SOCIAL PHOBIA - A DEBILITATING FEAR OF SCRUTINY  
   
A young professional is having sleepless nights for several days. Two weeks ago she committed herself to do a presentation in front of an important audience. Whilst she knows that this is a good chance for her to achieve some recognition, she is now starting to regret the moment she agreed to do the presentation. She is constantly preoccupied with the thought that she might mess up the presentation and that her boss and colleagues would think that she is incompetent. As a result she is unable to concentrate at work and is struggling with her preparation for the presentation........... This lady has been suffering from social phobia since her childhood. Her life has been a story of missed opportunities as she often avoided situations where she could be observed or scrutinised by other people. This is a familiar story in the lives of many people although most of them do not realise that their underlying problem is social phobia. 

Social phobia often starts in adolescence and is centred on a fear of scrutiny by other people in comparatively small groups, usually leading to avoidance of social situations. It occurs with almost equal frequency in men & women and is estimated to be prevalent in the general population at around 7-9%. The first episode commonly occurs in some public place, usually without any apparent reason and then it may be generalised to any similar social situations. 

The phobia may be about discrete situations such as eating in public places, public speaking, encounters with opposite sex etc., or may be generalised in almost all social situations outside the family circle. People with social phobias usually have a low self esteem and a fear of criticism. These individuals often have complaints of blushing, hand tremor, heaviness of breath, slurred speech, nausea, urgency for urination and they are often convinced that one of these symptoms is the primary problem. Anticipatory anxiety may also be felt prior to entering situations such as restaurants, canteens, dinner parties, seminars, board meetings or other places where they are likely to feel they may be observed. Sometimes the anxiety symptoms may progress to panic attacks with symptoms such as palpitation, chest pain, breathlessness, choking sensation, dizziness, sweating, shaking, feelings of unreality, fear of losing control etc. Socially phobic individuals tend to avoid the feared social situations or may not engage fully in those situations. For example, they may avoid making conversations or they sit in a place where they are least conspicuous. These practices almost invariably worsen their problem, resulting in them leading a very restricted life. In extreme cases a socially phobic individual could become almost completely isolated from the society. 

There is often an interaction between a strong genetic influence (i.e. occurrence of social phobia amongst close relatives) and nonspecific environmental factors (e.g. adverse and overcritical family and immediate social environments in early childhood) in the occurrence of this condition. Individuals with social phobia tend to have a core belief that other people are critical and that they are particularly vulnerable to be seen critically by others. Although it is not fully established with certainty whether this belief precedes the development of the phobia or occurs with it, it invariably leads to worsening and prolongation of the phobic anxiety. The psychological treatment of social phobia stems around this core belief and correction of it by various psychological methods. The most effective psychological treatment for this condition is cognitive behavioural therapy which addresses the underlying distorted cognitions and corrects the dysfunctional behavioural patterns. Medications such as SSRI’s are very effective in treating social phobia and they often help in significantly improving the anxiety states and enhancing the individual’ s quality of life. Various other techniques such as social skills training and relaxation training can also be helpful. Thus, it is important to know that the excessive fear of being judged by other people could be part of social phobia and that, whilst it is a common and debilitating problem, there are very effective treatment strategies which help the individual to lead a normally functional life.
 
   
 
   
 
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