Social Phobia Symptoms, Causes, Treatment

3888
Robert Johnston

The social phobia it is characterized by an excessive fear of relating to social situations, of being humiliated in public, or of acting in public. It is estimated that this disorder is suffered by 13% of the population at some vital moment. It usually begins in adolescence and is usually more common in young people between 15 and 29 years old, with little training, single and of low socioeconomic class..

Descriptions of shyness have been appearing in the literature since 400 BC. with Hippocrates, who made this description: “He does not dare to be in company for fear of being dishonored or used; he thinks other men are watching him ".

The first mention of the term social phobia was made at the beginning of the 20th century. Psychologists used the term "social neurosis" to describe extremely shy patients.

The idea that social phobia was a separate entity from other phobias came with the psychiatrist Isaac Marks in the 1960s. This idea was accepted by the APA (American Psychiatric Association) and was officially included in the third edition of the DSM..

Its definition was revised in 1989 to allow its comorbidity with avoidant personality disorder.

Article index

  • 1 Symptoms
    • 1.1 Emotional symptoms
    • 1.2 Physical symptoms
    • 1.3 Behavioral symptoms
    • 1.4 In children
    • 1.5 Stressful situations
  • 2 Causes
    • 2.1 Biological causes
    • 2.2 Psychological causes
    • 2.3 Social causes
    • 2.4 Cultural influences
    • 2.5 Physiological mechanisms
    • 2.6 Dopamine
    • 2.7 Other neurotransmitters
    • 2.8 Brain areas
  • 3 Diagnosis
    • 3.1 Diagnostic criteria according to DSM-IV
    • 3.2 Comorbidity
  • 4 Treatment
    • 4.1 Cognitive-behavioral therapy
    • 4.2 Group therapy
    • 4.3 Medication
  • 5 Self Help Tips
    • 5.1 Challenge negative thoughts
    • 5.2 How to stop thinking that everyone is looking at you?
    • 5.3 Control your breathing
    • 5.4 Practice relaxation techniques
    • 5.5 Face your fears
  • 6 References

Symptoms

Just because you are nervous in some social situations does not mean that you have social phobia (FS). Many people are shy or overly self-aware and that does not cause them big problems in their daily lives..

If FS interferes with your routine, it can cause anxiety and stress, and lower your quality of life. For example, many people get nervous when speaking in public, although people with FS find themselves preoccupied for weeks or months before doing so or literally paralyzed when they do so..

Emotional symptoms

  • Extreme fear of being watched or judged by others.
  • Excessive anxiety in everyday social situations.
  • Intense worry for weeks or even months before a social situation.
  • Fear that others will notice that you are nervous.
  • Fear of acting and being humiliated.

Physical symptoms

  • Fast breathing.
  • Turn red.
  • Nausea, stomach pain.
  • Chest pressure or tachycardia.
  • Trembling voice.
  • Feeling dizzy or fainting.
  • Sweats.

Behavioral symptoms

  • Avoiding social situations to a degree that limits your activities or interrupts your life.
  • Escape from social situations.
  • The need to always be surrounded by someone you know.
  • Drinking before social situations to reduce nerves.

In children

It is normal for a child to be shy. However, when you have FS, you experience extreme discomfort when doing daily activities such as playing with other children, reading in class, talking to other adults, or acting in front of others..

Stressful situations

The following situations are often stressful for people with FS:

  • Meet new people.
  • Be in the limelight.
  • Being watched while doing something.
  • Public speaking.
  • Perform in front of people.
  • Being criticized or judged.
  • Talk to "important" people or authority figures.
  • Go on a date.
  • Make phone calls.
  • Using public restrooms.
  • Do tests.
  • Eating or drinking in public.
  • Go to parties or social events.

The following descriptions could be of people with FS:

“In any social situation I am afraid. I am looking forward to leaving home and even more so throughout the event. The closer I am to the social situation, the more anxious I am. My heart starts to beat and I start to sweat when I think about social situations. ".

"When I enter a room full of people I blush and feel as if everyone is looking at me".

“At school I was always afraid of being called, even when I knew the answers. When I had a job, I hated seeing my boss. I couldn't eat with my colleagues or go to company parties. I worried about being judged or being looked at, I didn't want to sound silly. Sometimes I couldn't eat or sleep for days before a meeting. ".

