Many families have an aunt, cousin, or other relative who never shows up at weddings or other large gatherings. This kind of avoidance behavior may have nothing to do with the individual's like or dislike of family members. It may have everything to do with fear.

Social phobia, the overwhelming and disabling fear of disapproval in social settings, is one of a wide variety of known phobias. A phobia is defined as a persistent, irrational fear of a certain object situation. Phobic people often feel so overwhelmed by their anxiety that they will do almost anything to avoid the object of their fear.

Symptoms

When avoidance is impossible, a spectrum of symptoms can emerge. For example, when people with social phobia are forced into a social situation, or even into a conversation with their boss, they may experience blushing, sweating, trembling, rapid heartbeat, muscle tension, nausea or other stomach discomfort, lightheadedness, and other symptoms of anxiety.

According to the National Institute of Mental Health (NIMH), about 4% to 5% of Americans (at least 7.2 million people) experience a clinically significant phobia. The fear of a specific object (specific phobia) can occur at any age. Phobias of situations, such as social phobia, typically emerge between the ages of 15 and 20, although they can often begin in childhood. Phobic people generally know that their fear is irrational but cannot seem to overcome it on their own.

The focus of a person's fear dictates the extent to which the disorder affects normal functioning. Fear of snakes, for instance, may cause stress only if the phobic person wanders into to the reptile exhibit at the zoo or camps out in the desert. Most people with specific phobias experience mild-to-moderate symptoms when they encounter the feared object. When symptoms are severe enough to disrupt normal life, an evaluation by a medical professional is indicated.

Treatments

While most patients with specific phobias tend to recover without medication, anti-anxiety drugs have been found to help some people, particularly those with agoraphobia and social phobia, to reduce their panic or anxiety symptoms. By taking the edge off the physical symptoms of fear, medication may help a patient confront a phobic situation and ultimately conquer their fear. According to the NIMH, social phobia can be effectively treated with certain antidepressant medications including the monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs), as well as high-potency benzodiazepines. People with a specific form of social phobia, called performance phobia, have been helped by beta blocking drugs like opranolol. There is no proven drug treatment for specific phobias

According to the American Psychiatric Association (APA), exposure therapy, a form of behavior therapy, is the most effective and long-lasting treatment for specific phobias. In therapy, the patient is exposed either quickly or incrementally to the feared object or situation while accompanied by a trained therapist. By confronting, rather than fleeing, the object of fear, the patient gets used to it and eventually loses the terror, horror, panic, and dread he or she once felt, according to the APA.

A useful treatment for agoraphobia (the fear of being in a place or situation from which escape might be difficult or embarrassing) and social phobia is cognitive behavior therapy. In therapy, patients learn how to correct erroneous and catastrophic thinking patterns.