Do You Have Social Phobia?

Most teens get a little nervous in social situations, like public speaking or working in groups. Teens with social phobia are highly anxious in situations like these. Their anxiety may make them avoid everyday social activities and can make social interactions very uncomfortable.

If you have these feelings of social phobia, it's important to know that there are treatments that can help you cope with social situations and enjoy your life again.

What Is Social Phobia?

Social phobia is an irrational, intense, and persistent fear of a specific object, activity, or social situation, which people avoid or endure with extreme distress and anxiety.

In some teens, the fear is limited to one or two particular situations, like speaking in public or initiating a conversation. Other teens are very anxious and afraid of any social situation.

Social phobia affects about 5.3 million people in the United States. The average age of onset of social phobia is between age 11 and 19 -- the teenage years.

What Are the Symptoms of Social Phobia?

The symptoms of social phobia include:

  • Feeling very self-conscious in social situations, with symptoms like extreme shyness, stomachache, fast heart rate, dizziness, and crying
  • Having a persistent, intense, and chronic fear of being watched and judged by others
  • Feeling shy and uncomfortable when being watched (giving a presentation, talking in a group, performing at a piano or dance recital)
  • Feeling hesitant to talk to classmates or teammates (avoiding eye contact, sitting alone at lunch, being reluctant to speak during group projects)
  • Having physical sensations of anxiety (blushing, heart palpitations, nausea, and sweating, feelings of embarrassment or humiliation)

What Can I Do About Social Phobia?

If your social phobia keeps you from doing things you want to do, or from making or keeping friends, you may need treatment.

Talk about your fears and worries with a doctor or therapist who has experience treating social phobia. He or she will be able to tell if you have normal social anxiety or if you need treatment.

How Is Social Phobia Treated?

There are two effective treatments for social phobia: prescription medication and behavioral therapy. Teens may receive both at the same time. Here are some details on each:

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1. Medications. For some teens, taking a prescription medication can be an easy and effective treatment for social phobia. They work by reducing the uncomfortable and often embarrassing symptoms.

In some cases, medication can dramatically reduce social phobia or even eliminate it. Other teens do not react to a particular medication, and aren't helped at all. There is no way to predict if a medication will be helpful or not. Sometimes, you must try several before finding one that works.

The Food and Drug Administration (FDA) has approved four medicines for social phobia: Paxil, Zoloft, Luvox, and Effexor. Although these are the only medications approved specifically for social phobia, other medications may be used successfully as well.

The advantage of medications is that they are easy, and are taken just once a day. But there are some downsides.

First, medication only treats symptoms. If you stop taking it, social phobia symptoms can return. Second, many teens have side effects from anxiety medications. They may include headache, stomachache, nausea, and sleep difficulties.

Also, the FDA-approved medicines for social phobia, like all medicines that are also used to treat depression, carry a warning from the FDA . The FDA warns that they may paradoxically cause or worsen suicidal thoughts or behaviors in young people under age 24. Therefore, teens who take these medicines should be monitored closely for changes in thoughts about suicide.

For many teens, the advantages of medications outweigh the disadvantages. This is a choice that must be weighed by you, your doctor, and your parents.

If you take a medication for social phobia, call your doctor immediately if you develop any side effects, including feeling down and depressed. And never stop taking any anxiety medication without talking to your doctor first. Suddenly stopping an anxiety medication may cause serious side effects.

2. Behavioral Therapy. Behavioral therapy with a trained therapist can help you identify and change the fearful thinking that makes you anxious in social situations.

A type of behavioral therapy called exposure therapy is frequently used for social phobia. Exposure therapy works by gradually exposing you to social situations that are uncomfortable and waiting until you feel comfortable. During this process, your brain is learning that a social situation you were afraid of is actually not so bad.

Most therapists who practice exposure therapy begin with small exposures to uncomfortable situations, then move on to more difficult exposures once you feel comfortable. The advantage of this therapy is that you are treating the underlying problem, not just the symptoms of social phobia. So if you stop behavioral therapy, the chance of your social phobia symptoms returning is less likely.

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Other Therapies for Social Phobia

Other therapies have also been tried for treating social phobia. They include:

Relaxation Therapy. With this therapeutic approach, you learn techniques for relaxing like doing breathing exercises and meditation. Although relaxation therapy may help with some specific social phobias, it is not considered effective treatment for general social phobia.

Beta-blockers. These medications are used to treat high blood pressure or other heart problems. Yet beta-blockers are also effective for treating some people with a specific type of social phobia called "performance social anxiety." This is when you are afraid of performing, like giving a public speech. Beta-blockers are not effective for treating general social phobia. But they may help if fear of a specific circumstance, occurring at a specific, predictable time -- like giving a speech to a class -- is your problem.

When Should I Talk to My Doctor About Social Phobia?

First, it's important to know that you are not abnormal if you have social phobia. Many people suffer with social phobia, and it is treatable. If you have unusually high anxiety and fear about social situations, talk openly with your doctor about treatment. If left untreated, social phobia may lead to depression, drug or alcohol problems, school or work problems, and a poor quality of life.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on February 28, 2016

Sources

SOURCES: 

Schneier, F. Archives of General Psychiatry, 1992. 

Barlow, D. "Psychosocial treatments for panic disorders, phobias, and generalized anxiety disorder" in: A Guide to Treatments that Work, Nathan, PE, and Gorman, JM (Eds), Oxford University Press, New York, 1998. 

Anxiety Disorders Association of America: "Social Anxiety Disorders."

National Institute of Mental Health: "A Real Illness: Social Phobia" and "Facts About Social Phobia." 

Facts for Health: "Social Anxiety, Medications (Pharmacotherapy) and Ineffective Treatments." 

Anxiety Disorders Association of America: "Anxiety Medications and Kids." 

Medline: "Anxiety Disorders." 

National Institute of Mental Health: "Social Phobia."

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