Causes

It is currently considered an integrative model. That is, the causes that intervene in the development of social phobia are biological, psychological and social.

Scientists have yet to determine the exact causes. Studies suggest that genetics play an important role alongside environmental factors. SF generally begins at a specific point in life, from which it develops.

Biological causes

It seems that by evolution, the human being is prepared to fear people who reject us, criticize us or people who show anger. Thousands of years ago, our ancestors would avoid hostile rivals who could harm or kill them; it is something that actually occurs in all species.

This theory would defend that we have inherited the genes of those people who learned to walk away by picking up those signs of violence. As early as 4 months, some babies show patterns of shyness when crying or fidgeting with social stimuli or toys.

You can therefore inherit a tendency to be socially inhibited. Growing up with overprotective or hypercritical parents is also associated with FS.

Psychological causes

This factor involves learning that you are not in control of events. In addition, an unexpected panic attack can occur in a social situation that causes its association with social situations.

In this case, the person would feel anxiety every time they live a social situation similar to the one that caused the anxiety attack. There can also be real situations that produce trauma, such as bullying in adolescence or childhood.

On the other hand, the fact that parents transmit to their children concern for the opinions of others also influences.

Social causes

A negative social experience can cause SF to develop, with interpersonally sensitive people being more likely to develop it.

Approximately 50% of people diagnosed with social anxiety have had a traumatic or humiliating social event. Like direct experiences, observing or hearing about other people's negative experiences can develop SF.

Likewise, SF can be triggered by the long-term effects of not fitting in or being bullied, rejected, or ignored..

Cultural influences

Attitudes towards shyness and avoidance are factors that have been related to SF. One study found that the effects of parental education depended on culture.

American children appeared to be more likely to develop FS if their parents emphasized the importance of the opinion of others or used embarrassment as a disciplinary tactic..

However, that association was not found in Chinese children. In China, shy or inhibited children are more accepted than their peers and are more likely to be considered to lead, unlike in Western countries.

Physiological mechanisms

Although the exact neural mechanisms have not been found, there is evidence linking FS with imbalances in some neurotransmitters and hyperactivity in some brain areas.

Dopamine

Sociability is closely linked to dopaminergic neurotransmission. The misuse of stimulants, such as amphetamines, to increase self-esteem and improve social performance is common.

Other neurotransmitters

Although there is little evidence of abnormality in serotonin neurotransmission, the limited efficacy of medications that affect serotonin levels may indicate the role of this neurotransmitter..

Paroxetine and sertraline are two SSRIs (selective serotonin reuptake inhibitors) that have been confirmed by the FDA to treat social anxiety disorder. SSRIs are believed to decrease amygdala activity.

There is also a growing focus on other transmitters, for example norepinephrine and glutamate, which may be more active in social anxiety disorder, and the inhibitory transmitter GABA, which may be less active in the thalamus..

Brain areas

The amygdala is part of the limbic system, which is related to fear and emotional learning. People with social anxiety have a hypersensitive amygdala in threatening social situations or hostile facial faces.

On the other hand, recent research has indicated that the anterior cingulate cortex, which is related to the experience of physical pain, also seems to be related to “social pain”, for example with group rejection..

Diagnosis

Diagnostic criteria according to DSM-IV

A) Accused and persistent fear for one or more social situations or actions in public in which the subject is exposed to people who do not belong to the family environment or to the possible evaluation by others. The individual is afraid to act in a way that is humiliating or embarrassing. Note: in children it is necessary to have demonstrated that their abilities to relate socially with their relatives are normal and have always existed, and that social anxiety appears in meetings with individuals of the same age and not only in any interaction with an adult.
B) Exposure to feared social situations almost invariably provokes an immediate anxiety response, which can take the form of a crisis of situational or more or less situation-related distress. Note: in children anxiety can translate into crying, tantrums, inhibition or withdrawal in social situations where the assistants belong to the family framework.
C) The individual recognizes that this fear is excessive or irrational. Note: in children this recognition may be missing.
D) Dreaded social situations or public performances are avoided or experienced with intense anxiety or discomfort.
E) The avoidance behaviors, anxious anticipation, or discomfort that appear in feared public situations markedly interfere with the normal routine of the individual, with their work, academic or social relationships, or produce clinically significant discomfort.
F) In individuals under 18 years of age, the duration of the symptomatic picture should be prolonged for at least 6 months.
G) The measure or avoidance behavior is not due to the direct physiological effects of a substance or a general medical condition, and cannot be better explained by the presence of another mental disorder.
H) If there is a medical illness or other mental disorder, the fear described in Criterion A is not related to these processes.

