Social Phobia: Causes, Symptoms & Treatment

Social phobia, or social phobia, is an anxiety disorder. In it, sufferers fear attracting negative attention and embarrassing themselves in company. The fear revolves around the possibility that general attention will be focused on one’s own person. About 11 to 15 percent of people develop social phobia during their lifetime.

What is social phobia?

Social phobia is defined in the ICD 10 (published by WHO) as follows: People who suffer from social phobia fear standing out in smaller groups and being the focus of attention. Self-esteem is low and criticism is difficult to bear. Characteristically, this fear does not occur in large crowds. It is limited to specific social situations. In some cases, the fear is focused on occasions such as public meals or lectures. However, it is far more common for the fear to extend to many social situations. Symptoms may include palpitations, nausea, trembling, and sweating. Because the suffering pressure can increase to the point of panic attacks, affected individuals engage in avoidance behavior to escape the accompanying symptoms of social phobia.

Causes

Social phobia can have a variety of causes, usually involving a whole web of causes. On the one hand, studies have found that a genetic disposition can also play a role in such a disorder. This is shown, for example, by twin studies. Another reason for a social phobia may be anchored in the personality of the person affected. For example, people who have such difficulties tend to be more insecure and self-doubting, while others get over comparable things with humor. The low self-confidence can in turn have various causes: a loveless upbringing in which no basic trust could be formed, trauma or social deficits such as exclusion, rejection, etc. Psychotherapy can be used to analyze the reasons for social phobia.

Symptoms, complaints and signs

Typical symptom of social phobia is fear of social contacts. Interaction with other people is a stressful situation for sufferers. Therefore, one sign of social phobia is avoidance of situations in which one has to interact or have conversations with other people. This avoidance behavior results in corresponding complaints that can significantly reduce the quality of life. On the one hand, social contacts can hardly be avoided in a normal everyday life. Professional life, family meetings or contacts in everyday situations such as visits to the doctor or shopping then become stressful situations for people affected by social phobia. The complaints in such situations can also often be of a psychosomatic nature. Heart palpitations, sweating, the feeling of being close to fainting or tendencies to stutter are typical psychosomatic symptoms. New complaints arise from the attempt to avoid such situations. Those affected are threatened with social isolation. Total withdrawal from everyday life then initially alleviates the fear of having to cope in social situations. Nevertheless, most people with social phobia are not permanently happy with such a restricted life and wish they could interact normally with others. If left untreated, social phobia is accordingly often associated with depression and even suicidality.

Diagnosis and course

To reliably diagnose social phobia, the above criteria must be met. But how does such a disorder develop? Is there a typical course? As a rule, social phobias cannot be assigned a single causal reason. They are rather insidious and develop slowly over years. If the disorder is not treated appropriately, there is a risk of chronification. Frequently, addictive disorders and/or depression are added to the mix, with those affected trying to help themselves by means of alcohol, medication or drugs. This is called comorbidity. It is often the case that sufferers withdraw further and further and become lonely. However, if this disorder is treated in time, then the prognosis for recovery from social phobia is favorable.

Complications

Social phobia is a disorder that should not be underestimated. Affected individuals avoid interacting with other people.They withdraw, increasingly isolate themselves from the social “outside world” and not infrequently develop depression. Even going to the doctor is possible for many patients only after several attempts. The horror already begins on the street. There, phobia patients can still avoid other people, but on the bus, streetcar or subway, escape is impossible. The fear becomes entrenched. Those affected try to mask the condition. They resort to drugs such as tranquilizers (benzodiazepines). In order to get through the visit to the doctor, short-term use as an aid is perfectly justifiable. However, taking them for a longer period of time is strictly not advisable, as this leads to dependence and brings further problems. Some social phobics develop other strategies. They resort to alcoholic beverages. This can quickly develop into an alcohol addiction. Avoiding certain situations leads to further limitations in the everyday life of people with social phobia. This can make it difficult, for example, to choose a suitable job. If this is finally found, a dropout can still threaten. Even being in the classroom during theoretical lessons can trigger a threatening state in the phobic person. Not infrequently, this ends in panic attacks. Some of those affected manage to become skilled workers, while others remain unskilled for life and can only keep their heads above water temporarily with unskilled work. Without medical treatment, social phobia can intensify to such an extent that sufferers are no longer able to make social contact. Sometimes this can promote suicidal behavior.

