Social anxiety disorder (social phobia)

People with social anxiety disorder believe that in social situations they are being looked at, scrutinized and judged by other people. This produces great anxiety in the sufferers of social anxiety disorder. They try and avoid such environments, and if they cannot avoid them they refrain from participating in conversations and, for example, prefer to sit in a corner where they are least likely to draw attention to themselves. Even the thought of being in a social situation makes them anxious. Some people only become anxious in particular situations, like talking, writing, or playing an instrument in front of a crowd. Others experience anxiety in almost all social situations and environments like a restaurant, canteen, seminar room or a friends gathering, where they feel they are being looked at.

Although in social phobia all symptoms of anxiety can occur, reddening of the face and tremors are seen more common. The main thought that occupies the sufferer’s mind is that he may be judged by others. They can be inclined to use alcohol to alleviate their stress. Depression is another psychiatric illness that is frequently seen in sufferers of social phobia.

Social phobia usually starts in adolescence. The first attack can happen in a crowded space, without any apparent cause for the attack. The person progressively experiences more and more anxiety in such situations and as a result starts avoiding many such environments. This brings great limitations to his social life.

– How is the condition diagnosed?

A diagnosis of social phobia should be made by a psychiatrist, as there can be other reasons why the patient is avoiding social situations; for instance normal shyness, avoidant personality disorder, agoraphobia, panic disorder, generalized anxiety disorder, schizophrenia, or body dysmorphic disorder produce the same tendency. It is therefore essential for diagnostic and treatment purposes and with regards to the progression of the illness, that we differentiate between these conditions and social phobia.

– Causes of social phobia

Social phobia has a strong hereditary aspect. We know that social phobia is found more often in the relatives of the sufferer than amongst other individuals in the population. Social situations which resemble the situation in which social phobia was experienced, can trigger sudden attacks of social phobia. This points at the possibility that phobic symptoms developed afterwards may be due to conditioning. Recordings made whilst the patient is experiencing anxiety because he is imagining himself in a social situation, show increased activity in some parts of the brain. However we see that after treatment the activity in these parts of the brain returns to normal levels.

Treatment of social anxiety disorder (social phobia)

Treatment of social phobia involves drug therapy and cognitive and behavioural therapy techniques. The first choice in drug therapy are antidepressants.

What needs to be known about antidepressants

1. Antidepressants should only be used under the supervision of a doctor.

2. It takes 2-4 weeks before the patient experiences the full effect of the medication. They have no immediate calming effect.

3. Your doctor should decide whether the drug is sufficient for the patient’s needs, whether or not to change it, or whether additional medication is required in order to strengthen the effect.

4. After a certain level of improvement is achieved, you should continue with the treatment for at least 6-9 months. You should discuss the decision to stop the medication at the end of the treatment with your doctor and should decide in accordance with his recommendation.

5. Contrary to what is commonly believed, antidepressants do not have a cognitive effect. Your ability to think and decide is not affected during use of antidepressants.

6. Antidepressants do not cause drug dependency.

7. Side effects associated with antidepressants are usually mild and short-term. The usually occur during the first week of drug use. The patient may experience nausea, vomiting, headaches or a feeling of confusion. Longer term side effects may be a lack of sexual drive, difficulties in erection and ejaculation. Weight gain is only associated with a certain group of this medication and does not reach extreme levels. Do not refrain from sharing such side effects with your doctor, he will welcome it. If any unexpected side effects occur during treatment you must contact your doctor immediately.


The cognitive pattern in social phobia, which is the focus of cognitive treatment, is the patient’s tendency to believe that he is being criticized by others for no reason. Relaxation exercises and behavioural techniques like confrontation are beneficial when used together.