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

• Disability

  (Sheehan Disability Scale) and quality of life (short form-36). [ncbi.nlm.nih.gov]

  Despite its early onset, chronic course, disability and co-morbidity there is virtually no information about this disorder in young people in sub-Saharan Africa. [doi.org]

• Falling

  In both types of social phobia, people's anxiety comes from the belief that if their performance falls short of expectations, they will feel embarrassed and humiliated. [healthyplace.com]

  All aspects of your life, not just the social, could start to fall apart. Social anxiety disorder (also known as social phobia) is one of the most common mental disorders, so if you have it, there’s hope. [webmd.com]

  "The causes of the disorder are thought to fall into either the biological or environmental camps," said Cheryl Carmin, a psychiatrist and director of the clinical psychology training program at the Ohio State University Wexner Medical Center. [livescience.com]

  By this point, the child may be experiencing extreme isolation and falling behind developmentally and academically. Sometimes social phobia goes undiagnosed because parents confuse it with shyness. [careforyourmind.org]

• Crying

  Usually, social anxiety disorder is first noticed when Children throw tantrums, cry, cling, freeze up, or withdraw or refuse to speak in social situations. [msdmanuals.com]

  Social Phobia Interferes with normal daily routine Interferes with occupational or academic functioning Interferes with social activities or relationships Special criteria modifications in children Anxiety related to peer setting Anxiety expressed by crying [fpnotebook.com]

• Weakness

  They worry that they will appear inarticulate or stupid, or show embarrassing signs that they are anxious or weak. It is this feared disapproval from others that causes their distress. [anxieties.com]

  In these feared performance and social situations, individuals with social anxiety experience concerns about embarrassment and are afraid that others will judge them to be anxious, weak, “crazy,” or stupid. [psychcentral.com]

  As soon as you find the right surrounding and occupation that will use your strengths rather than challenging your weaknesses, you will reach the inner harmony. [themindunleashed.org]

  They especially fear the embarrassment of being deemed nervous, weak or stupid. [sciencedaily.com]

• Shivering

  When patients have been on medications for some time and want to reduce them, the bodily feelings associated with social phobia, like shivering, flushing and dizziness in social situations tend to return. [sciencedaily.com]

• Nausea

  Symptoms include excessive blushing, sweating, trembling, rapid heartbeat, muscle tension, nausea, and extreme anxiety. Social phobia can occur in very young children or emerge at a later age. [medicinenet.com]

  […] people with this disorder include: Attending parties and other social occasions Eating, drinking, and writing in public Meeting new people Speaking in public Using public restrooms Physical symptoms that often occur include: Blushing Difficulty talking Nausea [nlm.nih.gov]

  Many people with social anxiety disorder also experience strong physical symptoms, such as a rapid heart rate, nausea, and sweating, and may experience full-blown attacks when confronting a feared situation. [adaa.org]

• Vomiting

  A case of psychogenic vomiting in the context of social phobia was treated by a combination of exposure in vivo, social skills training, and cognitive modification. [ncbi.nlm.nih.gov]

  Fear of vomiting (emetophobia) is often (though not always) connected with social situations. Fear of vomiting can vary greatly. [anxietycare.org.uk]

  Often, the concern is that their anxiety will be apparent through sweating, blushing, vomiting, or trembling (sometimes as a quavering voice) or that the ability to keep a train of thought or find words to express themselves will be lost. [merckmanuals.com]

  Children are terrified that they will humiliate themselves in front of their peers by giving the wrong answer, saying something inappropriate, becoming embarrassed, or even vomiting. [msdmanuals.com]

• Palpitations

  The sensation of having a 'thumping heart' (palpitations). Shaking (tremor). Sweating. Feeling sick (nausea). Chest pain. Headaches. Stomach pains. A 'knot in the stomach'. Fast breathing. Blushing easily. [patient.info]

  Individuals with social phobia almost always experience symptoms of anxiety — such as heart palpitations, dry mouth, tremors, sweating, gastrointestinal discomfort, diarrhea, muscle tension or trembling, a shaky voice, blushing, and even confusion. [psychcentral.com]

  Heart palpitations, trembling and shortness of breath: those who suffer from social phobia avoid larger groups. Verbal tests or everyday arrangements are filled with fear – after all, other people could make a negative judgement. [uni-bonn.de]

  When the social phobia sufferer is faced with one of their feared situations they may experience physical symptoms of anxiety such as: blushing sweating dizziness heart palpitations tense muscles dry mouth trembling nausea Some sufferers do not experience [socialanxietyassist.com.au]

• Tachycardia

  Specifically, the SAD sufferer may experience trembling, sweating, dizziness, tachycardia, depersonalization (psychological state in which an individual feels that they or the outside world is unreal), numbness in the extremities, and other signs of sympathetic [britannica.com]

  Beta-blockers such as atenolol and propanolol have commonly been employed in performance anxiety, decreasing autonomic symptoms (eg, tachycardia, sweating and dry mouth). However, they are not effective in the generalized form of social phobia. [ncbi.nlm.nih.gov]

  Norepinephrine in Social Phobia Since autonomic hyperarousal (manifested by flushing, tachycardia, and tremulousness) is a common symptom of patients with panic anxiety and social anxiety in performance situations, understanding autonomic nervous system [doi.org]

  […] under study in our lab and others. 87,88 Patients with nongeneralized SAD often do well with PRN β-blocker administration used acutely before a speech or performance. 18 However, β-blockers seem more helpful for symptoms such as tremor, palpitations, tachycardia [primarypsychiatry.com]

• Sweating

  Beta-blockers may be used to reduce the increased heart rate, trembling, and sweating experienced by patients who are distressed by performing in public, but these drugs do not reduce anxiety itself. Click here for Patient Education [merckmanuals.com]

  An individual with agenesis of the corpus callosum associated with recurrent severe sweating and hypothermia developed a social phobia. Phobias may be adaptations to real and potentially dangerous physiological events. [ncbi.nlm.nih.gov]

  This is why someone concerned with sweating will think "Please, God, let me get through this party without sweating!", and pack some napkins in his pocket so he can dry his hands without observation. [anxietycoach.com]

• Flushing

  They may present to the doctor complaining of flushing, tremor, nausea, or urgency of micturition. They may be convinced that these physical manifestations of anxiety are the primary problem. It may progress to panic attacks. [patient.info]

  Obsessive Compulsive Disorder in the following ways: First, both involve unwanted fears/ thoughts; secondly, both involve physiological symptoms: heart pounding, heart racing, shortness of breath, lump in throat shakiness, feeling of unreality chills, flushing [beyondocd.org]

  When patients have been on medications for some time and want to reduce them, the bodily feelings associated with social phobia, like shivering, flushing and dizziness in social situations tend to return. [sciencedaily.com]

  She sweats and her face flushes and her hands shake uncontrollably. Susan is so afraid of humiliating herself, it's hard to speak. It's like the anxiety is physically strangling her - words can't come out. [hypnosisdownloads.com]

• Hyperhidrosis

  Botulinum toxin A may be an effective augmentation treatment option for severe axillary hyperhidrosis in patients with SAD. Studies show that patients with SAD who are maintained on paroxetine, sertraline, or clonazepam have a low relapse rate. [ncbi.nlm.nih.gov]

  While there are numerous manifestations of social anxiety, including performance anxiety, fear of public speaking, selective mutism, erythrophobia (fear of blushing), hyperhidrosis, fear of being noticeably nervous, school phobia, dependent personality [social-anxiety.com]

  This began as a treatment for excessive sweating (Hyperhidrosis) and surgeons then found that blushing was reduced too after this intervention. [anxietycare.org.uk]

• Erythema

  Reacting with panic-like symptoms when exposed to social situations is frequently accompanied by increases in warmth around the cheeks, resulting in blushing ( see also erythema ). [britannica.com]

• Anxiety Disorder

  TREATMENT OF SOCIAL ANXIETY DISORDER As with most anxiety disorders, social anxiety disorder responds well to pharmacologic treatment and psychotherapy. [pubs.niaaa.nih.gov]

  Antony, Anxiety Disorders: Social Anxiety Disorder and Specific Phobia, Psychiatry, (1019-1056), (2015). [doi.org]

  BACKGROUND: People with anxiety disorders represent a significant part of a general practitioner's patient population. [ncbi.nlm.nih.gov]

