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Social Anxiety Disorder

    Social Anxiety Disorder

    Social anxiety disorder is a mental disorder that leads to severe anxiety, fear, and distress in social situations. This condition can significantly impair your ability to function in daily life.

    What Is Social Anxiety Disorder?

    Social anxiety disorder, also known as social phobia, is associated with severe anxiety and fear in social settings, such as public gatherings, meetings, social events, public performances, etc 1. People suffering from social phobia are always apprehensive about negative scrutiny and public humiliation.

    They may be wary of attending social events, forming new relationships, appearing for a job interview, eating in front of others, etc. Social phobia can manifest itself as anxious and fearful behavior in social settings and can also involve a number of physical and mental symptoms, such as blushing, sweating, and shaking.

    People with social anxiety disorder tend to have unrealistic standards for their own social behavior and underestimate their ability to cope with a social situations 2.

    They often resort to “safety behaviors” 3 such as avoiding certain situations or focusing excessive attention on their minute movements in order to deal with the stress. They also have a tendency to ruminate about a single event or interaction and scrutinize every aspect of it.

    The worldwide prevalence of social anxiety disorder is 5 to 10% 4 and the lifetime prevalence is around 8.4% to 15%. Women are more commonly affected than men.

    Shyness Vs. Social Anxiety

    Social anxiety is often confused with shyness. However, a person who is shy in certain social situations might gradually be able to overcome the feeling on their own. On the other hand, social anxiety disorder is a more severe condition that affects a person’s quality of life and well-being on a regular basis and usually requires professional help.

    Case Example

    Jisha, a 28 year old copywriter, was plagued with the feeling that everyone was constantly judging her. She always wore a baseball cap or a hoodie in public, claiming that it made her feel safe from the scrutinizing gaze of people around.

    Ever since childhood, Jisha had been labeled as the “shy” girl who struggled to make friends. Even as an adult, she often had a hard time conversing with people, and maintaining eye contact.


    If she so much as had to make a phone call to place an order, her heart would start racing and she would pace for a good fifteen minutes before getting around to it.

    She had a habit of going over every single conversation in her head, repeatedly analyzing everything she had said or done, and criticizing herself for not being confident enough.

    Jisha’s fear of social interactions regularly slowed her down and caused her an immense amount of distress. Her acquaintances and colleagues often misperceived her behavior as arrogance or laziness, which increased her sense of guilt and loneliness.

    However, Jisha was actually suffering from the debilitating condition of social anxiety disorder and had little control over her symptoms.

    Symptoms Of Social Anxiety Disorder

    Social anxiety disorder symptoms involve physiological, behavioral, and cognitive signs of severe anxiety and fear. These have been discussed below:

    Symptoms Of Social Anxiety Disorder
    Social Anxiety Disorder

    1. Physiological Symptoms

    Social phobia induces a “fight-or-flight” response in its sufferers and this gets manifested in a number of physiological responses 5 . These may include:

    • Blushing
    • Excessive sweating
    • Palpitations
    • Nausea
    • Shaking or trembling
    • Breathing problems
    • Fainting
    • Inability to walk properly
    • Crying
    • Disjointed speech

    2. Behavioral Symptoms

    Severe anxiety disorder causes people to be overtly self-conscious in their personal perceptions and assessment. They are burdened by dreads of scrutiny, criticism, judgment, and underperformance in social contexts. Because of this, they may display the following behavioral symptoms 6:

    • Avoidance behavior (such as avoiding eye contact, physical contact, making conversation, etc.)
    • Awkward self-presentation
    • Withdrawing from social situations
    • Insecure, nervous, and unconfident behavior, etc.

    3. Cognitive Symptoms

    Social anxiety also involves a number of cognitive symptoms 7, which include the following:

    • Unrealistic social standards
    • Inability to select attainable social goals
    • Perception of self as a social object
    • Anticipation of negative evaluation from others
    • Negative interpretations of neutral events

    Causes Of Social Anxiety Disorder

    Social phobia has been examined from multiple perspectives—ranging from psychiatry and neuroscience to sociology and cultural studies. However, research is yet to uncover its exact causes. Some risk factors believed to influence the onset of social anxiety disorder are discussed below:

    1. Biological Causes

    Social anxiety disorder can be a result of genetic causes or dysregulation within the brain.

    A. Heredity

    Like any other behavioral disorder, social anxiety disorder shows great heritability 8. Research 9 suggests that a person is at a two- or three-fold greater risk of having social anxiety disorder if a first-degree relative already has it.

    B. Brain chemistry

    Research 10 has attributed the pathological causes of social phobia to neurotransmitters (such as dopamine, glutamate, serotonin) and increased activity in the limbic regions of the brain.

    A 2007 meta-analysis 11 suggests that individuals with a social anxiety disorder may have hyperactivation in the amygdala, the dorsal anterior cingulate, and insula areas—which are frequently associated with fear and negative emotional processing.

