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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

October 2013

Recognizing Social Phobia in the Primary Care Setting 


Although social phobia is prevalent and can be quite disabling, it sometimes goes undiagnosed. Being familiar with the symptoms below and incorporating brief screening questions into patient visits may improve rates of detection and treatment.

Social phobia is an intense, persistent fear of being embarrassed in social, performance, or everyday situations. Someone with social phobia is fearful of being watched, judged, criticized, or humiliated in front of others. Because social situations cause a great deal of stress, individuals with social phobia may try to avoid them altogether, interfering with academic, social, and family functioning and impairing their quality of life.

Social phobia is the third most common psychiatric disorder, following depression and substance abuse, with approximately 5.3 million Americans affected. Generally, it begins in childhood or adolescence and rarely develops after age 25. While social phobia occurs twice as often in women than in men, a higher proportion of men seek help for this disorder.

According to the National Institute of Mental Health, the signs and symptoms of social phobia include:

  • Feeling very anxious about spending time with other people and speaking to them (although they may wish they could)
  • Feeling embarrassed and highly self-conscious in front of others
  • Experiencing extreme fear that other people will judge them
  • Worrying for days or weeks before an event
  • Avoiding places where other people are present
  • Having trouble making and keeping friends
  • Blushing, sweating, or trembling around other people
  • Feeling nauseous around other people

These visible signs heighten the fear of disapproval, and the symptoms themselves can become an additional focus of fear. The more people with social phobia worry about experiencing symptoms, the greater their chances of experiencing them. People with social phobia may be hypersensitive to criticism, negative evaluation, or rejection; have difficulty being assertive; and have feelings of low self-esteem or inferiority. They often manifest poor social skills, such as poor eye contact, and underachieve in school or at work due to fear of talking in front of groups.

Social phobia frequently co-occurs with other anxiety disorders, depression, bulimia nervosa, and substance abuse/dependence. Complete remission is uncommon without formal treatment, which includes psychotherapy, medication (antidepressants or anti-anxiety medications), or both. Harvard Pilgrim’s behavioral health partner can assist you in treating members with social phobia.

How Optum/United Behavioral Health (Optum/UBH) can help your patients—For complex clinical situations, Optum/UBH is available to provide consultative assistance. Practitioners can call the Optum/UBH Physicians Consultation Service at (800) 292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call Optum/UBH at (888) 777-4742.

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