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Social Anxiety Disorder (Social phobia)

Updated: May 9, 2020


“When I am by myself, I can think of all kinds of clever remarks, quick comebacks to what my imaginary friends say. In my own company, I am witty and socially comfortable. But, all of this vanishes when I face people in the flesh: I lose my intelligence, I can no longer speak, because my voice suddenly ceases and I feel like I am being judged by all the eyes fixed upon me. Only my imaginary friends, only the conversations I have whilst daydreaming, are genuinely real and substantial.”― Fernando Pessoa.

In one situation or the other, we have come across individuals who have stood with us, and found it impossible to say a word, or better still, replied during conversations, and kept on asking if we are not offended by their response. This pattern of behavior emerges from the individual anticipating that you might evaluate them poorly, and this is associated with Social Anxiety Disorder, also known as Social Phobia.


Social Anxiety Disorder is a form of Anxiety Disorder, in which fear exists within the individual about social interactions, and they tend to avoid such situations that might require being evaluated by others. Socially phobic people are often preoccupied with the idea of being criticized by others in social situations, although they are aware that the idea is irrational.

These social settings include interacting with strangers, or a small group of familiar people, in which the individual would be observed carrying out an action e.g. stage performance, eating in a restaurant or speaking in a board meeting. These settings often bring about extreme anxiety within individuals, and in children, could be expressed by crying, clinging, shrinking or going mute in social settings.

The automatic thoughts or cognitive distortion of an individual with social phobia, is that of negative criticism, being embarrassed, belittled, rejected or offending others. Individuals with social phobia, may describe themselves as shy, but there is a difference, in that social phobia has a marked fear of avoidance of being the focus of attention or behaving in an embarrassing way, with significant affectation of performance and functioning with regards to social situations.

HOW COMMON IS SOCIAL ANXIETY DISORDER? The World Health Organization estimates a 15.9% prevalence in developed countries, and 14.3% in developing nations. A local study found that about 38 million Nigerians struggled with the disorder, many of whom remain undiagnosed in their lifetime. SAD is also seen in Children. In pediatrics, studies have quoted the prevalence rate of social anxiety disorder from 3% to 6.8%.


Although a single cause is not known, the commonly implicated factors include:

•Genetics- social anxiety disorder is more likely in individuals that are closely related to adults with social anxiety disorder.

•Early childhood adversity such as abuse, is implicated as a mediator in the onset of SAD.

•Conditioning- A sudden episode of anxiety in a social situation, can lead to the situation becoming a stimulus for the phobia

•Cognitive factors- A cognitive error here is the undue concern that other people will be critical of them in social situations


Social Anxiety Disorder may manifest in most social situations that would involve conversing with people, performing for an audience, public speaking that might require evaluation, hence resulting in various symptoms.


  • The behavioral symptoms in Children include: crying, irritability, angry outburst or tantrums, clinginess and overcautiousness. In adults, the symptoms may manifest as a conscious effort to avoid presentations, speaking in meetings, having meals in the lunch room or other situations that require constant interactions.

  • The physiological symptoms include: increased heart rate, sweating, flushing, nausea, abdominal problems, muscle tension and trembling all over.


  • Firstly, You must get a diagnosis from a mental health expert (Psychiatrist or Clinical Psychologist)

  • Treatment will depend on age (a child or an adult) and severity of the symptoms and the presence of other emotional disorders.

  • Social Anxiety Disorder is best managed with a combination of medications and psychotherapy.

  • The medications used in treating SAD, work at building up a brain chemical called Serotonin, whilst others help to control the physical symptoms of SAD.

  • Psychotherapy/Talk therapy, is highly indicated in the treatment of Social Phobias and include:

  • Cognitive-behavioral Therapy (CBT), which makes use of cognitive techniques, aimed at challenging negative thought processes, and developing healthy coping mechanisms.

  • Behavioral Therapy is aimed at helping the individual to learn how to overcome anxiety inducing social settings.


It has an early onset, usually in Childhood or adolescence and can persist for many years, sometimes into old age. There is a good prognosis attached to adhering to treatment guidelines and not dropping out prematurely from therapy.

In Conclusion, SAD has been linked to absenteeism and incomplete schooling amongst children and job difficulties and poor productivity amongst workers. Social Anxiety could also exist alongside depression, substance abuse, and other forms of anxiety disorders that cause severe personal and social disability.

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