Leliana Valentina Parvulescu

What is social phobia?

Psychology Hour
Dr. Leli

Social phobia (or social anxiety disorder) is a particularly widespread disorder in today’s society; it is part of the so-called anxiety disorders, a large group of disorders in which fear and anxiety are the predominant features. Fear is the emotional response to imminent danger, which may be real or perceived. Whereas anxiety is the anticipation of a future threat and is manifested by a behavior of psychological and muscular tension, preparatory vigilance, caution, avoidance behavior (eg, not participating in situations known to trigger anxiety).

We have all experienced these feelings in some circumstances of life, but in the case of social phobia they become excessive, they are triggered by non-threatening circumstances (for example, public speaking, meeting new people, going to dinner or parties). They are also permanent, last for many months, sometimes years, and are disabling, meaning they prevent normal daily activities and social relationships. Excessive fear and anxiety also occurs due to social interactions (meeting new people, public speaking) and the person’s fear of being observed, scrutinized while talking, eating, drinking, or even being judged, humiliated, or rejected. People suffering from this disorder will try as much as possible to avoid contexts considered dangerous and may wonder how others cope with the same situations so calmly.

Social phobia has an average prevalence (i.e. the number of cases in a given population) in Europe of about 2.3% and manifests itself from childhood (around the age of 8-13), rarely in adults and is more common in women. The disorder lasts for several months (more than 6 months), and in about 60% of untreated people the course is several years or even longer.

As with anxiety disorders and other mental disorders, the exact causes of social phobia are unknown, but there are factors and characteristics that contribute to the development of the disease; however, it should be noted that the phobia can develop in a more insidious way than a simple cause and effect mechanism.

Leliana Parvulescu

The most important risk factors are:
Biological factors: amigdala (centrul de gestionare a emoțiilor din creier) este hiperactivă în cazurile de fobie socială.
Behavioral traits: the tendency to behave with inhibition, shyness and fear of negative evaluations.
Stressful or humiliating experiences: history of abuse, bullying, domineering and authoritarian parents.
Life changes that require new social roles: promotion at work, divorce.
Genetic/familial factors: behavioral traits and environment interact and may increase the risk of developing the disease in first-degree relatives of people with social phobia.

In addition to the symptoms of anxiety and fear, there are the typical physical symptoms of “attack and flight” (activation of the whole organism to be ready, if necessary, to either fight the enemy or to flee), which are: restlessness, irritability, restlessness, tremors, muscle tension, sweating, increased heart rate, mild fatigue, difficulty concentrating or memory loss, sleep disturbances. The person fears that they will exhibit symptoms of anxiety (flushing, trembling, sweating, stuttering, etc.) and that they will be judged negatively, humiliating, embarrassing, will lead to rejection, or will be offensive to others. If a person is afraid, for example, of trembling, he will avoid drinking, eating, writing; if he is afraid of sweating, he will avoid touching or shaking someone’s hand; if she is afraid of blushing, she will avoid speaking in public, using bright lights, or having heated or intimate conversations. Some people are afraid to use public toilets in the presence of other people (shy bladder syndrome). At children, these emotions can be manifested by crying, tantrums, holding back, clinging, withdrawal or inability to speak (mutism). Adolescents have more extensive avoidance behaviors than younger children, while older adults have lower levels of anxiety but in a wider range of situations that may be related to the decline of certain functions such as vision, hearing or other medical conditions.

Social interactions are avoided or, if not possible, endured with intense fear and anxiety. Avoidance strategies may involve similar situations (not going to all parties, avoiding school, dinners with strangers) or may be less obvious (excessive preparation of the text of a speech, limiting eye contact).

Despite the significant impact on daily life due to social phobia, only half of people seek help and, on average, after 15-20 years of symptoms. Therefore, the repercussions are numerous on professional, social and emotional life, such as dropping out of school or work, unemployment, decreased well-being and quality of life, lack or absence of meaningful relationships and recreational activities, depression.

The treatment of social phobia is mainly based on psychotherapy, although some drugs can also be used, but with the risk of altering cognitive abilities (thinking, memory, etc.) Psychotherapy teaches people to recognize and control their false thoughts about the perceived threat and replaces them with more functional behavior. The so-called exposure therapy is a technique that consists of controlled exposure to the situation that causes anxiety (for example, public speaking) in order to realize that the consequences are not dangerous.

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