Social phobia: manifestations and treatment

Social phobia is a mental disorder that, in conditions where a person can become the object of attention from others, is accompanied by a pronounced fear of performing certain social actions. Like agoraphobia (fear of open spaces) or the fear of moving away from one’s home (according to the American classification ), it is included in the cluster of anxiety- phobic disorders. Often, the term social phobia is used to denote a pronounced fear of social interaction . 

Like other phobias, social phobias can be accompanied by a decrease in social adaptation. A person suffering from this disorder, as a rule, is aware of the irrationality of his fears, but, nevertheless, stubbornly tries to avoid those situations of social interaction in which it manifests itself.

Manifestations of social phobia

An unmotivated fear of certain social actions and the desire to avoid them are basic manifestations of social phobia. As a rule, the social phobia (as a person with this disorder is called) has several situations in which he feels uncomfortable. This can be public speaking, visiting cafes and restaurants, the need to communicate with strangers or representatives of the opposite sex, etc. similar – if in them he may encounter attention from others. In other cases, the social phobia feels completely free and does not avoid social interaction.

Cognitive manifestations of social phobia

People who have social phobia are horrified at the thought of being watched by someone else and may be judged by outsiders. Most often, in thinking, they tend to concentrate too much on themselves, their appearance or behavior and make excessive demands on themselves. The ability to draw attention to their actions causes an irrational fear in such a person, endless replaying of scenarios in the thoughts of the development of the situation, anticipation of their mistake – these are the most pronounced cognitive manifestations of social phobia. In the event that an unpleasant event does happen, the social phobia repeatedly scrolls it through his memory, scolds himself for mistakes and, as a result, reinforces the negative experience. Memories of uncomfortable social interactions become a source of fear in the future.

Behavioral manifestations of social phobia

The behavior of a person suffering from social phobia is aimed at avoiding frightening circumstances. Depending on what kind of situations of social interaction cause expressed anxiety, a person with this type of phobic disorder may avoid visiting catering establishments, signing documents in the presence of strangers, communicating with strangers, visiting official institutions, taking oral exams, etc. P. Efforts to avoid frightening interactions with other people are the most prominent behavioral manifestations of social phobia.

Most of the people suffering from social phobia admit that these fears are not justified, but, unlike healthy people, who may also experience anxiety before, for example, a public speech, social phobes cannot overcome their phobia and, as a result, their social adaptation is significantly reduced. … Behavioral manifestations of social phobia can become a diagnostic sign of this disorder only if they cause discomfort in the functioning of the personality and last a significant period of time (at least six months).

Physiological manifestations of social phobia

The bodily phenomena caused by the fear of attracting attention from strangers or being negatively evaluated are similar to those observed in other anxiety disorders. They are caused by the release into the blood of a substance such as adrenaline, a hormone in response to danger.

This physiologically active compound has a stimulating effect mainly on the sympathetic nervous system: pulse and respiration become more frequent, blood pressure rises – the human body comes in a state of readiness to repel a threat in one of two ways: attack or flight. This mechanism developed as a result of human evolution, when the mobilization of physical resources was required to avoid danger: strength and endurance. In a situation of social interaction, a person does not need to run away or attack a predator, but physiological reactions to a threat that have been fixed for many centuries have been preserved. 

Physiological manifestations of social phobia – excessive sweating, feeling of fever or chills, dizziness, flushing, tinnitus, tunnel vision, and the like . Is the result of the effect of the stress hormone on the human body.

Under the influence of adrenaline, the work of the digestive organs can slow down, as well as the concentration of sugar in the blood can sharply increase. But the effect of these substances is limited in time – about 30-40 minutes. After the splitting of adrenaline, a person feels overwhelmed, the body trembles, and thirst appears.

The spectrum of unpleasant sensations that a social phobia experiences in an uncomfortable situation of interaction with other people resembles a panic attack. The main difference between social phobia and panic disorder is that with it one or several (limited) situations can be distinguished in which a person experiences such pronounced psycho-vegetative reactions, and a panic attack arises spontaneously and does not depend on external factors.

The prevalence of social phobia

As a rule, the formation of social phobia occurs during adolescence. This disorder is relatively rarely diagnosed because people suffering from it rarely seek specialized help and try to adapt on their own. Unexpressed manifestations of social phobia may be virtually invisible to others and do not have a significant impact on a person’s daily activity. 

The prevalence of social phobia not complicated by comorbid (concomitant) diseases is estimated according to various sources at 3-13% of the adult population.

Social phobia and comorbid disorders

Social phobia can be lifelong, intermittent or progressive . Over time, the development of the disorder can lead to an increase in the range of circumstances of social interaction that cause severe anxiety, and, therefore, significantly limit the scope of functioning. Without psychiatric or psychotherapeutic help, a social phobia may develop concomitant disorders of the affective and anxiety spectrum: depression, agoraphobia, panic attacks, etc. In addition, the constant internal tension associated with the need to publicly perform certain actions (which was previously called expectancy neurosis) can provoke the use of alcohol or drugs, which leads to the development of addiction. Some studies have shown that social phobia often precedes disorders such as post-traumatic stress disorder (PTSD), depression, eating disorders, and others.

Social phobia and comorbidity (comorbid disorders) – worsens the prognosis of the course of both diseases and significantly reduces the quality of life. In addition, suicidal thoughts and intentions are more often detected in social anxiety disorders than in healthy individuals.

Diagnosing social phobia

Social phobia is a mental illness and is listed in the tenth edition of the International Classification of Diseases under F40.1.

The diagnosis of social phobia is based on clear criteria:

  • Persistent fear and pronounced anxiety about a limited number of situations of social interaction with the risk of close attention of others should be observed for a long time (at least six months).
  • The patient makes an effort to avoid frightening situations.
  • Negative emotions (fear and anxiety) are not justified, they significantly exceed the actual threat (taking into account socio-cultural norms).
  • Fear and anxiety about certain situations of social interaction limit the functioning of the individual and bring significant discomfort.

Social phobia treatment

The development of social phobia can lead not only to a limitation of the patient’s social activity, but also to the development of concomitant disorders. In order to prevent the formation of unhealthy ways of adaptation (taking alcohol or drugs, self-isolation) and other mental illnesses, timely diagnosis and therapy of social phobia is necessary.

Psychotherapy for social phobia

The most effective way to help with social anxiety disorder is psychotherapeutic work with the patient. Psychotherapy for social phobia is aimed at the patient’s gradual addiction to those social circumstances in which he experiences fear, restoration of interaction skills, and the development of more adequate reactions. The forms of psychotherapy for social phobia are cognitive-behavioral therapy, group psychotherapy and explosions. In addition, relaxation techniques are used to reduce the level of anxiety.

Medication for social phobia

The main method of biological treatment of social phobia is the use of antidepressants from the SSRI group, which restore the balance of neurotransmitters – substances that transmit nerve impulses.

Prescribing drugs that significantly reduce the symptoms of anxiety are adjuncts in the treatment of social phobia. The comparatively rapid decrease in the severity of anxiety and bodily manifestations of the disorder, which provides drug treatment for social phobia, should be used for a favorable start of psychotherapeutic work with the patient, since long-term use of anti-anxiety and sedatives is extremely undesirable. However, in most cases it is recommended to use medication in the first stage of therapy.

Prognosis for social phobia

Social phobia is a fairly well-known disease. The combination of drugs that eliminate anxiety and psychotherapeutic techniques allow the patient to cope with negative attitudes, overcome the belief in the inevitability of failure in situations of social interaction, and increase self-esteem. The prognosis for social phobia in the presence of patient adherence to treatment is favorable.

event_note June 11, 2021

account_box Winona Tse MD

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