Social phobia (sociophobia): causes, symptoms, diagnosis, treatment

Social phobia is an anxiety-phobic disorder that manifests itself in the form of an irrational fear of performing any actions that may be accompanied by attention from strangers (public speaking, doing something if someone is watching from the outside, eating in public places, visiting a public toilet, communicating with strangers, etc.). A person suffering from social phobia is afraid of being the center of attention, afraid of receiving a negative assessment of his actions by people around him, and avoids such situations in every possible way.

Social phobia does not always have a specific situational cause for its occurrence. It occurs in people of any gender, age and social category. Disorders can initiate in adolescence and young adulthood, as a consequence of psychogenic factors, and progress throughout life.

It is worth considering that many situations that cause fear in a social phobia (for example, fear of speaking in public) are often found in people without this disorder. When faced with a frightening situation, a person experiences symptoms of anxiety. However, some people may not complain about somatic disorders, but experience strong fear and fears for the outcome of the upcoming event. We can talk about the presence of social phobia syndrome if anxiety causes significant discomfort in everyday life, and the experiences are excessive and unreasonable. Social phobias are often part of depressive and anxiety-depressive conditions or are defined within the framework of certain personality characteristics.

Social phobia disorder can be isolated or generalized. Those who are isolated limit themselves to professional or social activities and present a fear of performing habitual actions in front of people, associated with anxious expectations of failure. Outside of specific situations in these areas, there is no difficulty in communication and action. For example, a person is afraid to go to interviews, make new acquaintances, communicate with people of the opposite sex, etc. Generalized includes almost all social situations outside the family circle. Avoidant behavior can seriously interfere with social and professional functioning.

Most often, people with this disorder focus on accompanying syndromes. Among patients who do not undergo treatment, the majority of people have social phobias that are practically invisible to others and do not greatly affect daily activities.

The development of social phobia is often associated with unfavorable psychogenic factors. The provoking reasons for the development of the disorder may be specific situations in a person’s life or interactions with a certain group of people. Social phobias can occur periodically or have a chronic course.

Social phobia syndrome is often combined with one or more mental disorders and addictions. Due to a lack of personal relationships and long periods of isolation, a person may turn to alcohol and drugs in an attempt to get rid of anxiety and depression. Often, social phobia can develop as part of depression, panic and anxiety disorders, obsessive-compulsive disorder, and be complicated by benzodiazepine and alcohol addiction. Possible association with bipolar affective disorder and attention deficit disorder.

Symptoms of social phobia

People with this disorder rarely go to the doctor and only when they have other concomitant disorders. Signs of social phobia can vary. The disorder appears unnoticed, both for the person himself and for his loved ones, and progresses over time. A person may refuse to participate or attend an event once, then refuse again under similar circumstances. Over time, symptoms may worsen, leading to even greater isolation.

A person suffering from social phobia is very demanding of himself. He is convinced that he will definitely disgrace himself in front of others, they will condemn him and make fun of him. Anxiety in anticipation of negative events and avoidance behavior are integral manifestations of social phobia and most often arise in connection with the possibility of being observed by strangers. The patient wants to run away, hide, and by any means avoid the circumstances that provoke his anxiety. Symptoms of social phobia include cognitive, emotional and physiological manifestations:

inflated demands on oneself and one’s behavior;
constant “playing out” in the head of situations that a person is afraid of fulfilling in life;
anxiety and fear of certain events where other people are involved;
Simply thinking about the situation may be enough to trigger a panic attack;
difficulty communicating with other people;
fear of judgment from others.

When a person is in a situation that causes him fear, or thinks about it, he may experience the following physiological and psychological disturbances:

tremor of the limbs (knees, hands tremble);
tachycardia, sweating;
possible loss of coordination of movements;
nausea, difficulty breathing, dizziness;
imperative urge to urinate
irritability, nervousness;
difficulty finding words, disruption of the sequential train of thoughts, decreased concentration.

If these symptoms bother you for a long time, this is a reason to seek specialized help.

Often, in anticipation of a traumatic situation, a person suffering from social phobia fantasizes about how all his plans collapse. Thinks through his actions in this situation and how to avoid it. A social phobe is terrified of criticism and condemnation. After the traumatic situation ends, the patient reflects on it and evaluates his actions, which seem ridiculous and shameful to him.

The disorder causes “selective blindness” to real facts. A person accepts only those facts that fit his distorted vision of the world, and rejects arguments confirming the opposite.