    2. Psychosocial Causes

    There are several psychosocial 12 and developmental risk factors that may make a person more prone to social phobia. A 2007 study 13 states that people who are inclined to inhibited shyness, unexpected bursts of emotions, lack of internal control, avoidant behavior, and interpersonal sensitivity are more susceptible to social anxiety.

    Some other factors that might play a role in the development of social phobia are:

    A. Temperament

    Temperament 14 is the early occurrence of traits or range of characteristics that go on to form a personality. Temperament research suggests that people who had a higher level of behavioral inhibition (BI) as children are more likely to eventually develop social phobia.

    B. Childhood environment

    The degree to which a child is exposed to social situations can be a crucial factor in determining whether they will grow up to be socially anxious. Restricted exposure can prevent a person from learning appropriate social skills. Moreover, if a child grows up around people who are also socially anxious, it is more likely that they will also learn the same behavior.

    C. Parenting style

    It has been seen that overprotection on the part of a parent can lead to social withdrawal in children. This can often develop into a social anxiety disorder. “Helicopter parenting” 15, a kind of parenting that involves a high level of involvement on the part of the parents, has also been found to be associated with social anxiety.

    D. Traumatic experiences

    First-hand negative social experiences involving public criticism and humiliation are potential triggers for social phobia. Some experiences that can lead to its onset include:

    • Bullying and harassment
    • Peer and parental pressure on children and adolescents 16
    • Emotional abuse involves intimidation, gaslighting, competitive berating, negative appraisal, etc.

    Diagnosing Social Anxiety Disorder

    According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5, social anxiety disorder can be diagnosed 17 if a person has been experiencing debilitating fear in one or more social situations where they are exposed to “possible scrutiny” by other people, for a period of more than 6 months. The fear experienced should be out of proportion to the threat.

    Mental health practitioners may examine self-reported data, patient history, symptoms, and other behavioral patterns 18 to arrive at a definite diagnosis. Certain assessments may also be used 4 for the diagnosis of social anxiety disorder such as:

    • Social Phobia Inventory (SPIN)
    • Liebowitz Social Anxiety Scale (LSAS)
    • Liebowitz Self-Rated Disability Scale
    • Brief Social Phobia Scale (BSPS)
    • Social Phobia Safety Behaviors Scale
    • Self Statements During Public Speaking Scale, etc.

    Social Anxiety Disorder Treatment

    Treatments for social anxiety disorder can include therapy or medication. Some of the most common treatment approaches are mentioned below:

    1. Psychotherapy

    Studies have found various psychotherapy treatment approaches to be effective for social anxiety disorder. Some of them have been elaborated on below.

    I. Cognitive behavioral therapy (CBT)

    Cognitive behavioral therapy (CBT) is currently considered the “gold standard” 19 psychological treatment approach for social phobia. Studies 20 show that CBT induces healthy self-focused attention and self-perception, and leads to reduction 21 of social withdrawal symptoms 22.

    About 56% to 95% of patients suffering from social anxiety disorder find respite by CBT 23.

    Read More About CBT Here

    II. Group psychotherapy

    Group psychotherapy 24 has been proven to be quite effective for treating social anxiety disorder. In fact, cognitive behavioral group therapy for social phobia (CBGT) is the most validated approach to treating severe social phobia.

    It is both an educational and supportive therapy. It enhances social skills while also addressing problems faced in socialization. Social self-appraisal therapy is another form of group therapy that focuses on addressing issues 25 of social skills and self-perceptions via discussions, video feedback, audio feedback, mirror exposure,etc. .

    III. Acceptance and commitment therapy (ACT)

    Acceptance and commitment therapy (ACT) 26 enables people to practice self-acceptance and meaningful communication 27. In a 2014 study 28, it was found that ACT predicted better outcomes post-treatment in over 39% of patients suffering from social anxiety disorder.

    2. Medication

    Selective serotonin reuptake inhibitors (SSRIs) 29, a second-generation antidepressant 30 is the most preferred form of medical treatment for social anxiety disorder 31. Some commonly used SSRIs are:

    • Paroxetine 32
    • Sertraline
    • Escitalopram 33
    • Venlafaxine XR
    • Fluvoxamine CR (luvox CR) 34.

    Research 35 shows that SSRIs help reduce general anxiety 36, hostility, and frenzied behavior.

    In most cases, a combination of psychotherapy and SSRIs is used to treat severe social anxiety.

    Myths About Social Anxiety

    Social anxiety disorder is an underdiagnosed anxiety disorder, a fact that can be attributed to the misunderstanding surrounding it. Some of the myths regarding social phobia have been countered below.

    1. Social anxiety is not the same as introversion

    Social anxiety disorder is sometimes confused with shyness or introversion. However, it should be noted that while introversion is simply a normal personality type, social anxiety disorder is a more severe condition that warrants treatment.