Specify if:

Generalized: if the fears refer to most social situations.

Comorbidity

FS shows a high degree of comorbidity (co-occurrence) with other psychiatric disorders. In fact, a population-based study found that 66% of people with FS had one or more additional mental disorders..

FS often occurs alongside low self-esteem and clinical depression, perhaps due to lack of personal relationships and long periods of social isolation.

To try to reduce anxiety and depression, people with social phobia may use alcohol or other drugs, which can lead to substance abuse.

It is estimated that one in five people with FS also suffer from alcohol dependence, although other researchers suggest that FS is not related, or that it is protective against alcohol problems.

Other common disorders with FS are:

  • The Depression.
  • Anxiety disorders, particularly generalized anxiety disorder.
  • Avoidant Personality Disorder.

Treatment

The most effective treatments for social phobia are cognitive behavioral.

Cognitive behavioral therapy

Cognitive behavioral therapy aims to modify thoughts and behaviors for more adaptive ones.

Appropriate treatments can be:

  • Group exhibition.
  • Social skills training.
  • Cognitive restructuring

1-Exposure

It is an effective treatment in generalized social phobia. It is intended for the person to actively come into contact with the situations they avoid, to face their fears and to get used to the situations until the anxiety decreases.

Some indications for exposure sessions are:

  • Short, repeated exposure sessions.
  • Teach how to take advantage of everyday life situations.
  • Accept that the behavior of others is unpredictable.
  • Explain how the problem originates and maintains.

2-Cognitive techniques

The most commonly used techniques are Beck's cognitive therapy and Ellis's rational emotive therapy..

The goals are:

  • Gain expectations of control over behavior and events.
  • Shift attention to increased arousal and physical symptoms.
  • Suppress repetitive thoughts about the occurrence of the symptoms or consequences that are feared.
  • Encourage proactivity and value the achievements obtained.

3-Social skills training

If for any reason the person has not been able to learn social skills, it will be important to establish this training.

When the person is afraid of showing physiological symptoms such as turning red, trembling or sweating, they can work:

  • The paradoxical intention.
  • Rational Emotional Therapy.
  • The exhibition.
  • In people with high levels of anxiety, relaxation techniques can complement exposure well..

In people with social phobia and some personality disorder, cognitive-behavioral therapies will have to be longer.

Group therapy can be too scary for some people, although it has certain advantages:

  • Build trust, rather than dependence on the therapist.
  • Allows you to do group presentation tasks.
  • Allows you to make a public commitment, which increases motivation.
  • The person perceives that there are other people with the same problem.
  • Create social resources.

Group therapy

Other cognitive-behavioral techniques for SF include role-playing and training in social skills, which may be part of group therapy.

Medication

Medication can be used to decrease symptoms associated with FS, although it is not a cure; if the medication is stopped the symptoms reappear. Therefore, medication is most useful when taken in conjunction with therapy..

Three types of drugs are used:

  • Beta-blockers: used to decrease anxiety. They work by blocking the flow of adrenaline when you are anxious. They do not affect emotional symptoms, although they do affect physical symptoms such as sweating or tachycardia.
  • Selective serotonin reuptake inhibitors (SSRIs): They are the first choice as drugs. Compared to other forms of medication, there is less risk of tolerance and dependence.
  • Benzodiazepines: they act quickly although they are addictive and sedative, so they are only prescribed when other drugs do not work.
  • Selective norepinephrine reuptake inhibitors (SNRIs): have shown similar effectiveness to SSRIs. Some are venlafaxine or milnacipran.

Self help tips

Challenge negative thoughts

If you have FS, it is very likely that you have negative thoughts and beliefs that contribute to anxiety. You may have thoughts like:

  • "I'm going to look like a fool".
  • "I am going to feel nervous and I will be humiliated".
  • "People will think I'm incompetent".
  • "I have nothing to say".

Challenging these negative thoughts on your own or in therapy is one way to reduce the symptoms of FS. First, identify what negative thoughts are under your fear of social situations.

Then challenge them and change them for more positive and realistic ones, with questions like:

  • Am i sure you look incompetent?
  • Are you sure I have nothing to say?

