Treatment now available for social phobia; both cognitive therapy and drugs can help

Social anxiety (or social phobia), which affects some 10 million people in the United States, is a condition almost as common as depression. However, the first study on it was not published until the late 1980s and only recently has the pharmaceutical industry marketed a drug to treat the disorder.

Social anxiety is severe pathological shyness, stemming from fear of rejection and humiliation. Socially anxious people tend to avoid situations such as talking to their boss, speaking up in meetings, asking directions or even writing a check in public. They believe they are the object of others’ scrutiny or harsh judgment, says Dr. Peter Roy-Byrne, professor of psychiatry and behavioral sciences at the UW School of Medicine and chief of psychiatry at Harborview Medical Center.

There are two types of social anxiety — discrete and generalized. The discrete type is linked to performance anxiety, such as a fear of speaking in front of others that is so intense a person may get physically ill just thinking about it and feel no relief after it’s over. For people with generalized social anxiety, forming relationships is difficult and about 75 percent of them remain single. They also tend to be underachievers, by not reaching a professional level that matches their skills or education. “For instance, you might find a Phi Beta Kappa graduate working as a file clerk,” says Roy-Byrne. “They are uncomfortable with the competition often seen in the workplace.”

Social anxiety stems from a combination of genetic vulnerability — it tends to run in families — and environmental circumstances. It usually begins in junior high, when social rules become more complicated, and is especially prevalent among women who are high strung and have low economic status. However, it’s also possible that social anxiety caused them to drift that way, says Roy-Byrne.

Although social anxiety ranks just behind depression and alcoholism among the nation’s most prevalent mental disorders, the three conditions often overlap — 80 percent to 85 percent of socially anxious people have clinical depression, while 25 percent to 35 percent of them have a drinking problem.

Most socially anxious people don’t realize they have a medical disorder and believe it’s just their personality type, says Roy-Byrne. However, he stresses, “This is a chronic condition. You can get substantial improvement with drugs and therapy but there is no cure.” There are two effective treatments for the socially anxious, both likely to produce results within six to 12 weeks: