Social Phobia

Social Anxiety Disorder (SAD) can affect people of any age; however, it typically emerges during early to middle adolescence.

Social Anxiety Disorder (also known as Social Phobia) is a condition in which people experience significant and sometimes paralyzing symptoms of anxiety in social situations, based on core deep fears related to evaluation and judgement by others. This anxiety and fear not only impedes an individual’s social life but also interferes with everyday activities, school, and professional life.

About 75% of SAD sufferers experience symptoms by age 13. SAD is influenced by the onset of puberty and associated hormones and physical changes, as well as the evolving and increasingly complex social networks and changes in the maturing teen brain.

Individuals with SAD are often socially inhibited and shy as young children and report a specific socially-humiliating experience prior to onset resulting in the avoidance of such experiences in the future.

The disorder is divided into the following two categories:
Generalized- symptoms are present in most social situations, and
Non-Generalized- symptoms are present in a select few social situations.

Children with this disorder may exhibit behaviors and traits such as crying, tantrums, clinging to familiar people, extreme shyness, refusing to speak in front of their class, and fear or timidity in unfamiliar settings and with unfamiliar people. Children diagnosed with SAD experience anxiety with their peers as well as with adults, but they do have the capacity to form social relationships with familiar people. SAD is harder to diagnose in children because they do not have the ability to describe the nature of their anxiety as effectively as adults. The disorder may therefore go unrecognized even though the child shows symptoms of the disorder. In children, Social Phobia may be intertwined with Separation Anxiety.

SAD typically emerges during adolescence in teens who have a history of a social inhibition. Females have 50% higher likelihood to be impacted than males. The lifetime prevalence of Social Anxiety Disorder is 13.6% in ages 18-29 and 6.9% for 17-18 demographic with 30% of annual cases classified as severe.

Children with SAD also report difficulty being assertive, feelings of inferiority, and a hypersensitivity to criticism and other negative judgments often leading to excessive anger.

This hypersensitivity also results in fear of others making both direct and indirect judgments. They may have extreme test anxiety or refuse to participate in class which compromises academic performance and may lead to avoidance of or dropping out of school.

It is more difficult for those with Social Phobia to develop intimate relationships. Research shows that left untreated, they are less likely to marry, less likely to have fulfilling friendships, and more likely to live with members of their biological family. Severe cases may experience suicidal thoughts, or development of substance abuse or other disorders.

As with other anxiety disorders, symptoms are experienced across emotional, cognitive, and physical domains; each of which play a role in the cycle of anxiety.

Physical symptoms can be visible or non-visible; acute or pervasive:

• Excessive sweating
• Blushing
• Muscle twitches/spasms
• Shaking and tremors
• Difficulty swallowing/dry mouth
• Increased heart rate
• Trouble catching one’s breath
• Dizziness or feeling faint
• Feeling like one’s mind has gone blank
• Upset stomach or nausea

Cognitive symptoms range from interpretations, predictions, memories  and often include the following “cognitive distortions:”

• Perfectionism – Setting unrealistic or excessive goals in social situations yet feeling like a failure for not meeting or exceeding the unrealistic goals.
• All-or-Nothing Thinking – Seeing interactions in black – or – white terms and if all does not go smoothly they feel dissatisfaction with their performance.
• Mind Reading – Assuming people are responding negatively without any clear evidence or without checking to find out what the person is really thinking.
• Discounting the Positive – Minimizing or forgetting positive social experiences and focusing only on times of embarrassment or discomfort.
• Looking for Flaws – Focusing on the smallest flaws in a social interaction, despite many positive aspects that are present.
• Overgeneralizing – Interpreting one negative event as representing a frequent pattern.
• Emotional Reasoning: Asserting that feeling something strongly is evidence that it must be true.
• Turning Predictions into Facts – Predicting a negative outcome and believing that the prediction is true.
• Believing you are the Center of the Universe – Assuming someone else’s behavior was caused by something the individual said or did.  
• Creating a False Theory of Relativity – Assuming that other people who appear strong do not have any weaknesses, when in fact they do.

Behavioral symptoms are actions done or avoided to prevent, decrease or reduce the symptoms of anxiety Check order

• Avoiding uncomfortable situations (public performance or interaction with others)  
• Acting passively or withdrawn    
• Using alcohol or substances to manage situations
• Avoiding eye contact
• Wearing makeup to cover blushing  
• Asking for reassurance    
• Apologizing excessively

Emotional symptoms the following are the most common feelings for sufferers of social anxiety Check the order of items  

• Self-consciousness
• Feeling misunderstood
• Feeling alone or trapped
• Restricted from living a “normal” life
• Life/world is getting smaller
• Like a failure
• Uncertainty, hesitation, lack of confidence

Prevalence of Social Phobia

In the 17-18 year old demographic, the lifetime prevalence of Social Phobia is 6.9%. In the 18-29 year old age demographic, the lifetime prevalence of Social Phobia is 13.6%. About 30% of annual cases of Social Phobia are classified as severe. Social Phobia typically emerges during adolescence in teens with a history of social inhibition. Females are 50% more likely to be impacted than males.

For many, CBT and ERP combined with medication provide much-needed relief for people suffering from Social Anxiety.

The evidenced-based treatment for Social Anxiety Disorder is Cognitive Behavioral Therapy (CBT), more specifically Exposure and Response Prevention (ERP). ERP involves the gradual exposure and habituation to triggering anxiety-inducing events (a feared object, situation, or place) to help people learn new ways of coping with their anxiety. It is called “response prevention” because the goal is to modify the habitual unhelpful response/thoughts and replace them with healthier behaviors and thoughts. ERP is an intensive practice of repeated exposures to the trigger.

Anxiety and Depression Association of America, ADAA:
https://adaa.org/understanding-anxiety/social-anxiety-disorder

Henderson, L., Gilbert, P., & Zimbardo, P. (2014). Shyness, social anxiety, and social phobia. Social Anxiety: Clinical, Developmental, and Social Perspectives, 95.

Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376.

National Institute of Mental Health (NIMH):
An organization with the National Institute of health dedicated to mental health research:
http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml

https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml