Many people give social phobia a romantic or mysterious aura, perceive it as something funny, as a character trait, and not a disease. However, this condition is very common (it is the third most common mental disorder after major depressive disorder and alcoholism), is chronic and can provoke other serious diseases. It has a destructive effect on a person’s life: it limits his intellectual and professional development, his personal life, and leads to the emergence of addictions.
Research shows that social phobia increases the risk of subsequent development of depression by 3–3.5 times, and suicide attempts in people under 24 years of age by 6 times. Children with this diagnosis are significantly more likely to drop out of school. In the United States, 70% of people with this mental disorder have a low socioeconomic status, and 22% are unemployed.
Social phobes are less likely to start families and do not fulfill their need for relationships. But emotional closeness and contact with family and friends prevent the development of the disease.
about the charm of social phobia are wrong: this disorder never gives a person uniqueness, on the contrary, it forces this uniqueness to be hidden. Social phobia, like any anxiety disorder, is a pathological condition that greatly interferes with life.
A social phobe is often called a person who is not interested in communication and therefore does not strive for it. In reality, a social phobe greatly needs contact with other people, but is very afraid that everything will turn out badly, and fences himself off from people not as something annoying, but as alluring, but unattainable. This is not a nice, modest guy who prefers to remain silent. Modesty is a character trait, and such a person takes longer to adapt to the situation and communicates less intensively, but this is not a problem. But for people with social anxiety, communication is a problem.
How my hand trembles: how social phobia differs from shyness
Social anxiety arises from the fear that others will not accept us. It is absolutely natural for all people: it is part of the fundamental biological human need to be loved. Psychological disorder begins when anxiety begins to greatly influence a person's behavior.
The difficulty is that it is impossible to accurately measure how much anxiety affects life - today more, yesterday less. It is especially difficult to determine this impact if the person has lived with the condition almost always. There is no standard for an acceptable level of social anxiety in certain situations. Is body trembling while speaking in front of colleagues normal or is it too much? What about the complete inability to talk to the person you like? Answer a simple question to the cashier?
People with phobic anxiety disorder develop a fear of situations that are not dangerous. This usually leads to the person beginning to systematically avoid these situations. So a social phobe refuses a number of social activities - for example, he may stop eating in public, using a public toilet, talking on the phone, going on dates or making friends. A person may oppose a wedding not only because he is afraid to start a relationship, but also because he is afraid to go to an event where he will be the center of attention. Many people with this disorder are very afraid of speaking in public.
Social phobia is called the disease of missed opportunities.
However, social phobics are not necessarily shy. Shyness is only one manifestation of the disorder; but different behavior patterns are possible. Such a person may give the impression of being touchy, gloomy, irritable, or, trying to hide his fears, he may act like a cheerful person who strives to please everyone.
Causes
Social phobia develops in adolescence, between 10 and 13 years old. Fear of society very rarely arises independently after 25 years; such manifestation is preceded by prolonged clinical depression.
Attacks of social phobia are observed much more often in women. Married people with a high level of intelligence are more susceptible to this disease.
The causes of this disorder:
- genetics;
- personal behavioral characteristics;
- congenital pathologies of the central nervous system;
- mental illness.
Social phobia in adolescents begins under unfavorable upbringing conditions. Reasons for its appearance: too strict upbringing in childhood, which gave rise to a certain aggression towards others. Excessive criticism or bad experiences with the opposite sex very often become the impetus for the development of a nervous disease. The development of personality, perception of oneself and the world around them is greatly influenced by a lack of social approval, constant interpersonal and social conflicts.
The inability to perceive oneself, suppression of one's sexuality and attempts to identify oneself as a person of a different gender is also a nervous disorder and leads to a reluctance to appear in front of others.
Definition of social phobia
What is a social phobe afraid of?
With social phobia, there are four main fears: being judged by others, being humiliated or disgraced, accidentally offending someone else, and being the center of attention.
A social phobe may realize that his fears are excessive and unreasonable, but this does not make it any easier to overcome them.
Manifestations of the disorder are divided into three groups: cognitive, behavioral and physiological.
