Office parties, business dinners, and other new social situations used to be agony for Regina E. She was consumed with dread for days beforehand. At the event, "I had terrible butterflies in my stomach and worried constantly about how I was coming across," says the 50-year-old San Diego lawyer. Later, she fretted over everything she had done or said. "It was misery," she says.
Then, in 1995, Regina enrolled in a clinical group-therapy trial at the University of California at San Diego (UCSD) for people with social-anxiety disorder. After months of sessions with 12 other women and men, she now enjoys and even seeks out opportunities to meet people. "I'm transformed," she says.
But Regina is an exception. Of the estimated 10 million people who suffer from social-anxiety disorder, just 5% get treatment. Chalking it up to shyness or a high-strung personality, "most people don't think of talking to their doctor because they don't know it's a real and treatable problem," says Jerilyn Ross, president of Anxiety Disorders Association of America in Rockville, Md. (301 231-9350; www.adaa.org).
ALL ALONE. Social-anxiety disorder may occur only in certain situations, such as speaking before large gatherings. But some find it so pervasive that every interaction--even paying for groceries--triggers symptoms ranging from "feeling very uncomfortable to shaking and becoming physically sick," says Dr. Murray Stein, professor of psychiatry at UCSD.
The problem is rooted in a fear of being humiliated or judged unfavorably. "This ingrained fear is usually a good motivator to prepare for presentations" and get along with others, says Dr. Michael Liebowitz, director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute in New York. A phobia occurs when this instinct goes awry, causing a surplus of adrenaline that can lead to blushing, trembling, and a racing heart.
While everyone gets nervous in social situations from time to time, people with social-anxiety disorder are so distressed that it degrades their quality of life. In extreme cases, they withdraw from society and are incapable of holding a job. Less obvious sufferers include the aloof co-worker who never accepts a lunch invitation. "Often people with this problem are seen as jerks or snobs," says Stein.
Theories differ on whether a biochemical imbalance or upbringing leads to the disorder. No identifying blood test exists, and since similar symptoms may occur in depression, diagnosis depends on a psychological evaluation. The problem "is definitely curable, even among those who have suffered for years," says Dr. Daniel Creson, professor of psychiatry at the University of Texas Health Science Center in Houston.
BETA BLOCKERS. Cognitive and behavioral therapy is the first-line treatment. In weekly individual or group sessions, sufferers try to identify why they are fearful and replace negative thoughts that create anxiety with more positive attitudes. They also take on assignments forcing them into uncomfortable situations, "then they have to come back and report on how they did," says Stein. "It's very hard work and requires a great deal of commitment." So much, that 30% of his research subjects drop out before the end of the three- to four-month treatment period. Insurance reimbursement depends upon your health plan's psychiatric coverage.
For those who can't overcome fear through therapy alone, drugs may help. Paxil, Prozac, Zoloft, and other medicines that increase the level of the neurotransmitter serotonin in the brain diminish symptoms. Tranquilizers such as Valium and Xanax also counteract symptoms by inhibiting the panic response. These take 2 weeks to 12 weeks to take effect. Blood-pressure medications known as beta blockers (Inderal and Tenormin), which blunt the vascular effects of adrenaline, are often prescribed to help people through occasional fear-inducing events, such as giving a big speech.
Without psychological therapy, symptoms usually return as soon as patients stop taking drugs. Indeed, medication "is a short-term solution," says Creson. It takes more than a pill to make fear disappear.