THE LUCKLESS Emmas of this world are just about to start the party season. To them, Christmas must be as much of an ordeal as sports day is for a totally unathletic adolescent.

The Emmas of Jane Austen’s day will have had hearts that sank deeper with every button they did up while dressing for their parties. All around them would have been the mounting excitement of the other women. Their chatter, speculation and increasing sexual tension, coupled with nervous excitement, would serve only to deepen an Emma’s gloom. A blushing, sweating, monosyllabic dinner would have been followed by the hell of being looked over, judged on appearance and rejected. The ritual humiliation would have been as great as it is for the schoolboy who is always last to be picked for a team in the gym or on the games field. They know before they start that their self-respect is about to take another battering.

Even the annual office party may be hell for those who suffer from social phobia or an avoidant personality disorder. The boundaries between shyness, social phobias and avoidant personality disorder blend into each other. It is pointless to tell the timid and socially insecure that they will know everybody at the party, as that can make the situation worse. The basic trigger for shyness or social phobia is the fear someone has that they are going to make a fool of themselves, and hence be humiliated and embarrassed. The better they know their fellow guests, the more they will want their approval.

They will be convinced not only that their dress will be wrong but that it will be noted and discussed by everyone. They will worry lest the person they are sitting next to is so beautiful, or so clever, that it will dissolve their power of conversation, leaving them tongue-tied and with a mouth so dry that they can’t swallow a morsel.

Above all, they will worry about blushing and sweating — and because they worry about it, they are almost bound to blush and sweat. If they pluck up the courage to talk, they will be certain that others will find their conversation trite, unamusing and boring, and will realise that they are as socially inept as they have always felt themselves to be. Even the alcohol may not dispel their anxieties — and if it does lift their inhibitions, their apprehension about meeting everybody the next day will be crippling.

Shyness shades into social phobia. Most people, but not all, outgrow shyness. As they grow older they may still expect their peers to judge their social performance, but will mind less about the rating they receive. However, those with a genuine social phobia don’t overcome it so easily. Their fears tend to be directed at avoiding situations where embarrassment is most likely — they avoid eating in public in case the vol-au-vent splatters down their shirt, and talking and eating at the same time in case they choke. The thought of speaking in public, alone behind a lectern with 300 judges in front, terrifies them.

Exposure therapy is a possible answer to social phobias. Rather than being allowed to hide away, they should seek out the situations that induce their fear so that in time, after exposing themselves to increasingly tense situations, the panic that they felt initially becomes no more than uneasiness.

Cognitive therapy also helps. An understanding of their own personality and an appreciation of its strengths and abilities as well as the knowledge that they exaggerate their perceived disadvantages paradoxically makes them less self-absorbed.

Psychotherapy of the American analytical type is not now recommended for phobias — it is no good dredging the murky well of memories to explore what it was that grandma said at the age of 3 or what you did behind the bushes aged 7.

The older beta-blockers, which cross the blood-brain barrier, help, as do an occasional benzodiazepine such as Frisium. Care is needed with tranquillisers or alcohol, as people with phobias are apt to become addicted.

Finally, there are those who have an avoidant personality disorder. This may be symptomatic of some other psychological problem or may exist by itself. So frightened are they of criticism, and so hurt by it, that they withdraw emotionally and wall themselves off mentally from other people by avoiding social activities that involve personal interaction. Afraid of emotion, they become rigidly unemotional. So fearful are they of social intercourse that characteristically they cancel engagements on some flimsy excuse at the last minute. Their inability to relate easily to others (other than one close confidante) leads frequently to anger, anxiety and depression.

• www.timesonline.co.uk/health

  E-mail Dr Thomas Stuttaford your questions on phobias