Cognitive manifestations:
- tendency to see oneself in a bad light
- horror from the gaze of other people,
- constant focus on yourself,
- disturbances in concentration,
- inflated demands on oneself.
Physiological manifestations:
- shiver,
- lack of coordination
- nausea,
- difficulty breathing,
- sweating,
- muscle tension,
- redness or paleness of the skin.
Behavioral:
- fussiness,
- shyness,
- avoiding contact with people,
- desire to run away, hide, etc.
Social phobia manifests itself quite early, on average at 11 years of age. Such children are clearly uncomfortable communicating with teachers or classmates; they avoid eye contact, speak very quietly and unintelligibly, and blush or shake when communicating. They are often afraid of saying something “stupid” or appearing funny.
Children with social phobia may pretend to be sick to avoid activities and try to spend a lot of time at home. These seemingly innocent actions may indicate that the child is developing psychological attitudes that will greatly complicate his life in the future.
Each patient will have their own manifestations, and they do not necessarily have to be many. Based on this principle, there are two types of social phobia:
- generalized - a person is very afraid of many social situations (or even all). As a rule, this form of social phobia affects a person comprehensively, its consequences are more severe, and treatment is more difficult.
- specific - a person is afraid only of certain situations, and there are few options for the manifestation of anxiety. For example, social phobia can only manifest itself when communicating with a hint of romance, during which a person’s hands begin to shake uncontrollably, an obsessive desire to escape appears, and all attention is focused on these reactions.
Possible prerequisites
When thinking about how to overcome and cure social phobia on your own, it is important to take into account one more nuance - the prerequisites for its development.
Factors influencing the development of social phobia:
- authoritarianism and cruelty of parents;
- inflated demands and expectations towards the child;
- bullying;
- comparing the child with other children in a negative way;
- ridicule by parents, teachers, peers;
- psychotrauma received in childhood or adulthood (a failed public performance, a painful breakup, etc.).
Important! Social phobia hides the fear of being rejected and the fear of not being liked or pleasing others. Social phobia is haunted by the question “What will people think/say?”
Why does social phobia appear?
As is the case with other mental illnesses and disorders, social phobia can be triggered by psychological trauma, instilled norms of behavior, and heredity. Since social phobia usually manifests itself early, its origins should also be sought in childhood. This could be a traumatic experience, a blow to self-esteem, fear of anticipation, overprotective or rejecting parents, and even heredity.
Traumatic experience
Triggers for social phobia can include bullying, domestic violence, humiliation, or long-term rejection by peers.
70% of patients with general social phobia surveyed reported that they had been exposed to at least one type of violence in childhood.
46.2% of respondents said that they experienced violence from a relative at an early age (for comparison: in the control group of people without anxiety disorders, this figure was 16.5 times lower).
A blow to self-esteem
How are anxiety reactions formed in situations that are not dangerous in themselves? In a certain situation, a person receives a low assessment from those around him who are significant to him. Circumstances change, but the person continues to perceive others as a threat to self-esteem. A persistent fear is formed that in a similar situation people will speak out in the same negative way. A researcher on the condition, Scott Stossel, described anxiety as “a premonition of future suffering, a frightening premonition of an unbearable catastrophe that there is no hope of preventing.”
Fear of waiting
Social phobia grows when there is a conflict of needs and opportunities: I want to communicate, but for some reason I can’t. This chain closes:
a person is afraid that he will not be able to perform a social action that is important to him ↓ because of fear he really cannot do it ↓ he is even more afraid
Frustration increases - suffering due to the inability to get what you want. This contributes to the development of depression due to unmet important social and biological needs.
Psychiatrist Viktor Frankl described the mechanics of phobia development as follows:
“A symptom causes the patient to fear that it may happen again, and with this comes a fear of anticipation (phobia), which leads to the fact that the symptom actually appears again, which only increases the patient’s original fears.”
Overprotective or rejecting parents
Parents can play a significant role in the formation of social phobia if they instill in their child the extreme importance of external positive evaluations and fixation on themselves. Overprotection in the family or, conversely, rejecting behavior can also have an impact. In addition, researchers have found a relationship between socially anxious, avoidant behavior of parents and the development of social phobia in children.
