Social phobia can be limited to situational events like standing in front of an audience or writing on a blackboard in front of an observing class. Social phobias can also be extended and broad where there is undue distress felt when interacting with people other than the immediate family.

These following physical presentation of symptoms are commonly seen in cases of social phobia:

• Trembling
• Stammering during speech
• Diaphoresis (excessive sweating)
• Blushing
• Nausea
• Near syncope
• Difficulty in initiating speech

There is no laboratory procedure designed to diagnose social phobia. Physicians or mental health provider will conduct a personal interview of the patient, his family and friends to get a general perspective and arrive into an accurate diagnosis.

A preformed questionnaire reflecting the different possible public situation that may trigger the attack, can be used during the interview.

The Diagnostic and Statistical Manual (DSM) is a manual published by the American Psychiatric Association (APA) used by primary care physicians and mental health providers to diagnose anxiety disorders like social phobia.

The following criteria must be met by the patient for one to be diagnosed with social phobia with definitive confidence:

• Persistent fear of social situations (where you feel that you’re being judged)
• Social situation causes an anxiety attack
• Ability to identify that the anxiety attack is severe
• Conscious avoidance of potential social situation that can cause the anxiety
• Level of anxiety or distress interferes with daily activities

There are two common modalities in the treatment of social phobia: Psychotherapy and medications.

Psychotherapy 

Psychotherapy is a major factor in the treatment of anxiety disorders like social phobia. The therapy will focus on reducing the negative image of the patient towards oneself. Cognitive behavioral therapy is also another form of psychotherapy that help patient to gradually face the situations that they fear the most [7]. This is sometimes referred to as exposure therapy where a battery of social related activities may be performed to overcome social phobia indefinitely.

Medication

The most common medications given to persistent cases of social phobia are the selective serotonin reuptake inhibitors (SSRI) like sertraline, paroxetine, fluoxetine and fluvoxamine [8]. Serotonin and norepinephrine reuptake inhibitors (SNRI) like venlafaxine may also afford a good option for social phobia cases [9]. Other cases of social phobia may benefit from antidepressants, antianxiety medications and beta-blockers [10].

The outlook for patients with social phobia is relatively good. The early diagnosis and treatment of this social disorder improves prognosis of the condition. Mortality does not happen with social phobia per se; but uncontrolled cases with suicidal ideations and depression may sometimes consummate their untimely deaths.

Complications

The following outcomes may be a direct or an indirect complication of social phobia:

• Chronic alcohol use
• Severe anxiety attacks
• Drug dependency and substance abuse
• Loneliness
• Antisocial behavior
• Depression
• Suicide

Patients with social phobia fear and avoid situation that they might be judged by others. The premorbid situation may emanate from adolescence due to limited social interaction opportunities or over-protective guardians. Unresolved issues of rejection during childhood like bullying, teasing and ridicule can predispose the child to develop social phobia. Social anxiety disorders can result from a past history of persistent family conflict and sexual abuse.

There is a strong correlation between social phobia and previous family history of social anxiety disorder. Predisposition to social phobia is equal in both sexes. People with social phobia are prone to alcoholism and undue drug usage for these are the things that make them calm during the distressing situations.

Studies have proposed the role of the neurotransmitter serotonin in the propagation of the exaggerated mood and emotional response in these patients. Theories postulate that an overactive amygdala of the brain can translate to disproportionate fear experienced by the patient.

In the United States, social phobia exists in 12.1% of adults and 9% of adolescents according to the National Comorbidity Survey Replication study [3]. There is a notably high comorbid correlation between adolescents with social phobia disorders and oppositional defiant disorder.

The worldwide incidence of social phobia is 7%-12% of the population [4]. Social phobia is generally underdiagnosed in patients with depression and suicidal ideations.

At present, the exact pathophysiology of social phobia is still evolving. Researches in cognitive behavior has postulated the following theories governing the origins of social phobia or social anxiety disorders:

Clark and Wells Cognitive model of social phobia: This cognitive model focuses on the negative observer-perspective of oneself and safety seeking behavior; thus, self-consciousness becomes overrated and over-emphasized [5].

Neurotransmitter theories: Leading researches point to serotonin as an influential factor in social phobia because symptoms are abated during the intake serotonergic reuptake inhibitors. Some researches proposes an adrenergic etiology because patients responds to propranolol. Amygdala hyperactivity has also been studied to cause the aversive social stimuli in patients [6].

There is no absolute and definitive way to prevent the occurrence of an anxiety disorder like social phobia. However, constructive steps can be taken to reduce its blow on self during the attack.

One should promptly consider professional help once diagnosed with social phobia to increase the chance of cure. Logging in one’s daily activities and journaling all anxiety occasions can greatly help your mental health provider in developing an effective action plan for you. Avoidance of alcohol and substance abuse will prevent dreadful complications in the future.

Social phobia is a chronic mental health disorder characterized by the irrational anxiety, undue fear, self-consciousness and perennial embarrassment towards everyday interactions. It is sometimes referred to as social anxiety disorder in some researches. Social phobia is one of the most common mental health disorder in the United States affecting at least 10 million Americans at present [1].

Social phobia has been known to elicit intense distress likened to a panic attack in response to public situations [2]. Public situations that cause the phobia include: speaking in public, engaging with social contacts and eating with other people.

Generally, patients with social anxiety disorders are subjected to psychological counseling and long term medications to improve their confidence and improve their inherent ability to interact with others.

Patients diagnosed with social phobia must embrace the idea that their own thoughts (not others’) determine the way we react or behave in public. They must also realize that not all public situations are within one’s control but our reaction to the situation is definitely within our control.

Psychotherapy and medical therapy takes months to years to make significant changes in the patient’s lives, absolute patience must be observed and a positive outlook should always be maintained.