“It’s hard to imagine a person who doesn’t get nervous before an important meeting or who hasn’t turned down a date at least once because they didn’t look good enough that day (by their own standards).
But what if your whole life starts to be built around such fears and feelings of inferiority? And what if the need to speak in public or to interact in some other way causes an overwhelming fear?
Let’s figure out what causes such difficulties. Today we’ll talk about social anxiety disorder or, in simpler terms, social phobia.”
What is social phobia?
Social anxiety disorder (SAD) is characterized by intense and excessive fear and anxiety that repeatedly arise in the same or several public situations. This may include interactions (for example, during a conversation), being in the public eye, or performing. The person worries that their behavior (display of anxiety) will cause negative evaluations from others.
He tries to avoid such situations. If they are tolerated, they are with intense feelings of fear or anxiety. The symptoms persist for at least several months and are quite severe. They cause marked distress or significant impairment in personal, family, social, educational, professional, and other important areas of life.
Research says that this disorder is present in 5-10% of the world’s population, and the numbers have been increasing over the past decades. Perhaps this is due to the ever-increasing standards of society, which requires one to be even more beautiful, successful, richer, etc. Another reason may be that today people have begun to seek help from psychologists and psychiatrists more willingly, so social anxiety disorder has become more frequently diagnosed.
There are also studies that say that the prevalence of SAD is lower in countries with lower income levels and higher in countries with higher income levels. That is, the better the conditions in which people live, the more of them are afraid of being judged by others for who they are.
How does social phobia arise?
If we talk about the causes of occurrence and factors that can influence the course of social anxiety disorder, the following components can be identified.
- Biological – possible genetic and hereditary causes, as well as neurophysiological and physiological reasons.
- Social – social and environmental conditions, social status, and events and situations that happened to a person in society. For example, one of my clients couldn’t have lunch with everyone at work because her grandmother had once told her as a child that she ate like a pig, and later a classmate at university had laughed at her for leaving a lot of crumbs behind. These two incidents overlapped and led to the woman eating in the cleaning lady’s utility room, holding her food over the trash can. She was afraid of leaving trash behind and didn’t want anyone to think she was the pig from her grandmother’s message.
- Psychological – cognitive attitudes and habits of thinking, patterns of emotional response and behavioral coping inherent to a person.
If we talk about biological factors in more detail , we cannot help but recall one interesting study on monkeys. During laboratory observations, subordinate and dominant individuals were identified among them. The former spent more time alone, cautiously studying their social environment, as if analyzing what they needed to be like so that the pack would not expel them.
Biological studies of subordinate individuals have revealed signs of hyperactivity of the hypothalamic-pituitary-adrenal axis, dysfunction of the serotonergic system and dopaminergic neurotransmission. It turns out that the distribution of roles in the social hierarchy of primates can be regulated by neurophysiological mechanisms. It is logical to assume that in humans, the feeling that they are worse than others (that there is a risk of being rejected) is partly caused by biological processes in the body.
Social factors of influence include both traumatic events in early childhood (bullying, domestic violence, public humiliation), as well as role-modeling and an overprotective parenting style – children learn to fear and avoid from the example of their parents.
As for psychological factors , people with SAD are prone to automatic thoughts, most of which are self-deprecating. They believe that they behave stupidly and absurdly in social situations, and at the same time tend to evaluate their behavior much more harshly than objective observers.
People with SAD are also prone to negative beliefs about other people and social relationships. Believing that others are critical of them, they are already sure of their negative assessment. They are also characterized by increased attention to the specifics of the social situation. Their importance is often overestimated. For example, a barely noticeable stutter can be perceived as an insurmountable obstacle to communication with others, dooming them to loneliness and social isolation.
Symptoms of social phobia
What symptoms might suggest possible social phobia and the need to see a specialist?
Symptom #1: Intense fear of being the center of attention or behaving in a way that will cause embarrassment or humiliation. The person avoids situations in which this scenario could be realized.
These fears manifest themselves in social situations, such as eating or socializing in public places, meeting acquaintances by chance, being in small groups (for example, at parties, meetings, in a conference room).
People with social phobia may literally lose the power of speech when it comes to giving a presentation, become paralyzed by a passing glance from a neighbor, or even try not to leave the house during the day to minimize encounters with people.
Symptom #2: Marked emotional distress due to symptoms or avoidance of situations and the awareness that the reaction is excessive and unfounded.
That is, if you don’t like parties and refuse to attend them without regret, then there is nothing to worry about. However, if you don’t go to corporate events only because everyone will find out (and judge you for it) that you chew funny or can blurt out stupid things (but in fact you really want to have fun with your colleagues), then there is reason to think.
