Individuals complaining of social phobia often provide vivid accounts of their distress in terms of various physical sensations (e.g. sweating, blushing, tachycardia, and tremulousness) they experience when, for example, entering a cafeteria, a classroom or meeting strangers at a party or imagining an interview lying ahead. At their peak, a vast range of somatic reactions include, among others: (1) palpitations and cool extremities and pallor (peripheral vaso-constriction); (2) respiratory difficulties; (3) the urge to urinate, intestinal cramps and alternating diarrhea and constipation, and vomiting; (4) muscle tension in the face, trembling, and incoordination of the hands; (5) speech difficulties due to troubled breathing and incoordination of muscles involved in articulation (“tongue-tied”). These are also accompanied by blunted perceptiveness and diminished responsiveness.

Although reported subjectively, these are not confabulations; many of these somatic responses can be independently measured. What could account for these very physical reactions experienced powerfully and bafflingly in seemingly anodyne circumstances?

A possible account could be that the brain processes involved in the regulation of the above reactions are defective. It has been suggested in this vein, that, “it is tempting to speculate that social phobics either experience greater or more sustained increases or are more sensitive to normal stress-mediated catecholamine elevations” (Liebowitz, Gorman, Fyer, & Klein, 1985, p. 729).

Background

With the exception of the brief statement of Liebowitz et al. (1985) a neurobiological formulation of social phobia has – to our knowledge – never been published.