BHC home - health and medical information for consumers

Health and medical information for consumers, quality assured by the Victorian government (Australia).

8 November, 2009

Home > Fact sheets by category > Diseases and conditions > Stress and anxiety > Types > Social phobia.

Health information

Resources and tools

Healthy eating

Find help

Social phobia

Social phobia is a type of anxiety disorder. People who have social phobia experience extreme and persistent anxiety associated with social or performance situations. A person with social phobia experiences anxiety in situations where they are likely to be scrutinised and observed by others. They may have persistent fears about being judged, criticised, ridiculed or humiliated.

Most people feel shy or nervous in certain social situations. Public speaking or entering a roomful of strangers can cause anxiety in many people. However this kind of common apprehension doesn’t indicate a social phobia. It becomes a social phobia when it:

Causes the person to avoid the feared situation.
Means the person endures the situation with intense distress.
Interferes significantly with their daily life including work, education, family and social life.

It is estimated that around three per cent of the Australian population experience social phobia in any one year - up to 13 per cent of the population may develop social phobia during their lifetime. Men and women are equally affected, though a higher number of men seek treatment. In many cases, social phobia begins with shyness in childhood and progresses during adolescence. The onset of social phobia generally occurs around ages 11-15. Social phobia is also known as social anxiety disorder.

Symptoms of social phobia
When exposed to a feared social situation, a person with social phobia may experience symptoms of extreme anxiety, including:

Blushing.
Trembling.
Feeling as if you have nothing to say.
Accelerated heart rate.
Shallow, fast breathing.
Sweaty palms.
Nausea.
Tense muscles.
Dry throat.
Stomach pain.
Feeling faint or lightheaded.
Feelings of self-doubt and uncertainty.
Negative thoughts such as ‘I’m making a fool of myself’.
Difficulty concentrating on anything other than physical sensations of anxiety, negative feedback from others and negative thoughts.
An overwhelming urge to flee the situation.
The realisation that these feelings are irrational and out of proportion.

A range of feared social situations
Some people with social phobia fear and avoid specific situations (such as performance anxiety), while others may feel generalised anxiety about several social situations (generalised social phobia). A person with social phobia can fear (and try to avoid) a range of situations, including:

Crowds and parties.
Public speaking.
Starting or having a conversation.
Talking to a large group.
Voicing opinions.
Meeting someone new, shaking hands.
Dating.
Using public toilets.
Shopping.
Talking with someone who is in a position of seniority or authority.
Being watched while doing something, such as eating, signing papers or talking on the telephone.
Situations that put them in the spotlight, such as parties to celebrate their own birthday.

Underlying fears
Some of the fears commonly aroused by social situations can include:

Worry that others will notice their physical symptoms of anxiety, such as blushing, sweating and stammering.
Fear of looking stupid, silly or ridiculous.
Fear of appearing quiet, boring and uninteresting to others.
Fear of being judged as socially inadequate.

Before and after the social event can be stressful
A person with social phobia can feel anxious while simply anticipating an upcoming social event. After the event, the person may replay the conversations they had and rate their performance. Brooding on these feelings of social failure can make the person feel even worse, and reinforce the desire to avoid social situations in the future.

Common complications
If left untreated, social phobia can severely affect quality of life. Some of the common complications may include:

Using alcohol to cope with anxiety during social events
Alcohol abuse
Misuse of prescription and non-prescription drugs
Difficulty forming and maintaining relationships
Curtailed education or employment opportunities
Depression
Suicidal thoughts
Isolation from family, peers and community.

Treatment options
Recovery from social phobia is possible with appropriate treatment. Depending on the individual, treatment options may include:

Cognitive behaviour therapy (CBT)
Anxiety management techniques
Social skills training
Medication.

Cognitive behaviour therapy (CBT)
This treatment aims to help people change the way they think, feel and behave in social situations. These techniques may help people to confront their fears. In time, people come to realise that others are unlikely to judge them harshly - and even if it does happen, they realise it’s not a major tragedy. They will also learn that they can exert some control and choice over their thoughts and feelings. Treatment using CBT may include:

Education about the nature of social anxiety
Challenging and changing false or distorted thoughts and beliefs
Gradual exposure to feared situations
Attention training.

Anxiety management techniques
Relaxation training and breathing techniques may help a person manage their anxiety symptoms. Some physical anxiety symptoms may be triggered by hyperventilation (overbreathing). Taking slow, deep breaths from the abdomen - rather than fast, shallow breaths from the chest - can reduce anxious feelings. Relaxation techniques include:

Progressive muscle relaxation
Meditation
Visualisation
Isometric relaxation exercises.

Social skills training
Some people who have suffered with social phobia for many years may develop habits that make it difficult for them to take steps towards recovery. For example, they may:

Find it difficult to make or maintain eye contact
Use soft or hesitant speech
Display closed body language
Have rigid facial expressions
Need a large personal space
Have difficulty listening or keeping a conversation going.

Social skills training methods include modelling the appropriate behaviour, role-playing and then practising in real life situations.

Medication
Some medications, such as selective serotonin re-uptake inhibitors (SSRIs), can help if the person is also suffering from depression. In the short term, drugs such as beta-blockers may be used to help manage some of the symptoms of anxiety.

Where to get help

Your doctor
Psychologist
Your local community health centre
Anxiety Recovery Centre Victoria Helpline Tel. (03) 9886 9377
Australian Psychological Referral Service Tel. (03) 8662 3300 or 1800 333 497

Things to remember

Social phobia is a type of anxiety disorder. People who have social phobia experience extreme and persistent anxiety associated with social or performance situations.
Some people with social phobia fear and avoid specific situations, while others may feel anxiety about several social situations.
Treatment options include cognitive behaviour therapy, anxiety management techniques, social skills training and medication.

You might also be interested in:
Agoraphobia.
Anxiety disorders.
Blushing explained.

Want to know more?
Go to More information for support groups, related links and references.

This page has been produced in consultation with and approved by:

(Logo links to further information)