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He was always shy, especially with women. When he asked a woman out, it was only a lengthy and painful process of mustering all his courage – the thought of a social anxiety disorder treatment was not even a consideration, let alone a much needed necessity.

On one occasion he took a woman to a restaurant and choked on a piece of food. Because he gave the incident vastly more weight than it deserved, his humiliation was complete. As far as he was concerned, the relationship ended then and there.

After that, when he went out on a date he would go to the movies, to a concert, but never to a restaurant. He might invite his date to his apartment and cook dinner for her. This allowed him to stick to foods he felt more comfortable with - mashed potatoes, vegetables or fish stews.

Reduced To Eating Baby Food

As in incredible as it may sound, in the end, he became so preoccupied with this he could only eat baby foods. Painfully and reluctantly, he remained alone. This man is a classic example of an individual suffering from social phobia. It’s not that a person with this disorder doesn’t like to be around people – far from it. They’re not reclusive or schizoid; on the contrary, they really want to be around people. But whenever they are they become very anxious - with an underlying fear that they will do something or say something that will be embarrassing or humiliating.

On top of that, these patients tend to overestimate the extent to which they have embarrassed themselves or attracted attention to themselves.

The typical social phobic is afraid mainly of a single thing, such as eating in public,  speaking or performing in public, using a public rest room or writing a check in public (for fear their hand will tremble).

Don’t Let Fear Control Your Life

The fear can be so irrational and uncontrollable that it can rule or ruin one’s life - as with the man who ate only baby food. Yet these people are normal thinking, functioning individuals, except in these discrete areas of anxiety.

Social phobias have been ignored for years by American psychiatrists. They were considered a “psychologically derived problem… best treated with psychological interventions or behavioral therapy,” rarely seeing a psychiatrist, often not treated at all.

Meanwhile, findings over the past decade that many panic disorders had large biological components led to new psychiatric interest in those disorders.

However, it’s been noticed in various studies, noticed that some patients who presented themselves for treatment of panic disorders did not fit the classic panic mode.

Patients came in complaining of panic attacks, but their phobias were not the typical fears of tunnels, bridges, stores or driving - situations where escape is not immediately available. On the contrary, this smaller group of patients tended to be uncomfortable in situations where scrutiny of any type elicited tremendous anxiety.

Most typical panic-disorder patients love to meet in groups and talk with others. You could place several panic patients into a group and leave the therapist out and still most would benefit significantly. Such settings enhance their self-image because they can feel, ‘I’m not alone; I’m not crazy; here’s a bunch of other people I like and enjoy who have the same problems.’

That can be tremendously helpful. But occasionally there’ll be a patient who would avoid that like the plague. Careful scrutiny of these patients indicated that they were having panic attacks all right, but these may have occurred only in social situations. The psychiatrists began to realize that here was a subgroup of panic-disorder patients who were also social phobics.

All this pointed to the theory that, in some cases at least, social phobia may be a form of panic disorder, and may have biological or genetic roots. Researchers have found that social phobics are a particularly heterogeneous group. Some respond to medications extraordinarily well, while others do better with social skills or behavioral approaches.

Because there has been so little attention paid to the problem, there are no good estimates of how many people may be afflicted. There are an awful lot of people out there suffering with this problem. More men than women suffer from social phobias, although panic disorders in general affect more women.

Ongoing studies continue to confirm a relationship between panic disorders and caffeine. Panic attacks, for example, can be induced by caffeine intoxication. Even newer studies have shown that at least 75 percent of patients with panic disorders may experience nocturnal panic attacks. These will often cause the victim to wake up with heart pounding and the all-too-familiar feelings of panic flooding their consciousness. Yet these have no relationship to nightmares or dreams.

Sleep studies at NIMH have determined that these night attacks do not occur, as one might have guessed, during the sleep stage known for dreaming - REM sleep.

That is a good indicator that these anxiety episodes have biological roots and are not associated with the stress and strains of the day because the imagery of those kinds of problems occurs during dreaming.

The nighttime attacks also support the biological explanation of panic attacks, by permitting pharmacological tests completely free of emotional or outside influences.

One of the controversies has been that because these are anxious people, there is an ‘expectancy bias’ when you give challenges such as caffeine, even when these are done in scientifically controlled experiments. Critics say that anything that reproduces any disturbance of a physiological system could cause an overreaction in these patients simply because they are anxious to begin with.

What is nifty about the nocturnal panic attacks is that at night you eliminate that whole notion of bias, because they’re not even dreaming.

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