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Many families have an aunt, cousin or other relative who never shows up at weddings or other large gatherings. This kind of avoidance behavior may have nothing to do with the individual's like or dislike of family members. It may have everything to do with fear.
Social phobia, the overwhelming and disabling fear of disapproval in social settings, is one of a wide variety of known phobias. A phobia is defined as a persistent, irrational fear of a certain object or situation. Phobic people often feel so overwhelmed by their anxiety that they will do almost anything to avoid the object of their fear.
Symptoms
When avoidance is impossible, a spectrum of symptoms can emerge. For example, when people with social phobia are forced into a social situation or even into a conversation with their boss, they may experience blushing, sweating, trembling, rapid heartbeat, muscle tension, nausea or other stomach discomfort, lightheadedness and other symptoms of anxiety.
According to the National Institute of Mental Health (NIMH), about 4 percent to 5 percent of Americans (at least 7.2 million people) experience a clinically significant phobia. The fear of a specific object (specific phobia) can occur at any age. Phobias of situations, such as social phobia, typically emerge between the ages of 15 and 20, although they can often begin in childhood. Phobic people generally know that their fear is irrational but cannot seem to overcome it on their own.
The focus of a person's fear dictates the extent to which the disorder affects normal functioning. Fear of snakes, for instance, may cause stress only if the phobic person wanders into the reptile exhibit at the zoo or camps out in the desert. Most people with specific phobias experience mild-to-moderate symptoms when they encounter the feared object. When symptoms are severe enough to disrupt normal life, an evaluation by a medical professional is indicated.
Treatments
While most patients with specific phobias tend to recover without medication, anti-anxiety drugs have been found to help some people, particularly those with agoraphobia (the fear of being in a place or situation from which escape might be difficult or embarrassing) and social phobia, to reduce the panic or anxiety symptoms. By taking the edge off the physical symptoms of fear, medication may help a patient confront a phobic situation and ultimately conquer their fear.
According to the NIMH, social phobia can be effectively treated with certain antidepressants, including the monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs), as well as high-potency benzodiazepines. Also, Effexor® (venlafaxine) Paxil® (paroxetine) and Zoloft® (sertraline) have been approved by the Food and Drug Administration (FDA) to treat social phobia.
People with a specific form of social phobia called performance phobia have been helped by beta-blocking drugs such as propranolol.
 Children, teens and adults being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.
Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the FDA. The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.
According to the American Psychiatric Association (APA), exposure therapy, a form of behavior therapy, is the most effective and long-lasting treatment for specific phobias. In therapy, the patient is exposed either quickly or incrementally to the feared object or situation while accompanied by a trained therapist. By confronting the object of fear, the patient gets used to it and eventually loses the terror, horror, panic and dread once felt, according to the APA.
A useful treatment for agoraphobia and social phobia is cognitive behavior therapy. In therapy, patients learn how to correct erroneous and catastrophic thinking patterns.
This article was reviewed and updated June 2007.
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