When should you see a doctor?

Social phobia, as a pathological anxiety disorder, is always a reason to see a doctor. In such a situation, psychotherapists are most likely to be able to help. However, it is problematic that the transition between a high level of shyness or insecurity and a real fear is not always clear. People who find social interaction very difficult and are characterized by fears of disappointment and failure are not necessarily affected by social phobia. Social phobia is therefore considered pathological when the fear leads to avoidance behavior. This means that the person affected really experiences limitations as a result of the fear. These limitations are then the reason to get help. The limitations may be social isolation, for example, or a fear of interaction in general. If it is unclear to what extent personal or psychological circumstances lead to these limitations, a professional should be consulted. This does not necessarily have to be a doctor. A psychologist can also help, as can a well-trained coach. The decisive factor is that if the social life is experienced as severely restricted, there is a willingness to examine and change this. If, on the other hand, the social phobia has progressed to the point where even that is no longer possible, the onus is on the environment.

Treatment and therapy

But how can social phobia be successfully treated? It has now been recognized that a combination of psychotherapy and drug treatment is most promising. Medication options include various antidepressants, such as sertraline or mirtazapine, which have an anxiety-relieving effect because they act on specific areas of the brain where anxiety originates. The right medication is a prerequisite for psychotherapy to be effective at all. Psychotherapeutically, cognitive behavioral therapy is usually used so that those affected learn to build up a positive self-image and to cope better with defeats. Within this framework, the aim is for patients to become more independent of the opinions of others. In addition, various relaxation techniques such as progressive muscle relaxation or autogenic training are practiced to reduce stress. Ideally, crises can be averted if these relaxation techniques are well mastered. In the short term, social phobia can also be treated with benzodiazepines. Diazepam or alprazolam, for example, can be used for this purpose. However, due to the addictive potential of these tranquilizers, they should be used as sparingly as necessary and for as short a time as possible. Accordingly, there are some approaches to treating social phobias.

Prevention

Since it is not known exactly what ultimately triggers social phobias, it is difficult to take preventive measures.However, it was found that a pejorative and rejecting attitude of parents or peers in childhood increases the risk. This should therefore be taken into account in one’s own parenting style. In addition, the following applies: At the first suspicion, one should seek treatment, because then the prognosis for the healing of a social phobia is best. A social phobia requires psychotherapeutic follow-up, because it accompanies the affected person for the rest of his or her life. If the patient was previously hospitalized during a hospital stay, aftercare prepares him or her for a return to everyday life outside of psychiatric care.

Aftercare

The extent of aftercare depends on the individual condition of the sufferer. Regardless, in phobia, anxiety is a primary symptom. Anxiety throws the sufferer off balance. Therefore, even in the case of a successfully treated person who has been emotionally stabilized, a possible deterioration can never be completely ruled out. During behavioral therapy follow-up, the patient deepens his knowledge of how to better integrate his phobia into everyday routines. At the same time, the psychologist educates him about what behavior is helpful in acute anxiety situations. The affected person should be encouraged to visit the therapist outside of regular office hours, especially during such events. The therapist’s address has the function of a ‘protective island’ here. If the patient is no longer able to pursue his or her previous profession due to the phobia, the psychologist will care for him or her in this case as well. There is a very high risk of depression developing in addition to the phobia as a result of the inability to work. This unfavorable course of the disease is counteracted during follow-up care.

What you can do yourself

Confronting the anxiety-provoking situations, as used in behavioral therapy, can also be done by sufferers themselves. Self-help books and training booklets can be of help. Although self-help books are not enough for every social phobic to completely conquer social anxiety, they can help some people improve significantly. People with social phobia can also find support on the Internet. Various online groups in the form of forums, apps and social media groups can help sufferers not feel alone with their fears. In addition, when online support groups work together to reduce avoidance behaviors and decrease other symptoms, they can bring about tangible progress. However, most forums and online groups focus on mutual relief rather than a (self-)therapeutic approach. Groups that meet in real life offer another opportunity for self-help. However, many social phobics’ fears get in the way of this, as they are reluctant to meet with a group of strangers in unfamiliar surroundings. Mindfulness can help alleviate symptoms of stress and also improve the specific symptoms of social phobia. Mindfulness is primarily an adjunct to other methods.