Social Anxiety, known clinically as social phobia, is just what it sounds like – a fear of being in social situations, or of being with other people outside one’s closest friends and family. Many people have some anxiety about socializing; nearly everyone worries from time to time what other people think of them, how they will “perform” socially, if they will be liked by others, etc. However, if this kind of anxiety is persistent, if it makes socializing more fear than fun, and prevents you from making real connections with others, therapy might be an appropriate way to learn to relax and feel more confident. Social anxiety may stem from feelings and beliefs gained in childhood, feelings and beliefs that lead you to feel inadequate, incompetent, worthless, timid, disempowered or even ashamed of yourself. Examining your sense of self and your beliefs about yourself can help unravel social anxiety.

Clinical Definition of Social Phobia

Social Phobia or Social Anxiety are diagnosed when there are:

A. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.

B. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.

C. The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.

D. The feared social or performance situations are avoided or else are endured with intense anxiety or distress.

E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

F. In individuals under age 18 years, the duration is at least 6 months.

G. The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., Panic Disorder With or Without Agoraphobia, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).

H. If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e.g., the fear is not of Stuttering, trembling in Parkinson's dsease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa.

Specify if: Generalized: if the fears include most social situations (also consider the additional diagnosis of Avoidant Personality Disorder)

Therapy for Fear of Being in Public - Case Example

Zack, 29, seeks help for his fear of going out in public, and of enclosed spaces. He already takes a medication for anxiety but “it’s not helping.” The therapist works with Zack to uncover the beginnings of this fear, and soon Zack is able to discover great anger at his parents and great fear of his own inadequacy. Working on these emotions, while gradually exposing Zack to open and closed spaces (with help from his closest friend, who accompanies him), therapy reduces Zack anxiety and frees him to function.

Treating Feelings of Rage in Crowds - Case Example

Kay, 54, has a long history of experiencing severe anxiety and feelings of rage when in crowds. The feelings subsided for a few years as she focused on her career, but now stress at work and some anxiety about her age have triggered an increase in panic attacks, and she finds herself literally running home after work and locking herself in her apartment all night, where she reads in bed for hours and talks to no one. Compounding her anxiety is a sense of shame about her feelings and actions; she has always considered herself a strong person and is embarrassed that she is afraid of crowds and public spaces. Although intelligent, she has little insight into her behaviors, knowing only that being home she feels calm and being in public she panics. Her previous therapist recommended she take a disability leave, but after a week at home her anxiety gave away to depression and it was even harder to go out than it had been when she was working. In treatment again, her therapist insists she spend an hour outside every night, even if she has a panic attack. He recommends against medications, firmly and repeatedly points out the irrational nature of Kay’s fear, and praises her profusely every time she makes an appointment, as doing so requires her to walk several blocks in a crowded part of town. Kay begins to unravel her attitude towards other people: She deeply fears their judgement, and resents and judges them as a defense against shame. She recognizes that working on her self-image, rather than avoiding frightening situations, si what can help her regain confidence and function normally.

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Last updated: 05-14-2013