Here are some common thought patterns in FS:

  • Mind reading: assuming that you know what other people are thinking and that they see you in the same negative way that you see yourself.
  • Predicting the future: assuming the worst will happen.
  • Catastrophic thoughts: taking things out of their real importance. For example, believing that if people notice that you are nervous it will be terrible or disastrous..
  • Personalize: assuming that people focus on you in a negative way.

How to stop thinking that everyone is looking at you?

To reduce self-attention, pay attention to what is happening around you, rather than observing yourself or focusing on your anxiety symptoms:

  • Observe the people in your environment.
  • Listen to what is being said, not your thoughts.
  • Don't take full responsibility for trying to get conversations going, silences are fine and the other can contribute.

Control your breathing

A change in your body when you are anxious is that you begin to breathe rapidly, which leads to other symptoms such as nausea, dizziness, hot flashes, rapid heartbeat or muscle tension..

Learning to control your breathing can help you reduce these symptoms. You can practice this exercise:

  • Sit comfortably and straight in a chair, leaving your body relaxed. Put one hand on your chest and the other on your stomach.
  • Breathe in slowly and deeply through your nose for four seconds. The hand on your stomach should rise, while the hand on your chest should move very little.
  • Hold your breath for two seconds.
  • Breathe out slowly through your mouth for six seconds, expelling as much air as you can. Your stomach hand should move as you exhale and your other hand should move little..
  • Continue breathing through your nose and expelling through your mouth. Focus on breathing slowly in a pattern of: inhale for 4 seconds, hold for 2 seconds, and exhale for 6 seconds.

Practice relaxation techniques

In addition to deep breathing exercises, regular practice of relaxation techniques such as yoga, medication, or progressive muscle relaxation will also help you control anxiety symptoms..

Visit this article to learn them.

Face your fears

One of the most valuable things you can do to overcome SF is to face your fears of social situations.

Avoidance keeps the disorder going; Although it makes you more comfortable in the short term, it prevents you from being more comfortable in social situations that you will have to face.

Avoidance keeps you from doing things you would like to do, reaching certain goals, or participating in social activities.

Follow these tips:

  • Face situations little by little: if you are afraid to speak in public, do not face a room of 100 people. For example, start by participating in groups by raising your hand. Subsequently, begins to do increasingly difficult activities.
  • Be patient: overcoming FS requires practice and patience. It is a gradual process and in the beginning it is normal that things do not go as well as you would like. The most important thing is to act.
  • Use the skills explained above to stay relaxed.
  • Build personal relationships

The following tips are good ways to start interacting with other people:

  • Take social skills classes.
  • Participate in a volunteer.
  • Work on your communication skills.
  • Sign up for social activities such as group sports, workshops, dance ...
  • Change your lifestyle.

The following tips can help you reduce your anxiety levels in social situations:

  • Avoid or limit caffeine: coffee, tea, or energy drinks act as stimulants that increase your anxiety symptoms.
  • Avoid alcohol: or at least drink in moderation. Alcohol increases your chances of having an anxiety attack.
  • Quit Smoking - Nicotine is a strong stimulant that leads to higher levels of anxiety.
  • Get enough sleep: When you are sleep deprived, you are more vulnerable to anxiety. Being rested will help you to be relaxed in social situations.

References

  1. Furmark, Thomas. Social Phobia - From Epidemiology to Brain Function. Retrieved February 21, 2006.
  2. Studying Brain Activity Could Aid Diagnosis Of Social Phobia. Monash University. January 19, 2006.
  3. National Center for Health and Wellness Causes of Social Anxiety Disorder. Retrieved February 24, 2006.
  4. Okano K (1994). "Shame and social phobia: a transcultural viewpoint". Bull Menninger Clin 58 (3): 323-38. PMID 7920372.
  5. Stopa L, Clark D (1993). "Cognitive processes in social phobia". Behav Res Ther 31 (3): 255-67. doi: 10.1016 / 0005-7967 (93) 90024-O. PMID 8476400.
  6. BNF; British Medical Journal (2008). "Anxiolytics". UK: British National Formulary. Retrieved December 17, 2008.
  7. Thomas Furmark (1999-09-01). "Social phobia in the general population: prevalence and sociodemographic profile (Sweden)". Retrieved 2007-03-28.

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