Scopophobia

What is scopophobia?

Scopophobia is an extreme fear of being watched or stared at and can lead to significant impairments in daily, social, or professional functioning ^[1].

While many people experience anxiety at the thought of performing or speaking in front of others, scopophobia is an intense fear of being looked at by anyone at any time, whether this is friends and family, colleagues, or strangers, so can be very disabling, potentially leading to a complete avoidance of any interactions or even leaving the house.

Although not specifically mentioned in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5), scopophobia is considered a specific phobia. Specific phobias are characterized by an irrational and disproportionate level of fear or anxiety when faced with a certain stimulus ^[2].

Scopophobia is also often linked with social anxiety disorder, formally known as social phobia ^[3]. This means many people with scopophobia also have social anxiety disorder. But it should be noted that although the two conditions share many similarities, they are two distinct conditions with different diagnostic criteria ^[2][3].

Current research on scopophobia is limited, partially due to the fact that many people do not report or seek help for phobias ^[4]. Similarly, many people may interpret their symptoms as being due to other conditions such as social anxiety disorder. As such, further research is required to clarify the causes of and circumstances surrounding the development of specific phobias such as scopophobia.

Symptoms of scopophobia

Symptoms of scopophobia may vary from person to person but can include ^[2][4][5]:

• Thinking about or being looked at causes immense fear and anxiety.
• Being unable to make eye contact with other people.
• The presence of physical symptoms of anxiety or a panic attack, such as sweating, shaking, fast heartbeat, dry mouth, difficulty concentrating, and breathing difficulties when thinking of being looked at or thought about.
• Avoiding situations in which another person might make eye contact or look at you, such as using public transport, attending meetings or appointments, or even sitting with a friend.
• Impairments in one or more areas of life, including social and professional functioning.
• The presence of other specific phobias, such as a fear of spiders or injections.
• The presence of other mental health conditions, such as social anxiety disorder, mood disorders, or substance use disorders.

Causes of scopophobia

The exact cause of scopophobia is not known and may differ from person to person. However, there are several theories about certain risk factors that may increase the likelihood of a specific phobia developing.

Genetics

Research suggests that there is a strong familial link associated with the development of specific phobias. Those with a specific phobia have been found to be significantly more likely than healthy individuals to have a relative with an anxiety disorder, phobia, or both, indicating that a genetic predisposition is likely ^[6].

Brain functioning

Research into the neurobiology of fear and specific phobias has found that some people have a difference in the activation and function of the fear response in the amygdala, suggesting that they may have an increased sensitivity to fear that could lead to the development of a phobia ^[7].

Past traumatic experience

Phobias can develop as a response to a traumatic experience ^[5]. For example, someone with scopophobia may have experienced bullying and teasing as a child. The bullying and/or teasing may have involved people looking at them and ridiculing them. The emotional response to this negative experience could then become associated with being looked at by others, thereby developing into a phobia ^[8].

Diagnosing scopophobia

Specific phobias are often not diagnosed, as many people live with their fear and avoid the stimulus that causes it ^[4]. However, if you think you have scopophobia, it is important to seek a diagnosis in order to receive appropriate treatment to prevent further impact on your life.

To diagnose scopophobia, you will be asked questions about your symptoms as they relate to diagnostic criteria. The diagnostic criteria for a specific phobia according to the DSM-5 includes ^[2]:

• Anticipating or facing a situation in which others may look at you causes intense feelings of anxiety, which may lead to prolonged or repeated avoidance of any social situations.
• The associated symptoms cause distress and impair social and/or professional functioning.
• The level of fear and anxiety is disproportionate to the potential danger or outcome.
• These symptoms have persisted for at least 6 months.
• These symptoms are not due to another condition, such as avoidant personality disorder, posttraumatic stress disorder (PTSD), or social anxiety disorder.

Treatment for scopophobia

The effectiveness of treatment for certain kinds of specific phobias is not well researched. Therefore, it is not clear if each phobia responds to treatment in the same way. Treatment for phobias typically involves systematic exposure and desensitization to gradually decrease the fear associated with the stimulus while also managing symptoms of anxiety ^[5].

