What Is Social Anxiety Disorder?

Prevalence (epidemiological characteristics)

Social phobia is a very common psychological problem. It has been reported that approximately 4 out of 10 college students experience social anxiety or shyness (Pilkonis & Zimbardo, 1979).

Lifetime prevalence rates range from 3-13%, depending on the methodology used, but the prevalence is higher than other anxiety disorders. It tends to be comorbid with other anxiety disorders, and many people tend to reduce their discomfort by avoiding social interactions rather than seeking treatment.

Epidemiological surveys of the general population have shown that social phobia is more prevalent in women, but in clinical populations, it is more prevalent in men or has a similar gender ratio. It is also more common in the immediate family of individuals with the disorder than in the general population.

Culturally, Korean, Chinese, and Japanese individuals are more likely than those from other cultures to exhibit the victimisation form of social anxiety, which involves the avoidance of social situations out of concern that one’s physical characteristics, smell, eye contact, facial expressions, or tone of voice will cause discomfort to others (American Psychatric Association, 1994).

Symptoms

The main symptoms of social phobia are First, a marked and persistent fear of social situations or tasks that have the potential to cause embarrassment.

Typically, they fear being judged negatively by others, being insulted, or being embarrassed in social situations. Examples include public speaking anxiety, stage fright, fear of eating in public, and red-face phobia, the fear of blushing in front of others.

Second, exposure to these social situations almost always results in an immediate anxiety response.

You blush, your muscles tense, your heartbeat quickens, and your hands and feet shake. They may have trouble digesting, feel sick to their stomach, and in severe cases, become confused.

Third, people who experience social anxiety recognise that their anxiety is irrational or excessive. They know there’s no reason to fear social situations, but they can’t let go of their fear of them.

Fourth, they try to avoid social situations. This may have a temporary effect of reducing anxiety, but in the long run, the person will continue to experience social anxiety and their social life will be negatively affected.

Diagnostic criteria

The DSM-IV-TR provides the following diagnostic criteria for social phobia (DSM-IV-TR, 2000).

(1) Persistent fear of one or more social situations or activities.
(2) Exposure to the feared social situation causes anxiety almost every time.
(3) You recognise that your fears are excessive or irrational.
(4) You try to avoid the feared social situation and experience anxiety and distress when you are unable to do so.
(5) The resulting distress severely interferes with occupational, functional, or social domains, or the person suffers severely from the fear.
(6) If the person is 18 years of age or younger, the period must be at least six months.
(7) The fear or avoidance is not caused by a substance or general medical condition and is not well explained by another mental disorder.
(8) If a generalised conscious state or other mental disorder is present, the fear in diagnostic criterion (1) must not be associated with it.

Causes

The biological position

1) It has been reported that people with social phobia have problems with autonomic nervous system activity, i.e., an overactive sympathetic nervous system or a poorly functioning parasympathetic nervous system, resulting in a tendency to be easily irritated by many stimuli or to take longer to settle down (Bruch, 1989; Plomin & Daniels, 1986).

2) Many relatives of people with social phobia exhibit similar symptoms (Reich & Yates, 1988).

3) In twin studies, the concordance rate for both twins to have social phobia was 24.4% for identical twins and 15% for fraternal twins (Torgersen, 1979).

4) These findings suggest a genetic component to social phobia.

The cognitive position

1) The following cognitive traits are common among people with social phobia.

First, they have a strong belief that they are unappealing to others, which means they have a negative social self-concept.

Second, they are strongly motivated to make others feel good about themselves. They value other people’s judgements, strive to be perfect in order to be liked and accepted, and take negative judgements painfully.

Third, they tend to be judgmental and believe that others will dislike and shun them if they make the slightest mistake.

Fourth, they tend to evaluate their behaviour in social situations negatively.

2) According to Clark & Wells (1995), people with social phobia have three themes of dysfunctional beliefs based on past experiences: excessive normative beliefs about social performance, conditional beliefs about social evaluation, and negative beliefs about the self.

The Psychoanalytic Position

1) Psychoanalysis interprets social phobia as an unconscious conflict projected onto social situations.

The person projects aggressive impulses that cannot be consciously accepted onto others, feeling that others will be aggressive or critical of them, and is afraid to be in front of others.

2) Object relations theory, one of the psychoanalytic theories, argues that a child’s relationship with his or her nurturing mother in the early years of life influences the formation of social anxiety later in life.

In other words, a child forms an internal representation of himself or herself and others through interaction with his or her mother, and the representation of himself, others, and the world formed at this time affects interpersonal relationships and causes social anxiety.

Cognitive behavioural therapy

Cognitive behavioural therapy is one of the most effective treatments for social anxiety. Cognitive behavioural therapy consists of cognitive restructuring to modify negative thoughts and beliefs about social situations, repeated exposure to feared social situations, such as giving a presentation in front of a group of people, role practice in real or simulated social situations, and relaxation training to reduce anxiety.

Cognitive behavioural therapy is highly effective in the treatment of social phobia, and it has been reported that treatment effects last for several years (Heimberg, Salzman, Holt, & Blendall, 1993).

Medication

Tricyclic antidepressants and MAO inhibitors, including beta-blockers, are commonly used to treat social phobia, and serotonin reuptake inhibitors have recently been shown to be effective.

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