The need for approval and communication remains, but a person cannot overcome the fear of the hostility of others. As a result, people with social phobia may accidentally violate other people's boundaries, subsequently encountering a negative reaction, which reinforces their experiences and beliefs. Therefore, others may think that the person himself is voluntarily withdrawing from being in the company

Introduction

Such fears can be caused by imaginary or actual observation from the outside. A person with social phobia may realize that his fears of social interaction are excessive or unreasonable, but this does not make overcoming them any easier. Some people with social phobia fear a wide range of social situations, while others fear only specific ones, such as those in which they need to perform at their best. In most cases, social phobia begins to appear at an early age. 50% of those suffering from this disease developed symptoms before they were 11 years old, and 80% before they reached 20 years of age. Because the disease begins to appear so early, comorbid disorders such as depression or substance abuse may also occur. As a rule, the psychological symptoms of social phobia are supplemented by physiological ones, such as: redness of the skin, hyperhidrosis (sweating), tremors, rapid heartbeat, nausea. Stupor and rapid, slurred speech may be present. In situations involving severe stress, panic attacks are possible. Early diagnosis usually helps minimize symptoms and avoid the development of additional (comorbid) disorders such as depression. Social phobia is sometimes called the “disease of missed opportunities.”

Social phobia and sociopathy, what is the difference?

Because of the similar name, social phobia is often confused with sociopathy, but these are two different mental disorders.

Sociopathy is a dissocial personality disorder. Human behavior is antisocial. For people with dissocial disorder, their own desires come first; they do not feel obligated to do anything to others.

Unlike a social phobe, such a person does not avoid contact with other people and does not experience fear when communicating. Prone to impulsive actions and aggressive behavior. Sociopaths lack empathy, they do not feel guilt, they are not able to form attachments, the feelings and needs of other people are not important to them.

Peculiarities

Age

Since a sociopathic child does not yet know how to masterfully hide his thoughts and emotions, it will not be difficult for attentive parents to see signs of the disorder:

tries to attract attention to himself at school and at home by any means (bites, breaks windows, throws tantrums); stealthily (and maybe in front of everyone) spoils things, most often the toys of other children; does not caress towards parents, is not attached to brothers and sisters; does not find a common language with other children, is conflictual and scandalous; often throws hysterics, there are uncontrollable outbursts of anger and aggression - especially at moments when he cannot achieve what he wants; does not listen to anyone's requests; manipulates parents; does not regret what he did, does not feel guilty.

The most obvious sign of sociopathy in children is the deliberate infliction of physical pain on a living being. This results in abuse of small animals. Or the child chooses a younger and weaker one and begins to surreptitiously pinch, bite, poke, or kick him with something sharp. At the same time, he carefully observes the reaction of his victim, whose pain gives him pleasure. If sociopathy is not recognized in a timely manner, it can take on more terrible forms in adolescents. Under the influence of hormones due to puberty, psychopaths commit their first crimes at this age.

If you suspect that a child is a sociopath, you should immediately contact a psychotherapist.

Gender

According to statistics, in men, sociopathy is most often detected in early childhood. There is an assumption that it is in them that the leading factor is a hereditary predisposition to the disorder. Another feature is that in most cases they suffer from a passive form of the disease. Distinguished by high mental abilities and a penchant for rationalism, able to restrain their emotions, male sociopaths lead a double life. In public (at work, with friends) they are quite decent. Although outbursts of anger still occur, and one can see them as skilled manipulators. At home, they usually turn into real tyrants. They beat their wife, abuse their children or elderly parents.

According to the same statistics, the cause of sociopathy in women is most often psychotrauma, i.e. it is usually acquired. The most common form is active. Being overly emotional by nature, women cannot always hide their true feelings towards others. Or to be more precise, their absence. That’s why women’s work teams are often called serpentariums: the level of conflict and quarrelsomeness in them is maximum.

Causes of social phobia

Social phobia belongs to the group of anxiety-phobic disorders. The disease begins in childhood or adolescence, much less often after 25 years.

A high predisposition to social phobia occurs in children whose families included people with this disorder; the provoking factor is the behavior pattern of a family member.

The disorder develops under the influence of a traumatic event. These could be episodes of violence at school, situations with loss of reputation in a public place or in front of a large number of people, etc. The negative experience experienced, due to age, is incorrectly interpreted by the teenager and is repressed into the subconscious. The repressed experience does not make itself felt until a similar situation arises.

A tendency to social phobia can be provoked by overprotection (freedom to express one’s own thoughts, protection from social contacts, etc.), or, conversely, by a lack of attention from parents. With a lack of attention, the child develops a deficit in the basic sense of security, and an attitude is formed that the world around him is dangerous. If such an attitude takes root, the risk of developing anxiety disorders increases. With overprotection, children do not have the opportunity to fully grow up and become independent. Dependence on parents does not allow adaptation to communication with other people; the teenager begins to perceive the world as a dangerous environment.

