DEAR DOCTOR K:
I’ve always thought of myself as shy. But my partner thinks I may have social phobia. Could he be right?
“Social phobia” goes well beyond shyness. People with social phobia feel a constant and powerful discomfort, self-consciousness and fear of humiliation in ordinary social situations. They feel as though all eyes are turned on them. Social phobia often leads people to avoid parties and other gatherings.
Most people don’t think twice about mingling with new acquaintances. But people with social phobia may have a bunch of disturbing symptoms. They may blush, sweat, tremble, feel nauseated and have difficulty talking. Being part of a social gathering may trigger a panic attack. During panic attacks, people have shortness of breath, sweating, rapid heartbeat, chest pain or a smothering sensation.
If you think you may have social phobia, answer the following questions. If you answer yes to three or more, you may have social phobia. If so, talk to your doctor about your concerns.
- Do you avoid certain situations because you are afraid you’ll embarrass yourself?
- Do you sometimes panic in unfamiliar social situations?
- Do you avoid social situations whenever possible?
- When you can’t avoid social situations, do they cause significant distress or anxiety?
- Does your distress or fear of social gatherings interfere significantly with your work? Relationships with friends and family? Normal routines?
If you do have social phobia, a doctor will probably recommend medication plus therapy. Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, are usually tried first. They are often prescribed with a benzodiazepine (medications used to treat anxiety).
These medicines usually are combined with cognitive behavioral therapy (CBT). Two forms of CBT are especially beneficial: anxiety management training and cognitive restructuring.
Anxiety management teaches relaxation techniques, such as deep breathing, to help control anxiety. Cognitive restructuring teaches people how to recognize the thought processes that lead to the phobia. It then teaches how to reframe those thoughts and replace them with more productive thinking. Group CBT and social skills training can also help build confidence in social situations.
I once had a patient with an unusual kind of social phobia. A quiet and studious person, by day he was an accountant. That was how he made a living. But he also was musically gifted and had a good voice. Sometimes in the evenings, he would play guitar and sing folk music at local clubs. I once saw him perform, and he was a confident, even charismatic performer.
Immediately after each performance, however, he always dashed out of the club — before people in the audience could find him. That was because he developed severe anxiety symptoms when mingling with other people. When he could perform from a stage and didn’t have to mingle with the audience before or after his performance, he was fine — so long as they liked his performance. And they always did.