Social phobia: what does it consist of and which people does it affect?
Have you ever heard of social phobia? Do you know someone who suffers from it, or may it even be that you have it yourself?
Social phobia is a type of anxiety disorder, in which the person feels a high degree of anxiety or fear in certain social situations (or in most of them).
In this article we explain the fundamental characteristics of social phobia, in addition to what are its typical symptoms, its causes and its possible treatments.
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Social phobia: what does it consist of?
Social phobia is an anxiety disorder, classified as such in the DSM-5 (Diagnostic Manual of Mental Disorders). Specifically, DSM-5 calls it "social anxiety disorder." Its main characteristic is an irrational, intense and disproportionate fear of social situations, ranging from interacting with people to speaking in public or meeting new people.
An edition prior to the one discussed, the DSM-IV-TR, raised three types of phobias: agoraphobia, specific phobia (phobia of a specific object or situation) and social phobia. These three types of phobia are characterized by the fact that they involve intense fear reactions, accompanied by avoidance induced by certain objects or situations, which can be real or anticipated (in the case of social phobia, the phobic or feared stimulus is the situations social).
On the other hand, these situations do not objectively justify said responses of fear or anxiety. Finally, comment that it is not necessary for the mentioned avoidance to occur, if the dreaded situation is endured with great anxiety or discomfort.
In social phobia, as in the other types of phobia, the person is not aware that his fear and avoidance are exaggerated or irrational; However, this criterion is not required in children. That is, in children this criterion is not necessary to be able to make the pertinent diagnosis.
Dreaded situations
The feared situations in social phobia can be of two types: interpersonal situations or situations of public performance.
As concrete examples of interpersonal situations we find: telephoning someone, talking to strangers, talk to authority figures (for example a police officer), meet someone, attend a party, hold a interview…
On the other hand, Regarding examples of situations of public action, we find: speaking in public, writing while they observe us, using public toilets, shopping in a busy store, giving a report at a meeting, dancing or singing in front of others, eating or drinking in public, etc.
In social phobia, anxiety can appear before the first situations, before the second or both.
General characteristics
Some interesting facts to know in relation to social phobia are the following:
- We found two types of social phobia: circumscribed (fear of speaking in public) and generalized (fear of social situations in general).
- Most people with social phobia have the circumscribed type.
- According to the DSM-5, between 3 and 13% of the population suffers from it.
- It is frequent its appearance together with other specific phobias and together with agoraphobia.
- It is associated with low self-esteem and a tendency to fear criticism.
Causes
The causes of social phobia can be very diverse. A traumatic event related to people or to being in front of the public, can cause it, such as “making the ridiculous ”(or feeling ridiculous) in a public exhibition, when interacting with certain people, at a party, etc.
On the other hand, having a very introverted personality (being “excessively” shy) can also be at the base of social phobia.
Regarding biological hypotheses, we found studies that speak of different alterations in anxiety disorders. Examples are: alterations of gamma-amino-butyric acid (GABA), overactivity of the locus coeruleus (which increases norepinephrine, and therefore anxiety), hypersensitivity of serotonergic receptors, etc. However, none of these hypotheses is determinative (that is, none have been 100% proven.
On the other hand, there is an agreement that some vulnerability to developing an anxiety disorder is likely to be inherited in general (and not so much a specific anxiety disorder). This individual vulnerability, manifested by some people, added to a traumatic event related to negative evaluation by others, can lead to phobia disorder Social.
Symptoms
Although we have already seen in summary what the symptoms of social phobia are, we will explain each of them below.
1. Intense fear or anxiety
The main symptom of social phobia is an intense fear or anxiety of social situations that may imply an evaluation or judgment of oneself, by others. Generally, more than fear, it is anxiety, which can even turn into anguish.
2. Avoidance
As in all phobias, there is an avoidance, in this case of social situations. Examples of social situations are: starting a conversation with someone, presenting a job in public, speaking in public, socializing with new people, making friends, etc.
However, it can also happen that instead of avoiding the situation, it is endured but with high discomfort (or anxiety).
3. Poor social execution
Another symptom of social phobia is poor social performance. by the person who suffers it. That is, their social skills they are usually quite deficient, although not in all cases.
4. Deterioration or discomfort
The above symptoms cause a significant deterioration or discomfort in the life of the individual. In fact, this deterioration or discomfort is what determines the existence or not of a psychological disorder, in this case social phobia.
5. Psychophysiological symptoms
In addition to the above symptoms, Physiological symptoms such as tachycardia, sweating, tension, migraine, flushing may appear, pressure on the chest, dry mouth, etc., given the possibility of being exposed to the phobic situation.
Treatment
The psychological treatment of choice to treat social phobia is treatment for exposure (In fact, it is the one that has shown the highest degree of effectiveness). This consists, fundamentally, in exposing the patient to social situations, gradually.
Other possible treatments for social phobia include: cognitive behavioral therapy (which is often combined with antidepressants) and social skills training (the latter is mainly used in patients with deficits in social skills). All of these treatments are slightly less effective than exposure treatment, although they are also useful and widely used.
Finally, another option that we have is pharmacotherapy, which involves the use of antidepressants and anxiolytics (logically, it is the treatment that the psychiatrist or general practitioner will apply, not the psychologist), although such treatment is the least effective for social phobia until the moment.
Treatments according to the type of social phobia
We have discussed, in a generic way, the treatments used for cases of social phobia. However, We can still specify more, since depending on the type of social phobia that the patient presents, the most recommended is one treatment or another.
There are, broadly speaking, two types of social phobia: circumscribed (in which the patient only feels anxiety about the fact of speaking or acting in public) and generalized (in which the patient fears most social situations that occur outside the family context).
In the case of circumscribed social phobia, exposure therapy is used; On the other hand, in generalized social phobia, a combination therapy is usually used, which includes: exposure, cognitive restructuring and training in social skills.
Bibliographic references
American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.
American Psychiatric Association (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Barcelona: Masson.
Belloch, A., Sandín, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
Pérez, M., Fernández, J.R., Fernández, C. and Friend, I. (2010). Guide to effective psychological treatments I and II:. Madrid: Pyramid.