  Epidemiology Social anxiety disorder is one of the most common anxiety disorders. It has been estimated that 12% of adults in the USA will have social anxiety disorder at some point in their lives. [patient.info]

• Fear

  Phobias are a type of anxiety disorder in which certain situations or objects make people fearful and anxious and cause them to avoid those things. The fear and anxiety are out of proportion to the actual threat (taking social norms into account). [merckmanuals.com]

  Furthermore, a latent class analysis of NCS data [21] revealed two primary classes of persons with social phobia: those with exclusive speaking fears and those with one or more other social-evaluative fears. [ncbi.nlm.nih.gov]

  In adults, the social phobia is recognized as excessive or unreasonable Anxiety or fear associated with actual or anticipated oral communication with others Extreme apprehension or fear of social interaction or social situations in general. [icd9data.com]

  Gradual exposure to feared situations Gradual challenges into feared social situations VII. [fpnotebook.com]

• Low Self-Esteem

  Scale were applied to assess social phobia, depression, suicidality, and low self-esteem, respectively. [ncbi.nlm.nih.gov]

  It can also lead to: Low self-esteem Negative thoughts Depression Sensitivity to criticism Poor social skills that don’t improve [webmd.com]

  self-esteem and self-critical thoughts) Female voice, with music. 36 mins 30s 2.50 CONFIDENT & COMPETENT mp3 (for low self-esteem and self-critical thoughts) Male voice, with music. 39 mins 2.50 Other Anxiety Self Help Resources Social Anxiety Self Help [getselfhelp.co.uk]

• Dizziness

  Specifically, the SAD sufferer may experience trembling, sweating, dizziness, tachycardia, depersonalization (psychological state in which an individual feels that they or the outside world is unreal), numbness in the extremities, and other signs of sympathetic [britannica.com]

  Signs of social anxiety disorder include: feeling anxious in social situations (physical symptoms include racing heart, sweating, queasy stomach, dizziness, shortness of breath) feeling pressure to do things ‘right’ in social situations feeling self-conscious [au.reachout.com]

  Again, the experience may be different for everyone, but if you have social anxiety and you’re in a stressful situation, you might have physical symptoms like: Rapid heartbeat Muscle tension Dizziness and lightheadedness Stomach trouble and diarrhea Inability [webmd.com]

  If unavoidable, they may become overwhelmed with intense anxiety that can lead to physiological reactions, such as racing heart, hyperventilation, sweating, nausea, dizziness, headache, stomachache, etc., and result in a panic attack. [psychalive.org]

• Tantrums

  Usually, social anxiety disorder is first noticed when Children throw tantrums, cry, cling, freeze up, or withdraw or refuse to speak in social situations. [msdmanuals.com]

  Phobia Interferes with normal daily routine Interferes with occupational or academic functioning Interferes with social activities or relationships Special criteria modifications in children Anxiety related to peer setting Anxiety expressed by crying, tantrums [fpnotebook.com]

• Tremor

  BACKGROUND: Essential tremor (ET) and Parkinson's disease (PD) are the two most common movement disorders, and tremor is the most visible symptom. [ncbi.nlm.nih.gov]

  Individuals with social phobia almost always experience symptoms of anxiety — such as heart palpitations, dry mouth, tremors, sweating, gastrointestinal discomfort, diarrhea, muscle tension or trembling, a shaky voice, blushing, and even confusion. [psychcentral.com]

  Shaking (tremor). Sweating. Feeling sick (nausea). Chest pain. Headaches. Stomach pains. A 'knot in the stomach'. Fast breathing. Blushing easily. You may have an intense desire to get away from the situation. You may even have a panic attack. [patient.info]

• Agitation

  Full advice about benefits and risks of medication should be discussed with patients and in particular the risk of early activation symptoms (increased anxiety, agitation, jitteriness) and the development of the anxiolytic effect over two or more weeks [patient.info]

  […] note that venlafaxine ER treatment was not associated with a significantly greater incidence of agitation or nervousness compared with paroxetine or placebo treatment in this study. [doi.org]

• Tremulousness

  Norepinephrine in Social Phobia Since autonomic hyperarousal (manifested by flushing, tachycardia, and tremulousness) is a common symptom of patients with panic anxiety and social anxiety in performance situations, understanding autonomic nervous system [doi.org]

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.