Heredity
Social phobia can be caused not only by external factors, but also by physiological ones:
- anatomical features of the brain - the structure of the prefrontal cortex, increased sensitivity of the amygdala and hypothalamus (these are areas associated with the formation of anxiety and fear);
- genetic - similar chromosome features were found in people with anxiety and panic disorders.
Heredity increases the likelihood of developing not only social phobia, but also any anxiety or depressive disorder, but, according to various estimates, it is no more than 25–50%.
The dangers of social phobia
Social phobia can only conditionally be called a fear of society. When taken more seriously, this disorder does not mean a fear of people as such, but a fear of certain life situations in which the individual will find himself in the public eye. In these circumstances, the social phobe experiences a pronounced fear that he will certainly find himself in a humiliating or shameful position.
And then social phobia manifests itself with many very unpleasant symptoms: anxiety, panic, rapid heartbeat, increased blood pressure, impaired breathing, dizziness, stuttering, nausea, trembling hands, increased sweating. A person may experience redness of the skin of the face and neck, dry mouth, muscle tension, and may feel internal stiffness. The patient's condition may be aggravated by a feeling of unreality of what is happening.
If social phobia is not overcome, then against its background there is a high probability of developing other diseases. Firstly, there are various mental disorders: depressive, anxiety, anorexia, bulimia, panic attacks. The desire to stop attacks of fear with alcohol-containing drinks often leads to the development of alcoholism. The combination of social phobia with other diseases greatly increases the risk of suicidal episodes.
Secondly, the increased levels of adrenaline and cortisol secreted by the adrenal glands during an attack of fear increase the activity of the autonomic system. Long-term increased activity of the autonomic nervous system can provoke the development of hormonal diseases, gastritis, peptic ulcers, ulcerative colitis, heart attack, stroke and other somatic diseases.
Why is social phobia often combined with other diagnoses?
All anxiety disorders are highly comorbid, that is, a person can simultaneously have several disorders that are pathogenetically related.
90% of social phobics have at least one other psychiatric diagnosis. Typically, social anxiety disorder appears first.
The most common accompaniments of social phobia are major depressive disorder (41.8%), panic disorders (5.5%), post-traumatic syndrome (5.4%), as well as alcoholism (48%) and drug addiction (18%). ). 25% of people with a first episode of psychosis have social phobia. In young people, addictions combined with social phobia are much more common - according to some data, in 85.2% of cases.
Comorbid disorders respond less well to treatment. For example, depression and bipolar disorder take longer to treat and are less effective if the patient also has an anxiety disorder.
The manifestations of anxiety disorders may change over time - from natural causes (chronic illness, other diseases in the background) or due to medication, incomplete or inadequate treatment. A person may begin to be afraid of something else, become suspicious, the symptoms of the underlying disorder become stronger and stronger, and it may become chronic and resistant to therapy.
Social phobia is a disease of developed countries
Social phobia is distributed very unevenly in different parts of the world. Research shows that in Western countries, 7–13% of people experience social phobia at least once in their lives, with the United States leading in the number of cases (12–13% of the population).
Social phobia is much more common in developed countries than in developing countries. In 2021, scientists surveyed 142 thousand respondents from 26 countries, 13 of which had a high standard of living, 7 - average, 6 - below average or low.
Countries with low living standards (Africa and the Eastern Mediterranean) had significantly fewer social phobics than countries where people earned a lot (North America and the Western Pacific).
On average, people experience social phobia during their lifetime:
- in high-income countries - 5.5% of the population,
- in countries with upper middle income - 2.9%,
- in low-income countries - 1.6%.
Stefan Hoffman, director of the Laboratory of Psychotherapy and Emotion Research at Boston University, believes that the prevalence of social phobia also depends on the type of society - collectivist or individualistic. Where the individual is less likely to be the center of attention, social anxiety tends to be less pronounced than in cultures that emphasize the uniqueness of everyone.
This is confirmed by the figures in the study mentioned above: in China, social phobia manifests itself throughout life in 0.5% of people, and in the USA - in 12.1%.
An Unidentified Disorder: Why Social Phobia Is Rarely Diagnosed
Scientists have calculated that, on average, social phobia lasts almost 23 years. Although it seriously affects all aspects of life, only about 20% of sufferers seek professional help, and usually only 15–20 years after the onset of symptoms. Less than 5% of people go to the doctor during the first year.
