Anxiety Disorders 281
challenges their self-esteem, increasing their anxiety during subsequent performances
or tests. Similarly, achievement at work may suffer because they avoid social situa-
tions that are important for advancement on the job, such as making presentations.
People with social phobia are less likely to marry or have a partner than people who
do not have this disorder. People with severe social phobia may quit school and be
unable to get a job because the social interactions required at school or work are
more than they feel they can endure.
Sometimes, a clinician or researcher cannot easily distinguish whether an indi-vidual’s symptoms indicate that he or she has a social phobia or panic disorder with
agoraphobia. However, there are two key features that distinguish these disorders:
- People with social phobia fear other people’s scrutiny.
- People with social phobia rarely have panic attacks when alone.
In contrast, people who have panic disorder with agoraphobia do not exhibit these
features.
Did Howard Hughes have social phobia? Biographical material suggests that hemay well have: Although we don’t know the degree of his fear of certain types of so-
cial situations (Criterion A), he is reported to have avoided parties and other occa-
sions that involved meeting large numbers of people, whenever possible. However,
in the fi rst few decades of building his empire, he met with strangers or large groups
of people when it served his business ends and he did not appear to have had panic
attacks in the process. As a child, Hughes tried to avoid many social situations that
seemed to make him anxious, and this preference continued throughout his adult-
hood (Barlett & Steele, 1979) (Criterion B).
Did Hughes recognize that his fear was excessive or unreasonable (Criterion C)?For a man as wealthy and powerful as Hughes, we can’t know what he considered
unreasonable or excessive. This was a man who accomplished achievements that
others thought impossible or ridiculous. When he could, he avoided social situations
that caused him anxiety, although when business required it, he endured uncomfort-
able situations (Criterion D). His social fears and avoidance signifi cantly interfered
with his life in the sense that they contributed to his becoming a recluse—he was last
seen in public in 1958, when he was 53 years old (“The Hughes legacy,” 1976).
These considerations lead us to infer that Hughes may have had social phobiaas an adult, but this would not have been a lifelong diagnosis: For most of his adult
life, the severity of his symptoms waxed and waned, and there were many periods
when his symptoms do not appear to have met the criteria for this disorder.
Understanding Social Phobia
Social phobia is best understood as arising from interacting neuropsychosocial
factors. Because of the very nature of this disorder, social factors are prominent
contributors to it, along with neurological and psychological factors. As we’ll see,
Howard Hughes’s history indicates that all three types of factors contributed to his
problems: neurological and psychological vulnerabilities and social events that ex-
acerbated his shyness.
Neurological Factors
Why does social phobia exist at all? Evolutionary psychologists speculate that social
phobia may have its origins in behaviors of animals that are lower on a dominance
hierarchy: Less powerful animals fear aggressive action from those more dominant
and therefore behave submissively toward them. It is possible that social phobias
arise when this innate mechanism becomes too sensitive or otherwise responds im-
properly (Hofmann, Moscovitch, & Heinrichs, 2002).
Various facts about the brains of people with social phobia are consistent withthis conjecture. As we shall see, a variety of brain areas are overly active in these
patients (including those involved in fear), neurotransmitter systems do not operate
normally (particularly dopamine), and these people may even have a genetic predis-
position for developing one of several disorders, including social phobia.