Therapy

• Behavioral therapy: Therapy such as cognitive behavioral therapy (CBT) aims to relearn emotional responses and behavior that have been conditioned as a response to fear, by providing skills to tolerate distress, reducing extreme emotional responses to fear, and teaching positive coping strategies ^[4][9].
• Exposure therapy: For someone with scopophobia, exposure therapy may involve a gradual desensitization of being looked at, involving techniques such as virtual reality therapy, exposure and response prevention (ERP), or eye movement desensitization and reprocessing (EMDR) ^[5].
• Other therapies: Interpersonal therapy, family therapy, and other forms of therapeutic intervention may also be useful, in which the individual can receive support and validation, with the aim to reduce negative emotions associated with their phobia and help them to manage their feelings of anxiety ^[9].

Medications

Although there are no approved medications for the treatment of a specific phobia, a medication may be prescribed to help manage the symptoms of scopophobia, including ^[4][8][9]:

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, citalopram, and fluoxetine, or serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine are commonly prescribed to treat phobias and symptoms of anxiety.
• Antihistamines: Hydroxyzine is the only antihistamine approved by the FDA to treat anxiety symptoms and may be effective at manage symptoms of scopophobia.
• Anxiolytics: Although not usually a first-choice medication, benzodiazepines such as diazepam can be effective as a short-term treatment of acute anxiety and phobias but should not be used long-term.
• Beta-blockers: Beta-blockers such as propranolol are commonly used to manage the physical symptoms of acute anxiety.

It is important to take your medication exactly as prescribed by your doctor, as taking too much, skipping doses, or suddenly stopping a medication can cause adverse effects and may worsen your mental and physical health.

Self-care for scopophobia

If you have scopophobia, you may be able to manage some of your symptoms by utilizing some self-help techniques, including ^[9][10]:

• Talking to others: Speaking with friends and family or with a professional, in person, online, or over the phone, can help to lessen the impact of your anxieties and fears.
• Relaxation exercises: Calming activities, such as breathing exercises, meditation, or yoga, can help to reduce feelings of anxiety and may be useful in managing acute symptoms of a panic attack or severe emotional responses to triggering situations.
• Support groups: Attending a support group in person or online may help to improve understanding and acceptance of your phobia and sharing with others who have had similar experiences can help to reduce your feelings of distress.
• General wellbeing: Looking after your general wellbeing, by eating healthily, ensuring you get enough sleep, and engaging in regular exercise, can help to reduce feelings of anxiety.

Frequently asked questions about scopophobia

How common is scopophobia?

The prevalence of scopophobia is not known, due to a lack of research and reporting of the condition. However, it is believed that between 1-10% of the population experiences a debilitating phobia and females are significantly more likely to be diagnosed with a specific phobia than males ^[11].

How does scopophobia impact daily life?

Scopophobia can have detrimental effects on daily, social, and professional functioning.

If the individual is unable to be near other people for fear of being looked at, they may be unable to attend medical appointments or speak with friends and family, so cannot receive the support they require, which may worsen their mental wellbeing. They may also be unable to go to work and could lose their employment, thus creating financial struggles.

Someone with scopophobia may even be unable to leave their home or enter any public place because of their fear, which may lead to them becoming entirely isolated and experiencing a decline in their mental wellbeing.

Scopophobia vs Social Anxiety Disorder – What is the difference?

Social anxiety disorder and scopophobia share many similarities, as they both can cause severe anxiety when faced with a social situation and may lead to functional impairment or avoidance of certain situations.

However, scopophobia is a specific fear of being looked at, while social anxiety disorder applies more generally to being judged or scrutinized in any social situation ^[2].

For example, a musical performance for someone with scopophobia may not cause anxiety if people cannot see them, such as an audio recording or performing in the dark, as their phobia is related only to being looked at, whereas a person with social anxiety disorder may be unable to perform regardless, as their anxiety is related to the scrutiny of their performance.

Someone with social anxiety disorder may also have scopophobia, causing their anxiety to increase while being looked at. However, research suggests that for some people with social anxiety disorder, being looked at has no impact on their anxiety levels, showing that there is a distinct difference, although this requires further research and understanding ^[8].