Often, such people consider social phobia to be a part of their personality that cannot be changed, or they look for the root cause of physiological symptoms.
Many children and teenagers are convinced that they will gradually outgrow this condition, but this is usually a misconception.
Social phobia is detected late and for other reasons:
- specialists do not always make the correct diagnosis;
- psychological help is stigmatized;
- the patient is afraid of being assessed by doctors;
- there is little information about effective treatment for social phobia;
- There are not enough therapeutic services.
Very often, social phobia is not diagnosed at all, and the person lives with this disorder all his life.
After the first manifestations of a phobia, a person (usually a child) subconsciously or consciously trains himself to avoid situations in which he becomes the center of attention and experiences severe anxiety. Due to this, the disorder is not so traumatic, but for the same reason it is less diagnosed. A person simply gets used to living with social phobia - to the detriment of self-realization.
Seeking help is also a social situation that the patient may avoid. Therefore, the disorder is often discovered when a person begins to treat a concomitant psychological condition that is more difficult not to recognize: addiction, panic attacks, depression.
If you think you may have social anxiety, take a test
to determine the level of social anxiety (Liebowitz scale).
Why face fear: therapy for social phobics
Social phobia is a chronic disease with a high risk of relapse. A Harvard University study confirms that it is also one of the most persistent mental disorders.
Scientists observed for 12 years how anxiety and affective disorders developed in 711 patients. At the start of the study, participants had remained diagnosed for an average of 19 years. Without treatment, 37% of participants recovered from social phobia during the experiment—this was the lowest rate among other mental illnesses studied. For comparison, generalized anxiety disorder went away on its own in 58% of participants, major depressive disorder in 75%, and panic disorder in 82%. However, with regular and long-term help, social phobia is highly treatable.
The disorder is based on a lack of social support and experience, and this cannot be compensated for with drugs alone.
At the same time, any psychotherapeutic practices are very effective: when a person discusses with a specialist for a long time what is bothering him, he feels better.
The task of a psychotherapist in the treatment of social phobia is to help the patient correct their dysfunctional thinking styles and irrational attitudes (for example, that failures in communication are inevitable) and learn to cope with traumatic situations. Due to this, a person should regain his self-esteem and develop the correct attitude towards the reactions of others. As a result, he will also get rid of the physiological manifestations of social phobia.
One of the most effective methods of treating social phobia is the cognitive-behavioral approach. This is the name given to a group of psychotherapy methods that are designed to change a person’s thoughts and/or behavior. It is believed that maladaptive behavior is often associated with a way of thinking and, if you change your thinking, you can influence problematic reactions.
ACKNOWLEDGMENTS
Many of my colleagues contributed to the creation of this guide. First of all, I would like to express my gratitude to Louis Marquini, Jean Willem van der Das, Desiree Oosterbaan and Richard van Dyck from the Readers Group association, as well as Pien van de Kieboom, Philippe Spinhoven and Louise Prisse for their assistance in editing and publication.
Many of the ideas contained in this guide come from years of work with my colleagues at the Anxiety Disorders Clinic. I also thank my secretary TillyRijkhof for her professional work. I express special thanks to Saskia Struij for her invaluable contribution to the preparation of this work.
J. W. Beek
Amsterdam,
September 1995
Over the past few years, our knowledge about the phenomenon of social phobia has expanded significantly. A large number of treatment methods have emerged that help people suffering from this disorder quickly and effectively overcome this condition. In order to increase general knowledge about social phobia and teach new methods of treating this disease, the World Psychiatric Association is introducing an educational program for professionals, as well as a self-help program for those who suffer from social phobia.
We would like to thank Mr. J. W. Beek, Professor Richard van Dyck, and for permission to use the educational program “Overcoming Social Phobia.”
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This manual outlines the basic principles of behavioral psychotherapy and special techniques that help people cope with anxiety, fear and worry.
I am sure that this approach will help people who experience inconvenience and discomfort in certain situations.
Professor J. A. Costa and Silva,
Chairman of the Committee
educational programs on social phobia
World Psychiatric Association
