Social phobias prohibit a normal life

Recently, several readers of this column have presented the following dilemmas:

Situation 1 – “Although I make many speeches as part of my job, I usually feel very nervous before starting the speech. I often worry about forgetting what I am going to say right in the middle of the speech.

“I often sleep poorly the night before I give a talk, and I dread making speeches in certain situations, especially when I am very busy in other areas of my life.

“My wife is tired of hearing me complain about what she says are ‘stupid’ fears, and, as she accurately points out, I usually receive many compliments and applause after I finish my presentation. Have you ever heard of a problem like mine?”

Situation 2 – “Please tell me if I am going crazy. When I am asked to sign my name in front of other people, such as signing my name on a check or sales receipt in a store, I become extremely nervous and feel as if I cannot move my hand.

“My heart pounds, I have trouble breathing, and sometimes I even feel faint. It has gotten to the point that I pay for everything with cash.

“I am in my 40s, but this problem has been going on almost 20 years. Do you know what my problem might be and if there is help for me?”

Situation 3 – “I am a man in my mid 30s and have a most unusual problem. When in public restrooms, such as at ball games, restaurants or office buildings, I find myself unable to urinate if there is anyone in the restroom with me or if I believe someone is about to enter the restroom.

“My job takes me too many public places and I like to attend sporting events in large stadiums, ball parks, etc. I am to the point that I consider my fluid intake before going out and I spend a lot of time hunting for restrooms that accommodate only one person at a time. This is inconvenient and makes me feel silly and angry at myself.

“I am becoming more reclusive. I read somewhere that my problem is not all that uncommon. Where can I get help?”

All of these individuals suffer from what is known as social phobia. They have an irrational fear that their behavior will be scrutinized or criticized by others and that they will become anxious and unable to complete a certain task or behavior. The concern and worry about what might happen (anticipatory anxiety) often becomes so severe that the individual avoids all anxiety provoking situations.

Phobias related to speaking in public and anxiety in social situations are relatively common and numerous. Less frequently seen are the more specific and well defined symptoms of fear, such as those in situations 2 and 3.

As in many anxiety disorders, the “fear of the fear” develops, and this anticipatory anxiety becomes the “trigger” for a self-fulfilling prophecy.

Phobias, such as simple phobia (an irrational fear focused on a particular situation or object such as animals, closed places or heights), agoraphobia and social phobia, are often accompanied by depression. In next week’s column I will discuss simple, also known as specific, phobias.

Copyright c 1994 Harold H. LeCrone, Jr., Ph.D.