Social phobias also develop due to prolonged exposure to stressful situations (constant conflicts at work, in an educational institution, belittlement or ridicule in a certain circle of people). Subsequently, the person begins to transfer the feeling of threat from the source to other people.

Research has been conducted to identify the causes of social phobia by studying the characteristics of higher nervous activity of people with this disorder. Research has revealed that social phobia is directly related to the deficiency and imbalance of certain neurotransmitters. A possible cause may be improper distribution of serotonin in brain cells. Physiological causes of social phobia also include excessive stimulation of certain areas of the brain.

In people with social phobia, the sensitive amygdala is a part of the limbic system that is responsible for a person’s emotional state and is associated with the experience of fear. Also, in many of the patients examined, the anterior lumbar cortex, which is involved in providing cognitive functions such as anticipation of criticism or reward, control of impulsivity and emotions, is very receptive.

Szondi test

The test is aimed at identifying psychological abnormalities.
It consists of several stages. At each of them you will be shown portraits, from which you will need to choose the least and most pleasant ones in your opinion. This testing method was developed by psychiatrist Leopold Szondi in 1947. The doctor noticed that in the clinic, patients communicated more closely with those who had the same diseases. Of course, an online test will not give you a diagnosis - it will simply help you identify certain tendencies. Moreover, depending on the state of the psyche, the results will be different, so you can take the Szondi test in any incomprehensible situation.

Take the test →

Diagnosis of social phobia

The main criterion for diagnosing social anxiety disorder is an irrational, obsessive fear of being the center of attention or performing certain actions in the presence of people. The psychologist assesses the degree of impairment of the patient’s quality of life. Often with social phobia there are severe symptoms of agoraphobia and depression, which can aggravate the patient’s condition and lead him to complete self-isolation.

Diagnosis of social phobia is complicated by the fact that patients often mistake anxiety as the main problem. During the conversation, specific situations that provoke symptoms are identified and the level of impairment in the social and professional spheres is diagnosed.

Differential diagnosis with agoraphobia is based on the source of the patient's fear. Agoraphobia is a mental disorder in which a person experiences fear in situations where they feel trapped, in places where they have no control over the surrounding events or being far from their comfort zone, this could be open space, large crowds of people, public transport, moving alone, etc. The cause of the development of agoraphobia is a psychotraumatic situation. The disorder accompanies many mental illnesses, often anxiety and panic disorders, and social phobia. A person with agoraphobia tries to leave home only when accompanied by trusted people with whom they feel safe (spouse, children, friends), so often agoraphobes may not leave their “safe zone” for a long time. The comfort zone, with this disorder, may be limited not only by place, but also by a certain condition (fear of eye contact). Anxiety is usually caused by the fear of having a panic attack or feeling helpless in a public place.

With social phobia, the primary fear is of evaluation of actions, condemnation and humiliation in society, and patients with agoraphobia are afraid of a panic attack or loss of control over themselves in situations that they cannot avoid.

With depression, a person may avoid communication because it does not give him pleasure. The diagnosis of depressive disorder is not made until full-blown depressive syndrome is identified.

Social phobia often precedes alcohol abuse. The period of time from the onset of manifestations of social phobia to the onset of alcohol abuse helps to differentiate social phobia from alcoholism.

Forecast

Social phobia negatively affects the quality of life; a person is in a state of anxiety and tension in various situations involving other people. In the absence of timely diagnosis and treatment, the quality of life of a patient with social phobia gradually decreases. Problems arise with social life (building a family, finding friends), and the very way of life changes. It is difficult for a person to seek medical help, find a job (prefers vacancies that have no direct or no contact with other people), and stagnation occurs in career growth and social skills. Inconveniences are also brought by physiological symptoms that increase over time. Without treatment, social phobia can lead to complete self-isolation of the patient.

Overcoming an illness through self-healing is possible if common sense and willpower prevail over fear. To overcome social phobia, it is necessary to analyze personal experience in search of a traumatic event that led to the development of the disorder. It is necessary to fight the wrong reaction to the situation rooted in the subconscious, correctly evaluate it and replace it with a constructive one. However, self-cure of the disorder is not always effective and not for everyone; often one person will not be able to cope with his disorder.

Social phobia is highly treatable. Early diagnosis and prescribed treatment will help to avoid inadequate ways of adapting a person to his condition and the development of other mental disorders against the background of the main one.