Social Phobia: Causes, Types, Symptoms, And Treatment

Social Phobia: Causes, Types, Symptoms, And Treatment

Feeling shy, uncomfortable, and anxious about situations that demand social interactions is how most people would describe social phobia or social anxiety disorder (SAD). What’s often dismissed as shyness and timidity by most people might actually be a symptom of social phobia.

Signs of SAD usually start surfacing by age 11 in about 50 percent and age 20 in about 80 percent of the patients in general. This early onset disorder is a risk factor for subsequent depressive illness and substance abuse.


[pullquote]The fears and worries in SAD patients can be so pronounced that they shun most interpersonal encounters or endure such situations only with intense discomfort.[/pullquote]

People with SAD usually fear and avoid the scrutiny of others. SAD patients fear being judged and therefore feel that they will say or do something that will result in embarrassment or humiliation. They run the risk of being termed as “loners” or “snobs.”1


For these very reasons, social phobia has rightly been called “a disorder of lost opportunities,” one that propels individuals to make major life choices to accommodate their illness. For instance, they may drop out of school due to their fear of speaking in groups. They may not date much, even though they might crave company, and usually take up jobs where they can work in isolation and not interact with anyone.2

Symptoms Of Social Phobia

  1. People with social phobia are generally characterized by low self-esteem and high self-criticism.3
  2. They may go to great lengths to avoid important activities, such as attending classes and meetings. If they do attend, they may avoid active participation.
  3. They have a clear and persistent fear of social or performance situations involving unfamiliar people or exposure to possible scrutiny by others. They fear of acting in a way that will be humiliating or embarrassing.
  4. Sweating, trembling, and blushing in social situations can be a common symptom. Patients are convinced that these physical manifestations of their anxiety will definitely be noticed by others.
  5. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a panic attack. Sometimes, the fear and worry may begin days or even weeks before the event.
  6. The patients are aware that their fears and anxieties are excessive or unreasonable, yet they are powerless to overcome them.
  7. They hate being the center of attention and fear coming across as stupid, boring, and unlikable.4

What Are The Causes?

There could be a number of factors that lead to the development of social phobia.


1. Heredity And Environment

These can be among the chief causes of social anxiety disorder.

  • Toddlers who seem to be shy and with an inhibited temperament have been observed to be at an increased risk of developing SAD by the time they reach their teens. However, thankfully, the disorder does not develop in most shy children.
  • Overprotective and hypercritical parenting has also been associated with the disorder.5

2. Biological Factors

Dysfunction in the brain’s dopaminergic systems may be to blame here.6 Studies have found poor serotonin function while neuroimaging or brain imaging pointed to increased reactivity in the amygdala (section of the brain responsible for detecting fear and preparing for emergency events) to social cues, such as faces, in affected persons.7


Types Of Social Phobias

SADs are largely divided into two categories – specific and generalized.8

  1. Specific social phobias involve fear regarding a particular social situation such as the fear of speaking in front of groups or dining in gatherings.
  2. Generalized SAD is more prevalent, and the patients here are anxious, nervous, and uncomfortable in almost all social situations.

Are There Any Effective Treatments?

1. Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) remains a popular and effective treatment for social phobia. It is directed at changing the patient’s views and perceptions of social situations.


Although the therapy might not give immediate results, the effects are long-lasting. Research by Swiss scientists have shown that structural changes occur in brain areas linked to self-control and emotion regulation after 10 weeks of CBT. A University of Zurich study showed changes in the brain via before and after MRIs of the patients.9

2. Medication

Treatment with medication is another option and offers faster results than CBT. Based on the case, doctors prescribe medications like selective serotonin reuptake inhibitors, antidepressants, and anticonvulsants.


For specific social phobias, the treatment may involve beta-blockers or benzodiazepines. Often, doctors will use a combination of medication and CBT to treat social phobias. This is because discontinuation of medication after 5 to 12 months of treatment has often resulted in a relapse rate of 20 to 60 percent.10

3. Talk Therapy

A 10-year study at the Norwegian University of Science and Technology suggests that “talk therapy” or just cognitive therapy works better than any other alternative or combination treatment for social phobia. In this study, over 100 patients were divided into 4 groups, each receiving either only medication or only cognitive therapy or a combination of the two, and a placebo pill.


The 4 groups were compared along the way, and a follow-up was conducted a year after the treatment. The cognitive therapy group fared the best.11

4. Fermented Foods

Interestingly, in a fascinating study, it was reported that young adults who consumed more fermented foods have fewer social anxiety symptoms. The effect was greatest among those at genetic risk for SAD as measured by neuroticism, a long-term tendency to be in a negative emotional state.

The probiotics in such foods possible change the gut environment positively, which in turn influences social anxiety.12 So is a better diet really the answer to social phobia? We’ll know only with further research in the future.