our doctors may also 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.
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 cognitive behavior therapy, while others do better with medication. Still others do best with a combination of the two. Our doctors review the different treatment options that they feel are be best for each individual. If they feel that medication may be necessary, they will discuss the pros and cons of different medications as well as the possible side effects. We will work with you to tailor a treatment plan that is right for you. It is important that you feel thoroughly educated, have enough time to think about your options and feel that you and your doctor are working as collaborators.