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Social Phobia

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What is Social Phobia?
       Social Phobia, also called Social Anxiety Disorder, is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with Social Phobia have an intense, persistent, and chronic fear of being watched and judged by others and of doing things that might embarrass them. They might worry for days, weeks, or even months before an event is to occur. Their fears can become so severe that they can't work, go to school, engage in other ordinary activities, or make and keep friends simply because these activities involve other people. While many people with Social Phobia realize that their fears are excessive or inappropriate, they're unable to overcome them. Even if they manage to confront their fears and be around others, they're usually very anxious beforehand, are intensely uncomfortable throughout the encounter, and for hours afterward worry about how they were judged. Social Phobia can be limited to one situation, such as talking to others, eating or drinking in public, or writing in public (paying for something with a check or writing on a blackboard), or may be so broad that the person experiences fear around almost everyone except family.
       Social Phobia affects about 15 million American adults. Women and men are equally likely to develop Social Phobia, 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, and Substance Abuse may develop if the sufferer tries to self-medicate. Social Phobia can be successfully treated with certain kinds or medications and/or psychotherapy.
One Person's Story:
       "I felt afraid in every social situation I was ever in. I would be anxious before I even left the house, and it would just get worse the closer that I got to school, a party, work, or wherever I was going. In school I was always afraid I'd be called on, even when I knew the answer. When I got my first job I hated having to meet with my boss and couldn't eat lunch with my coworkers. Everyone though I was stuck up. I constantly worried that I'd make a fool of myself in meetings. Sometimes I couldn't sleep or eat for days before a meeting or a party. I would feel sick to my stomach—it felt like I had the 'flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being outside of myself and withdrawn 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 because all I could do was stand off in a corner by myself, unable to think of anything to say to anybody. It was humiliating. I felt so stupid I couldn't wait to leave. Now I'm taking a medication and seeing a therapist to get over my fears. I have to work hard and it's scary, but I feel better. I'm glad I decided to call to get help. " 
What are the symptoms of Social Phobia?

       Physical symptoms that often accompany Social Phobia include:
  • blushing;
  • profuse sweating;
  • trembling;
  • nausea;
  • and difficulty talking.
       While experiencing these symptoms people with Social Phobia often feel as if everyone's looking a them, which makes them feel even more uncomfortable. 
What disorders often accompany Social Phobia?

       Social Phobia doesn’t seem to be associated with any general or specific medical conditions. However, it may be associated with other Anxiety Disorders, Mood Disorders, Substance-Related Disorders, and Bulimia Nervosa (an Eating Disorder), and it’s frequently associated with Avoidant Personality Disorder (a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism).

What causes Social Phobia?

       There's no single cause for Social Phobia. Rather, it most likely results from a combination of genetic, biochemical, environmental, and psychological factors. Social Phobia is a disorder of the brain. Brain-imaging scans such as magnetic resonance imaging (MRI) have shown that the parts of the brain responsible for regulating mood, thought, sleep, appetite, and behavior function abnormally in phobic people. In addition, important neurotransmitters (chemical messengers) are out of balance. This knowledge doesn't explain WHY people become phobic, however.

       Social Phobia sametimes runs in families, suggesting a genetic component. Social Phobia also occurs in people without family histories of phobia, however. The probability that anyone will experience Social Phobia results from the interaction between multiple genes and environmental or other factors. In addition, trauma, the loss of a loved one, a difficult relationship, or any other significantly stressful situation may trigger Social Phobia. Subsequent episodes of phobia may not have an identifiable trigger, though.

How is Social Phobia diagnosed?

       Even the most severe Social Phobia is highly treatable. As is true of most medical and psychological disorders, the earlier that treatment begins the more effective it is and the higher the likelihood that recurrences can be prevented.

       The first step toward getting help is to see your Primary Care Provider (PCP), the medical provider whom you see for other disorders. Certain medications and medical conditions can cause the same symptoms as Social Phobia. Your PCP can rule out these conditions by conducting a physical examination, asking questions, and/or ordering lab tests. If medications and medical conditions can be ruled out, your PCP will then prescribe an appropriate medication and/or refer you to a mental health professional for further evaluation.

       A mental health professional will conduct a complete diagnostic evaluation, including a discussion of any family history of Social Phobia and other psychological disorders and a complete history of symptoms. This history will include when your phobia started; how long you've been phobic; how severely phobic you are; whether or not you've had Social Phobia before; if so whether or not you received treatment and how successful that treatment was; whether or not alcohol and/or substance abuse are involved; whether or not there are other psychological disorders present; and whether or not you feel suicidal and/or are planning to harm or kill yourself.  

How is Social Phobia treated?

       Effective therapies for Social Phobia are available, and research is uncovering new treatments that can help most people with Social Phobia lead productive, fulfilling lives. The most common treatments are medication, psychotherapy, and a combination of the two. Medication can’t cure Social Phobia, but it can keep it under control while you participate in psychotherapy. The most common medications used to treat Social Phobia are antidepressants, anti-anxiety drugs, and beta-blockers. Antidepressant medications were developed to treat depression but are also effective for anxiety. Although these medications begin to alter brain chemistry after the very first dose, their full effects require a series of changes to occur in the brain, so it usually take about four to sixs weeks for symptoms to begin to fade. It’s therefore important to take an antidepressant long enough for it to work for you.

