Social anxiety

Social anxiety or social phobia (English social phobia , social anxiety disorder ; SP, SAD; hereinafter referred to as SF) is a strong fear of probable communication / contact with strangers, or the possibility of getting under attention and condemnation. A person is afraid that he will behave in an inappropriate, shameful, unworthy way. These situations are overcome with great stress. Such people try to impress others, but at the same time they are sure of their failure, they often replay the likely situation, tormenting themselves with obsessive doubts. Such people focus on their failures, both real and imaginary, tend to interpret the behavior of others as potentially unfriendly, judgmental. As a rule, avoidant behavior is formed in the future.

SF begins more often before the age of 20, in the literature the age is indicated – 11 years. Such a teenager begins to stand out for his fearfulness and shyness and often becomes the object of bullying. Remember, there were such people in your school? All this, like a vicious circle, pulls into a knot and intensifies the symptoms of social phobia, and in their eyes their initial fears are ” confirmed”, “fears are beginning to come true.”

SF leads to difficulties in interpersonal communication, in making friends, leads to loneliness and isolation.

The most common fears of social phobia ( D. Nutt et al . 2007):

speaking in public (90%),

enter a room where others are already sitting (63%),

meeting a stranger (47%)

But there are other fears as well:

upcoming phone conversation

go outside the house

public speaking to the public

fear of a party, restaurant, etc.

As we can see, such fears and emerging avoidance leads to a gradual narrowing of social contacts, and their rights. Such a person avoids the struggle for rights; return the goods to the seller; write a claim or file a lawsuit, etc. The social phobia is less likely to find a future spouse. Such people may lose their jobs and in the future they will face failure, loss and loneliness. Sufferers of this ailment often resort to the use of alcohol and even drugs – to correct their anxiety and shyness.

Do you have a social phobia?

I would suggest relying on the following criteria:

Fear, anxiety about a possible meeting with people (strangers or significant people), or even getting in their eyes;

Feelings of insecurity, failure, and personal vulnerability to perceived criticism. Usually, a person is sure that outsiders will definitely notice and begin to release comments and stinging criticism.

Frequent replay of the upcoming situation in the mind and constant imagination of personal failure and failure;

A strong desire to avoid this situation: choose a different route, a different time, abandon your plans, etc.

Vegetative manifestations: chills, coldness in the extremities, dizziness, tearfulness, nausea, redness, sweating, etc.

If you understand and are familiar with these points, then it is possible that you know about this firsthand. The specially designed, highly valid LSAS ( Libovitz Social Anxiety Scale ) will also help you.

Reasons for SF:

There are multiple reasons for SF. There are genetic and twin studies that indicate a 30-50% risk of phobias.

Socio-psychological factors can also be the reasons: a history of fear, situations of ignorance and rejection in the family, persecution by peers. At the same time, there is evidence that such children receive much less support from their peers, and this aggravates their isolation. There are cases when even observing someone else’s traumatic experience associated with humiliation, rejection, etc. can cause problems in the social sphere.

Distribution of SF:

According to Kessler (1994, 1995), SF ranks third in prevalence after depression and alcoholism – 13.3%. Men and women suffer from SF in about the same way. It is very often combined with alcoholism, depression and panic attacks. SF is a rare diagnosis. In all my practice, I made such a diagnosis 1 or 2 times in a hospital, now I come across such a disorder much more often. I believe that social phobia is ignored by patients, their relatives, as well as doctors.

Relatives and friends will most often say:

“You’re just too shy”

“Do not worry…”

“Take it for courage …”

“Don’t be weak …”

Psychologists (psychotherapists):

      all the problems from childhood …

      draw a picture …

      go to the training … etc.

Doctors (psychiatrists) will see in these complaints:

“Absence of disease”

“Weakness of character …”

“Personality traits …”


“Sluggish schizophrenia” and so on.

Social phobia is greatly underestimated. For most ordinary people, it does not exist, and doctors themselves also notice it little. It is worth noting that, after all, social phobia exists as a diagnosis and even has the ICD-10 code “F40.1”. Social phobia is a disease that must be treated. Social phobia is serious enough, according to some reports, 34% of patients with social phobia have suicidal thoughts. Other authors note that the presence of a social phobia increases the suicidal risk by 10 (!) Times.  


High evidence (category A) is available only for the following drugs, which belong to certain types of antidepressants:

SSRIs (Selective Serotonin Reuptake Inhibitors)





SSRIs (Selective Serotonin and Norepinephrine Reuptake Inhibitors)



Cognitive Behavioral Psychotherapy

Other methods of psychotherapy have no proven effect, and some may be not only of little use, but also dangerous, such as: ” rebirthing “, ” holotropic breathing”, personal growth trainings.

Now you know enough about social anxiety. I hope you enjoyed this introductory article and was not overly boring. I would be glad if it would benefit someone.

event_note August 22, 2021

account_box Winona Tse MD

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