On a physical level, symptoms of social phobia may manifest as “standard” indicators of anxiety: flushing, trembling, rapid heartbeat, sweating, dry mouth. There may be difficulty breathing, discomfort or pain in the chest, nausea, burning in the stomach, a feeling of dizziness and unsteadiness.
Sometimes there may be a feeling that objects are not real, or that the self is distant or “not really there” (depersonalization). The person fears losing control or even dying. Hot flashes or chills, numbness, or tingling sensations may often accompany anxiety disorder.
Specific to social anxiety disorder are the fear of vomiting and the urge or fear of urination or defecation. These symptoms are often the most unbearable for people with SAD, because if this really happens, it seems that there is no strength to bear such shame.
It is important to mention that the symptoms of anxiety should appear only or predominantly in situations that cause fear, or when thinking about them. If they appear at other times, it is likely that other disorders may be involved.
How is social phobia diagnosed?
What should you do if you suspect that you or someone close to you has social phobia? There are now a large number of questionnaires, tests and scales that can be used to see if a person has any manifestations of SAD.
- Social Anxiety Questionnaire for Adults (SAQ-A30).
- Brief Fear of Negative Evaluation Scale (BFNE-S).
- Social Phobia Inventory (SPIN) questionnaire.
- Liebowitz Social Anxiety Scale (LSAS).
- Negative Self-Portrayal Scale (NSPS).
- Social Interaction Anxiety Scale (SIAS).
However, only a specialist can interpret the results as accurately as possible, so if you have taken the test and found symptoms of SAD, contact a psychiatrist or psychologist. They will talk to you and conduct the necessary diagnostics. The psychiatrist can also prescribe medications if necessary.
It is also important to consult specialists because social phobia is often comorbid with other disorders (i.e., coexists with them). Depression, dysmorphophobia, obsessive-compulsive disorder, or another anxiety disorder may be involved. Sometimes it is even difficult to determine which of them is the root cause, but this is important, as it affects treatment.
If a comorbid disorder remains unnoticed, a person may not receive the necessary therapy. Then the results will be unsatisfactory. Therefore, it is better not to self-medicate, but to contact professionals.
It is believed that SAD usually begins in early adolescence and most often persists until effective treatment is provided. However, seeking help is usually rare, late, and often accompanied by another mental disorder.
For example, a person comes to us complaining of a depressive state, of a lack of strength and desire to communicate with loved ones (and especially unfamiliar people). And already at the psychologist’s appointment it turns out that this very unwillingness is caused not by depression, but by social anxiety, which does not allow one to build a normal life, communicate and develop in society. And this ultimately leads to the emergence of depressive symptoms.
Treatment of social anxiety disorder may include drug therapy if necessary (for example, drugs containing selective serotonin reuptake inhibitors), psychotherapy. Group sessions are also effective. Moreover, the very fact that a person attends them, interacts with society – is already a powerful factor contributing to recovery.
How does social phobia affect a person’s life?
It is obvious that social anxiety disorder worsens a person’s quality of life, because the fear of being in the spotlight often leads to social isolation, problems in the professional sphere, and can also provoke various psychological problems and disorders.
Agree, if your job involves communicating with people, but you are afraid to talk to them, then achieving success in your career will not be so easy.
I had a client in my practice who spent huge amounts of money on taxis because of her social phobia. Her job required her to travel around the city a lot, she didn’t drive a car herself, and she couldn’t be on public transport because she was experiencing symptoms of social phobia. She felt sick, dizzy, and was overcome by terrible fear. She was afraid that people around her would do something to her because she didn’t fit into her own invented standard of how a person should look and behave on the subway.
Needless to say, getting rid of social phobia freed up not only psychological resources, but also significant amounts of money?
Separately, it is necessary to say what will happen if social phobia is not treated. Our brain is designed in such a way that if it does not receive refutation of information through experience, then it increasingly believes in the initial belief. That is, a person will increasingly immerse himself in his thoughts about how he is somehow different, that society condemns and rejects him. The symptoms of the disorder will begin to manifest themselves more and more strongly. This can even lead to the emergence of another mental disorder. For example, depression.
That is why it is so important to seek help as early as possible. Moreover, modern evidence-based approaches to psychotherapy show very high efficiency in treating SAD. You should also not be afraid of psychiatrists and taking medications needed to relieve anxiety. Correctly selected medications will definitely benefit mental and psychological health. Competent specialists, a correctly selected therapy regimen and a person’s desire to improve their life will definitely bear fruit.