    2. Social phobia is different from specific phobias

    Social anxiety disorder, though synonymously termed as “social phobia”, should be differentiated from specific phobias like claustrophobia, hydrophobia, and the like. According to a 2003 study 37, social phobia is different from other phobic disorders by the characteristic age of onset in the mid-teens and greater ratio of women to men.

    3. Social phobia is different from other anxiety disorders

    The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) prescribes specific criteria for the diagnosis of social anxiety disorder 17 which is different from other disorders, such as generalized anxiety disorder. [Read more]

    Social phobia may sometimes manifest in a panic attack, which is a key symptom of panic disorders 38. However, symptoms of social phobia can be differentiated by their confinement to situational encounters 39.

    Read More About Panic Disorder Here

    4. The “fear” in social anxiety is very distinct

    The most common symptom of social anxiety disorder is extreme and persistent fear of embarrassment and humiliation while participating in social activities.

    This fear 40 often results in self-defeating thoughts, ambiguous actions, cognitive distortions, and awkward self-presentation. One must be careful that this fear is not the effect of substance abuse or a different medical or psychological condition.

    Living With Social Anxiety Disorder

    Everyday life can be quite exhausting if you have social anxiety. It can often lead to other mental disorders such as depression and greatly affect your well-being.

    Some self-help strategies for social anxiety that can go hand-in-hand with professional treatment have been mentioned below.

    1. Recognize your symptoms and triggers
    2. Practice mindfulness
    3. Try participating in small support groups, like clubs, travel groups, etc.
    4. Practice small-scale networking to broaden social horizons at a healthy and acceptable pace
    5. Engage in stress management techniques, such as yoga 41, meditation 42, deep breathing exercises, muscle relaxation techniques, 43, etc.
    6. Indulge in leisure activities like journaling, taking long walks, making art, 44 or doing any other hobbies that may give you pleasure.
    7. Be patient with yourself throughout the process of recovery.

    Takeaway

    Social phobia is one of the most common but widely underdiagnosed anxiety disorders. If not treated, it can interfere with your quality of life, career, and relationships. Early diagnosis and effective treatment (involving therapies, medication, self-help strategies, etc.) can significantly help manage and overcome the effects of social anxiety disorder.

    At A Glance

    1. Social anxiety or social phobia is the fear linked to being in social settings.
    2. Its causes can range from genetic to psychological, biological, and socio-cultural factors.
    3. Severe social anxiety manifests in negative emotions, avoidance and safety behaviors, disjointed speech, etc.
    4. The symptoms of social anxiety involve blushing, palpitation, excessive sweating, breathing problems, fainting, etc.
    5. If untreated, social phobia can lead to a number of severe physical and mental health conditions.
    6. Social anxiety disorder also has negative effects on a person’s quality of life, reputation, career, and relationships.
    7. The treatment for social anxiety includes both psychotherapies and medication.
    8. Social phobia can be managed better with healthy coping strategies.

    Frequently Answered Questions (FAQs)

    1. Is social anxiety a mental illness?

    Social anxiety disorder is a form of anxiety disorder that leads to severe distress and anxiety in social situations. It is considered to be a mental disorder.

    2. Do I have social anxiety?

    If you dread social interaction and are afraid of public humiliation, embarrassment, etc. to a point where it significantly affects your wellbeing, you might have social phobia. However, this is very different from shyness or having an introverted personality. For an accurate assessment and diagnosis, it is advised that you consult a mental health professional.

    3. What does it mean to have social anxiety?

    A person has social anxiety if they fear social interaction or social events. A social context triggers social phobia, resulting in symptoms such as blushing, sweating, breathing problems, fainting, etc.

    4. Can social anxiety be cured?

    Social phobia is a very common anxiety disorder that can be easily treated with the help of therapy and/or medication. It can also be managed with the help of certain healthy coping techniques.

    5. How do we help someone with social anxiety?

    The key to helping someone deal with social anxiety involves free communication, patience, and understanding. Focus on their feelings and body language and listen patiently. Try distraction techniques (such as laughter, games & discussing hobbies) to ease their social stress. Most importantly, encourage them to seek help.

    6. How to overcome social anxiety disorder naturally?

    Some natural remedies for social anxiety disorder include yoga, meditation 45, and exercise 46 among other techniques.

    7. What are the most common social phobias?

    Studies have identified two main types of social phobia: the speaking-only phobia, which is characterized by a fear of public speaking, and the complex social phobia, characterized by a fear of multiple social situations 47.

    8. How is social anxiety disorder different from other anxiety disorders?

    Social anxiety disorder is different from other anxiety disorders as it specifically involves a fear of social situations.

    9. How can you prevent social anxiety disorder?

    Since social anxiety disorder usually begins in childhood, prevention techniques are focused around improving the developmental environment, such as the home and school. Certain measures to prevent peer victimization in schools have been proven to be effective in combating the risk of developing social anxiety 48.

    10. Is social anxiety disorder more common in poor people?

    Social anxiety disorder has been found to have a significant association with a lower socioeconomic status. 49

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