Social phobia

Social phobia

Phobias are often encountered in the psychiatric clinic, being among the most common anxiety disorders. They begin in childhood, adolescence and disappear or not in adulthood. They can persist chronically in an individual and are not always pathologically significant.

Social phobia is the irrational fear of public situations - of speaking in public, of eating in public, of using public toilets, etc. The fear is intense and the patient fears that he is being examined critically, negatively by others, that he will be humiliated, that he is behaving inappropriately in social situations. It is more common in females and begins between 13 and 24 years.


  • Marked and persistent fear of one or more social or performance situations, in which the person is exposed to unknown individuals or possible constant attention from others.
  • The patient is afraid that he will behave in ways that will be humiliating or shameful.
  • Exposure to the social situation produces anxiety that can take the form of a panic attack.
  • The patient recognizes that the fear is excessive or inconsistent with reality.
  • Social situations are avoided or endured with anxiety or intense suffering.
  • Avoidance, anxiety anticipation or suffering significantly interferes with normal activity, occupational functioning or social relationships.


  • The genetic component is supported by some studies: the risk for social phobia is about 10 times higher among first-degree relatives than in control groups. Family members may also have common experiences and behaviors that can be accentuated or contaminated in a phobic sense.
  • Personality factors - low sociability can be a predisposition to social phobia.
  • Neurobiological factors - changes in brain perfusion have been found in certain areas of the brain in patients with social phobia while speaking in public. Selective hypersensitivity to the serotonin system is involved in the occurrence of social phobia.
  • Conditioning hypothesis - is based on contagious emotions that can facilitate the learning of the anxious response to certain situations.


The treatment aims to reduce phobic fears and avoidance behaviors. SSRI antidepressants - paroxetine, fluvoxamine, sertraline, fluoxetine - are the first choice in this condition.

Clonazepam, alprazolam or buspirone anxiolytics decrease the intensity of anxiety. Cognitive-behavioral psychotherapy can give fast and very good results. Relaxation techniques, exposure to phobic situations and cognitive restructuring are used.

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