       Antidepressants normalize the functioning of neurotransmitters (chemical messengers) in the brain, primarily serotonin, norepinephrine, and dopamine. These particular chemical messengers are involved in regulating mood, although there's still no complete understanding of how this occurs. These medications include newer types, such selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), and older types, such as tricyclics/tetracyclics (TCAs) and monoamine oxidase inhibitors (MAOIs). Wellbutrin (bupropion) is a unique antidepressant, unrelated to any other, which, while it's more effective for depression than anxiety, is sometimes used to treat anxiety by itself or in conjunction with an SSRI.
       Anti-anxiety medications, primarily benzodiazepines, reduce daytime anxiety and excessive excitement and generally quiet or calm people. At low doses they have few side effects other than drowsiness and dizziness; at higher doses they produce significant drowsiness and facilitate sleep. (WARNING; It is especially important to limit or better yet avoid alcohol while taking any benzodiazepine.) Because they are potentially addictive, benzodiazepines are typically prescribed for only short periods of time, especially for people with histories of alcohol and/or drug abuse. An exception to this is people with Panic Disorder, who can generally take benzodiazepines for up to a year without risk of harm. Some people experience withdrawal or discontinuation symptoms if they stop taking benzodiazepines abruptly instead of tapering off of them gradually. Some also experience rebound anxiety, a resurgence of anxiety stronger than they felt before starting on the medication. Unfortunately, these problems inhibit some Primary Care Providers from prescribing benzodiazepines in adequate doses or, in some cases, prescribing them at all. Buspar (buspirone), which is not a benzodiazepine, is a unique anti-anxiety medication primarily used to treat Generalized Anxiety Disorder (GAD). Beta blockers such as Inderal (propranolol) are used to treat heart conditions, but can also be used to prevent the physical symptoms of Panic Disorder. If one medication doesn't work, be open to trying another. People who don't improve after taking one medication increase their chances of getting better by switching to a different medication or adding a second medication.

       Psychotherapy involves talking with a trained mental health professional, such as a Counselor, Psychiatrist, Psychologist, or Social Worker, to explore what is causing the Social Phobia and how to manage or eliminate the symptoms. Some types of psychotherapy are short-term (10 to 20 weeks) and others are long-term (more than 20 weeks). Which might be suitable for you can be determined between you and the mental health professional whom you see. There are many types of psychotherapy, all of which can be effective in treating Specific Phobias, but two types, Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), have well-established histories of being effective. CBT helps people change negative and self-critical styles of thinking and behaving that contribute to or worsen anxiety, replacing them with more positive, functional, and adaptive ways. For example, CBT can help people experiencing Panic Disorder learn that their Panic Attacks are not really heart attacks and help people experiencing Social Phobia learn how to overcome the false belief that other people are always observing and judging them. CBT often lasts about 12 weeks. IPT helps people understand and work through dysfunctional and/or maladaptive relationships that contribute to or worsen anxiety. It emphasizes the relationships between a person and other people rather than that person’s internal psychological processes. It’s intended to change the person’s symptoms by helping him deal more realistically and effectively with his family, marital, parental, and work situations.

       For those who are mildly or moderately anxious, psychotherapy alone is often the best treatment option. However, for certain people, especially those who are severely anxious, a combination of psychotherapy and medication may be necessary.

How can I help someone who is suffering from Social Phobia?

       If you know someone who has Social Phobia, odds are that his or her anxiety affects you, too. The first and most important thing that you can do to help a friend, family member, or coworker who has Social Phobia is to help him get diagnosed and treated. You might have to schedule an appointment on behalf of the person or even go with him to see a provider. Encourage him to stay in treatment or to seek different treatment if no improvement occurs after six to eight weeks of medication or eight to 12 weeks of psychotherapy. In addition:
  • don’t downplay or trivialize the anxiety;
  • don’t demand improvement if the person isn't in treatment;
  • offer emotional support, understanding, and patience;
  • engage the person in conversation and, most importantly, listen nonjudgmentally;
  • never criticize or belittle feelings the person expresses, but rather point out realities and offer hope;
  • never ignore comments about suicide. Encourage the person to share these thoughts with his provider and/or mental health professional, and report them yourself if you believe the person won't;
  • invite the person to participate in walks, outings, and other activities. Keep trying even if he declines, but don't push him to do too much too soon. Making the person feel as if you have too many expectations of him may inadvertently cause feelings of failure;
  • and remind the person that with time and treatment the anxiety will inevitably improve.
© 2010
Dr. Thomas E. Hranilovich
Licensed Psychologist

Psychiatric Associates / 4084 Okemos Rd. / Suite A / Okemos, MI 48864
Phone: (517) 347-4848 / Fax: (517) 347-4844