Holiday Season May Raise Anxiety For People With Social Phobia

BETHESDA, MD, December 1997 - Who's always missing at your holiday party? Aunt Betty? Your reclusive neighbor? They may have declined your invitation because they are among the millions of Americans living with social phobia. For these people, the holiday season can spark such intense feelings of anxiety and dread that they avoid social gatherings altogether.

"A lot of people have anxiety in social situations, such as when meeting new people at a holiday party, but the fear is not severe and typically passes," said Una McCann, M.D., chief of the Unit on Anxiety Disorders at the National Institute of Mental Health (NIMH). "For people with social phobia, however, the fear of embarrassment in social situations is excessive, extremely intrusive and can have debilitating effects on personal and professional relationships."

People with social phobia have an overwhelming and disabling fear of disapproval in social situations. They recognize that their fear may be excessive or unreasonable, but are unable to overcome it. Symptoms of social phobia include blushing, sweating, trembling, rapid heartbeat, muscle tension, nausea or other stomach discomfort, lightheadedness, and other symptoms of anxiety.

To uncover the biological and behavioral causes of social phobia, NIMH is conducting and supporting research on this disorder.

"Without treatment, social phobia can be extremely disabling to a person's work, social and family relationships. In extreme cases, a person may begin to avoid all social situations and become housebound," said Dr. McCann. "But the good news is that effective treatment for social phobia is available and can be tremendously helpful to people living with this disorder."

Effective treatments include medications, a specific form of psychotherapy called cognitive-behavioral therapy, or a combination. Medications include antidepressants called selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as well as drugs known as high-potency benzodiazepenes. People with a specific form of social phobia, called performance phobia, can be helped with drugs called beta-blockers. Cognitive-behavioral therapy teaches patients to react differently to the situations and bodily sensations that trigger anxiety symptoms. For example, a type of cognitive-behavioral treatment known as "exposure therapy" involves helping patients become more comfortable with situations that frighten them by gradually increasing exposure to the situation.

At least 7.2 million Americans experience clinically significant phobias in a given year, many of them have social phobia. Phobias are persistent, irrational fears of certain objects or situations; they occur in several forms.

While social phobia is a fear of embarrassment, humiliation, or failure in a public setting, specific phobias involve fear of an object or situation. These include small animals, snakes, closed-in spaces, or flying in an airplane.

Phobias are one of five major anxiety disorders that are being addressed in a national education program conducted by NIMH. In addition to phobias, these disorders include:

• Panic Disorder -- Repeated episodes of intense fear that strike often and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying.
• Obsessive-Compulsive Disorder -- Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.
• Post-Traumatic Stress Disorder -- Persistent symptoms that occur after experiencing a traumatic event such as rape or other criminal assault, war, child abuse, natural disasters or crashes. Nightmares, flashbacks, numbing of emotions, depression and feeling angry, irritable, distracted and being easily startled are common.
• Generalized Anxiety Disorder -- Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea.

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