Social Phobia's Traumas and Treatments

by Food and Drug Administration (FDA)

When his self-described "worst episode" of anxiety lay hold of him on stage in 1994, Donny Osmond was no fledgling entertainer. The singer-actor had been in the public spotlight for more than 30 years — four of those, starting when he was just 18, as co-host of a popular variety program with his younger sister, Marie.

"Once the fear of embarrassing myself grabbed me," Osmond writes in his recent autobiography, Life Is Just What You Make It, "I couldn't get loose. It was as if a bizarre and terrifying unreality had replaced everything that was familiar and safe. I felt powerless to think or reason my way out of the panic."

At the time, Osmond was playing the lead character in the Andrew Lloyd Webber musical "Joseph and the Amazing Technicolor Dreamcoat." "... I kept trying to remember the words," he continues, "but they slipped through my fingers like mercury, defying me to try again. The harder I tried, the more elusive they became. The best I could do was to not black out, and I got through the show, barely, by telling myself repeatedly, 'Stay conscious, stay conscious.'"

This was not garden-variety stage fright, Osmond explains. The entertainer who had confidently mixed with such stars as Bob Hope, John Wayne, Andy Griffith, Lucille Ball, Danny Thomas, and Farrah Fawcett, and who had won two celebrity auto races by driving his cars at speeds of up to 150 miles an hour, had become afraid — not just of humiliating himself during his shows, but of being scrutinized off-stage, as well, while doing things as mundane as returning merchandise to the store for a refund. The fear, Osmond says in his book, stemmed from the possibility of not always being in control of what happened to him. His mind would race: "What will I do? What will people think? Will I look stupid?"

As Osmond discovered, the condition that caused his foreboding panics had a name: social phobia. Also called social anxiety disorder, social phobia is an extreme fear of public embarrassment and being judged by others. The condition affects as many as 13 of every 100 Americans at some point in their lives, according to the Anxiety Disorders Association of America, making it the third most common psychiatric condition after substance abuse and depression.

To control his condition, Osmond learned techniques to manage his fears by changing his thought patterns. While many people address their social phobia with such psychological therapy alone, many others find medication helpful, either alone or coupled with psychotherapy. In May, Paxil (paroxetine hydrochloride) became the first drug approved by the Food and Drug Administration specifically for treating social phobia.

Way Beyond Butterflies

Social phobia is far different from the run-of-the-mill nervousness associated with stressful situations. It's the intensity of the fear that distinguishes the condition from the almost inevitable butterflies that most people feel when they are about to give a speech or go to an interview or even a party.

When people with social phobia perceive that others will judge their "performance" in a certain situation, their bodies undergo physical changes, which typically include profuse sweating, rapid heartbeat, shortness of breath, faintness, and blushing.

"In the more severe cases, people can have a panic-like reaction and become so overwhelmed with anxiety that they feel completely disoriented," says Jerilyn Ross, president of the Anxiety Disorders Association of America and a psychotherapist who has treated thousands of patients with social phobia, including Osmond. "Your fight-or-flight alarm system that warns you when there's danger goes off at the wrong time. You literally feel like you're losing control, you're going to do something stupid to embarrass yourself, you're going to die."

Una McCann, M.D., an associate professor of psychiatry at the Johns Hopkins University School of Medicine and former head of the anxiety disorders unit at the National Institute of Mental Health, admits that when she started at NIMH, even she underestimated the life-altering impact that social phobia could have. "My initial reaction toward social phobia was probably typical of most people's," McCann says. "I thought, 'What's that? That's a disorder?' Because everybody experiences anxiety in some social situations, like public speaking, large crowds, or being the center of attention, it really seemed like a pseudo-disorder to me at first. Until I met some patients. Then, I suddenly realized how unbelievably debilitating social phobia can truly be."

For Marissa Turner, now 27 years old, even visiting her own aunt used to trigger panic-type symptoms. "It was pretty hair-raising," says Turner. "Standing on my aunt's doorstep, I'd be hyperventilating, shaking, and feeling hot when it wasn't hot outside. I'd feel like I wanted to turn around and run a mile. My throat would constrict, and it felt like if I opened my mouth to talk it wouldn't make a sound."

To avoid the frightening, panic-like reactions, people often rearrange their lives to sidestep their personal triggers rather than endure the intense anxiety. "What we're talking about is an anxiety so severe that a person is unable to function, either socially, academically or occupationally," explains Thomas Laughren, M.D., the team leader for FDA's psychiatric drug products group. "You hear of people who would turn down a promotion or quit their job rather than dealing with talking to groups of people. Other people are shut-ins because they fear being judged in almost any social interaction outside of their family."

It's not that these people are shy, necessarily. Turner, for example, craved social interaction. "I could list a million things I wanted to do, which my peers were doing, that I couldn't," Turner says. "I didn't date. I rarely went to parties, and when I did, I was very scared the whole time."

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