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.
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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..
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..
The following situations are often stressful for people with FS:
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. ".
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.
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.
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.
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..
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.
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.
Sociability is closely linked to dopaminergic neurotransmission. The misuse of stimulants, such as amphetamines, to increase self-esteem and improve social performance is common.
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..
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..
Specify if:
Generalized: if the fears refer to most social situations.
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 most effective treatments for social phobia are cognitive behavioral.
Cognitive behavioral therapy aims to modify thoughts and behaviors for more adaptive ones.
Appropriate treatments can be:
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:
The most commonly used techniques are Beck's cognitive therapy and Ellis's rational emotive therapy..
The goals are:
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:
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:
Other cognitive-behavioral techniques for SF include role-playing and training in social skills, which may be part of group therapy.
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:
If you have FS, it is very likely that you have negative thoughts and beliefs that contribute to anxiety. You may have thoughts like:
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:
Here are some common thought patterns in FS:
To reduce self-attention, pay attention to what is happening around you, rather than observing yourself or focusing on your anxiety symptoms:
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:
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.
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:
The following tips are good ways to start interacting with other people:
The following tips can help you reduce your anxiety levels in social situations:
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