DEPARTMENT OF HEALTH AND HUMAN SERVICES • PUBLIC HEALTH SERVICE • NATIONAL INSTITUTES OF HEALTH

Social phobia, also called social anxiety, is adisorder characterized by overwhelminganxiety and excessive self-consciousness ineveryday social situations. People withsocial phobia have a persistent, intense, andchronic fear of being watched and judged byothers and of being embarrassed orhumiliated by their own actions. Their fearmay be so severe that it interferes with workor school – and other ordinary activities.While many people with social phobiarecognize that their fear of being aroundpeople may be excessive or unreasonable,they are unable to overcome it. They oftenworry for days or weeks in advance of adreaded situation.

Social phobia can be limited to only onetype of situation – such as a fear ofspeaking in formal or informal situations, oreating or drinking in front of others – or, inits most severe form, may be so broad that aperson experiences symptoms almostanytime they are around other people. Socialphobia can be very debilitating – it mayeven keep people from going to work orschool on some days. Many people with thisillness have a hard time making andkeeping friends.

Physical symptoms often accompany theintense anxiety of social phobia and includeblushing, profuse sweating, trembling, andother symptoms of anxiety, includingdifficulty talking and nausea or otherstomach discomfort. These visible symptomsheighten the fear of disapproval and thesymptoms themselves can become anadditional focus of fear. Fear of symptomscan create a vicious cycle: as people withsocial phobia worry about experiencing the

symptoms, the greater their chances ofdeveloping the symptoms. Social phobiaoften runs in families and may beaccompanied by depression or alcoholdependence.

How Common Is Social Phobia?■ About 3.7% of the U.S. population ages18 to 54 – approximately 5.3 millionAmericans – has social phobia in any givenyear.

■ Social phobia occurs in women twice asoften as in men, although a higherproportion of men seeks help for thisdisorder.

■ The disorder typically begins inchildhood or early adolescence and rarelydevelops after age 25.

What Causes Social Phobia?Research to define causes of social phobia isongoing.

■ Some investigations implicate a smallstructure in the brain called the amygdala inthe symptoms of social phobia. Theamygdala is believed to be a central site inthe brain that controls fear responses.

■ Animal studies are adding to theevidence that suggests social phobia can beinherited. In fact, researchers supported bythe National Institute of Mental Health(NIMH) recently identified the site of a genein mice that affects learned fearfulness.

■ One line of research is investigating abiochemical basis for the disorder. Scientistsare exploring the idea that heightened

Social Phobia

sensitivity to disapproval may be physiologi-cally or hormonally based.

■ Other researchers are investigating theenvironment’s influence on the developmentof social phobia. People with social phobiamay acquire their fear from observing thebehavior and consequences of others, aprocess called observational learning orsocial modeling.

What Treatments Are Available forSocial Phobia?Research supported by NIMH and byindustry has shown that there are twoeffective forms of treatment available forsocial phobia: certain medications and aspecific form of short-term psychotherapycalled cognitive-behavioral therapy.Medications include antidepressants such asselective serotonin reuptake inhibitors(SSRIs) and monoamine oxidase inhibitors(MAOIs), as well as drugs known as high-potency benzodiazepenes. Some people witha form of social phobia called performancephobia have been helped by beta-blockers,which are more commonly used to controlhigh blood pressure.

Cognitive-behavior therapy is also veryuseful in treating social phobia. The centralcomponent of this treatment is exposuretherapy, which involves helping patientsgradually become more comfortable withsituations that frighten them. The exposureprocess often involves three stages. The firstinvolves introducing people to the fearedsituation. The second level is to increase therisk for disapproval in that situation sopeople build confidence that they can handle

rejection or criticism. The third stageinvolves teaching people techniques to copewith disapproval. In this stage, peopleimagine their worst fear and are encouragedto develop constructive responses to theirfear and perceived disapproval.

Cognitive-behavior therapy for socialphobia also includes anxiety managementtraining – for example, teaching peopletechniques such as deep breathing to controltheir levels of anxiety. Another importantaspect of treatment is called cognitiverestructuring, which involves helpingindividuals identify their misjudgments anddevelop more realistic expectations of thelikelihood of danger in social situations.

Supportive therapy such as grouptherapy, or couples or family therapy toeducate significant others about thedisorder, is also helpful. Sometimes peoplewith social phobia also benefit from socialskills training.

What Other Illnesses Co-OccurWith Social Phobia?Social phobia can cause lowered self-esteemand depression. To try to reduce theiranxiety and alleviate depression, peoplewith social phobia may use alcohol or otherdrugs, which can lead to addiction. Somepeople with social phobia may also haveother anxiety disorders, such as panicdisorder and obsessive-compulsive disorder.

NIMH ANXIETY DISORDERS EDUCATION PROGRAM SEPTEMBER 1999 ■ OM-99-4171

For more information aboutsocial phobia and otheranxiety disorders, write:

The Anxiety DisordersEducation Program,National Institute of

Mental Health6001 Executive Blvd.

Room 8184, MSC 9663Bethesda, MD 20892-9663

Or call 301-443-4513.

Publications and other information are also

available online from theNIMH Website at

http://www.nimh.nih.govor by calling toll-free

1-88-88-ANXIETY (1-888-826-9438)

This is the electronic version of a National Institute of Mental Health (NIMH) publication, available from http://www.nimh.nih.gov/publicat/index.cfm. To order a print copy, call the NIMH Information Center at 301-443-4513 or 1-866-615-6464 (toll-free). Visit the NIMH Web site (http://www.nimh.nih.gov) for information that supplements this publication.

To learn more about NIMH programs and publications, contact the following:

Web address: E-mail:http://www.nimh.nih.gov nimhinfo@nih.gov

Phone numbers: Fax numbers:301-443-4513 (local) 301-443-42791-866-615-6464 (toll-free) 301-443-5158 (FAX 4U)301-443-8431 (TTY)

1-866-415-8051 (TTY toll-free)

Street address:National Institute of Mental HealthOffice of CommunicationsRoom 8184, MSC 96636001 Executive BoulevardBethesda, Maryland 20892-9663 USA

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A specific example is:National Institute of Mental Health. Childhood-Onset Schizophrenia: An Update from the National Institute of Mental Health. Bethesda (MD): National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services; 2003 [cited 2004 February 24]. (NIH Publication Number: NIH 5124). 4 pages. Available from: http://www.nimh.nih.gov/publicat/schizkids.cfm