I remember a friend in college who would blush, sweat, and tremble when required by a teacher to speak in class. A few weeks before the presentation, he'd be anxious, agitated, and couldn't sleep. Because I was still a student then, I didn't have any clue what he was going through. But I knew that something was terribly wrong.

A few years ago while in the airport, I noticed a man who'd wait for everyone to leave the washroom before he'd use the urinal. He wasn't comfortable that someone would see him urinate.

In retrospect, I can say (now that I'm a psychiatrist) that those two individuals might have suffered from Social Phobia or Social Anxiety Disorder (SAD). I just hope that they are doing well now but the symptoms that they manifested at the time were consistent with this devastating illness.

How bad is Social Phobia or SAD?

Social Phobia or SAD is a type of anxiety disorder characterized by extreme fear, anxiety, or distress when exposed to a social gathering or when doing something before a group of people.

Public speaking is the most common situation that exposes the individual's social fears. An individual suffering from this disorder develops significant anxiety symptoms such as sweating, fast heart beat, tremulousness, and restlessness when making a presentation or giving a minor talk. Even small corporate or committee meetings can cause grave distress.

Urinating in public washrooms, eating in fast food restaurants, writing in front of people or signing documents in a bank can also trigger feelings of fear and discomfort. Individuals with this illness are preoccupied with being embarrassed or criticized by others. Some patients feel that people are so focused on them and are only waiting for blunders to happen.

So Social Phobia can be devastating to a lot of patients and their families. Because of their difficulties in a social milieu, some of them have eventually lost their jobs, friends, and spouses. It is an illness that has wrought havoc to many. It is therefore vital that Social Phobia should be recognized and treated without delay.

Is there any treatment for this illness?

Fortunately, some newer antidepressants such as paroxetine and venlafaxine are known to work and have caused significant relief to a lot of individuals. However, these medications don't work right away. They need to be taken daily for a few weeks to see any benefit. Moreover, the medications' maximum effect may occur within 6-8 weeks or longer. To maintain stability after feeling "normal," patients may have to take the medication for several months to a few years.

In addition to medications, cognitive-behavioral intervention also works well. By restructuring the person's cognition, patients eventually learn to face social situations without fear and uncertainty.

Dr. Michael G. Rayel - author (First Aid to Mental Illness-Finalist, Reader's Preference Choice Award 2002) psychiatrist, and inventor of Oikos Game: A Personal Development and Emotional Skills Game. For more information, please visit www.oikosgame.com.

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