Social phobia, also known as social phobia, is an anxiety disorder. Those affected are afraid of attracting negative attention in society and embarrassing themselves. The fear revolves around the fact that general attention could be directed towards oneself. About 11 to 15 percent of people will develop social phobia in their lifetime.
What is social phobia?
Social phobia is defined as follows in ICD 10 (publisher: WHO): People who suffer from social phobia are afraid of standing out in small groups and becoming the focus of interest. Self-esteem is low and criticism is hard to take. For microscopic polyangiitis explanations, please visit aviationopedia.com.
Characteristically, this fear does not occur in large crowds. It is limited to certain social situations. In some cases, the fear is focused on events such as public dining or lectures. It is far more common, however, that the fear extends to many social situations.
Symptoms can include tachycardia, nausea, tremors and sweating. Since the level of suffering can increase to the point of panic attacks, those affected display avoidance behavior in order to escape the side effects of social phobia.
Social phobia can have various causes, usually it is a whole network of causes. On the one hand, studies have found that a genetic disposition can also play a role in such a disease. This is shown, for example, by twin studies.
Another reason for a social phobia can be rooted in the personality of the sufferer. People who have such difficulties tend to be increasingly insecure and self-doubting, while others ignore similar things with humor.
The low self-confidence can in turn have various causes: a loveless upbringing in which no basic trust could be formed, trauma or social deficits such as exclusion, rejection, etc. In psychotherapy, the reasons for social phobia can be analyzed.
Symptoms, Ailments & Signs
A typical symptom of social phobia is the fear of social contact. Interaction with other people is a stressful situation for those affected. A sign of social phobia is therefore avoiding situations in which you have to make contact with other people or have conversations.
This avoidance behavior results in corresponding complaints that can significantly reduce the quality of life. On the one hand, social contacts can hardly be avoided in normal everyday life. Working life, family meetings or contacts in everyday situations such as visiting the doctor or when shopping then become stressful situations for the people affected by social phobia.
The symptoms in such situations can also often be of a psychosomatic nature. Heart palpitations, sweating, the feeling of being close to fainting or a tendency to stutter are typical psychosomatic symptoms. Trying to avoid such situations gives rise to new complaints. Victims are at risk of social isolation.
The total withdrawal from everyday life then initially alleviates the fear of having to survive in social situations. Still, most people with social phobia are not consistently happy with such a restricted life and wish to be able to interact normally with others. If left untreated, social phobia is often associated with depression and even suicidal tendencies.
Diagnosis & History
In order to be able to reliably diagnose a social phobia, the above criteria must be met. But how does such a disease develop? Is there a typical course?
As a rule, one cannot assign a single causal reason to social phobias. They are rather insidious and develop slowly over years. If the disease is not treated appropriately, there is a risk of it becoming chronic. Addiction and/or depression are often added, with those affected trying to help themselves with alcohol, medication or drugs.
One then speaks of comorbidity. It is often found that those who are ill withdraw more and more and become lonely. However, if this disorder is treated in time, then the prognosis for curing social phobia is favorable.
Social phobia is a disease that should not be underestimated. Affected people avoid contact with other people. They withdraw, isolate themselves more and more from the social “outside world” and often develop depression. Even going to the doctor is only possible for many patients after several attempts. The horror begins on the street.
Phobia patients can still avoid other people there, but escaping on the bus, tram or subway is impossible. The fear solidifies. Those affected try to cover up the condition. They resort to drugs such as sedatives (benzodiazepines). In order to survive the trip to the doctor, a short-term intake as an aid is quite justifiable.
However, it is strictly not advisable to take it over a longer period of time, as this leads to dependency and other problems. Some social phobics develop other strategies. They turn to alcoholic beverages. This can quickly develop into an alcohol addiction.
Avoiding certain situations leads to further restrictions in the everyday life of people with social phobia. This can make it difficult, for example, to choose a suitable profession. If this is finally found, there can still be a risk of termination. Even staying in the classroom during theoretical lessons can trigger a threatening state in the phobic. This often ends in panic attacks.
Some of those affected make the step to becoming a skilled worker, while others remain unskilled for the rest of their lives and can only occasionally keep their heads above water with unskilled work. Without medical treatment, social phobia can become so severe that those affected are no longer able to socialize. Sometimes this can lead to suicidal behavior.
When should you go to the doctor?
As a pathological anxiety disorder, social phobia is always a reason to see a doctor. In such situations, psychotherapists can best help. The problem, however, is that the transition between a high level of shyness or insecurity and genuine fear is not always clear.
People who find it very difficult to socialize and who are characterized by disappointment and fear of failure are not necessarily affected by social phobia. Social phobia is considered pathological if the fear leads to avoidance behavior. This means that the person concerned really experiences limitations as a result of the fear. These restrictions are then the reason for getting help. The restrictions can be social isolation or the fear of interaction in general.
If it is unclear to what extent personal or psychological circumstances lead to these restrictions, a professional discussion partner should be consulted. This does not necessarily have to be a doctor. A psychologist can also help, as can a well-trained coach. It is crucial that there is a willingness to examine and change a social life that is experienced as severely restricted. If, on the other hand, the social phobia has progressed so far that this is no longer possible, the environment is responsible.
Treatment & Therapy
But how can a social phobia be treated successfully? It has now been recognized that a combination of psychotherapy and drug treatment is the most promising. There are various antidepressants, such as sertraline or mirtazapine, which have an anxiolytic effect because they act on certain areas of the brain where the anxiety arises.
The right drug setting is the prerequisite for psychotherapy to be effective at all. Psychotherapeutically, cognitive behavioral therapy is usually used so that those affected learn to build a positive self-image and deal better with defeats. Within this framework, the aim is for patients to become more independent of the opinions of others.
In addition, various relaxation techniques such as progressive muscle relaxation or autogenic training are practiced to reduce stress. With good mastery of these relaxation techniques, crises can ideally be averted. In the short term, social phobia can also be treated with benzodiazepines. For example, diazepam or alprazolam are suitable for this.
Due to the addictive potential of these sedatives, however, they should be used as sparingly as necessary and for as short a time as possible. There are a number of approaches to treating social phobias.
Since it is not known exactly what ultimately triggers social phobias, it is difficult to take preventive measures. However, it was found that a derogatory and negative attitude of parents or peers in childhood increases the risk. You should therefore take this into account in your own upbringing style. In addition, the following applies: At the first suspicion, one should seek treatment, because then the prognosis for healing a social phobia is best.
Social phobia requires psychotherapeutic aftercare because it accompanies the affected person for a lifetime. If the patient has previously been treated as an inpatient during a hospital stay, the follow-up care prepares him to return to his everyday life outside of the psychiatric ward.
The extent of the follow-up care depends on the individual condition of the patient. Regardless, a major symptom of a phobia is fear. Fear throws people off balance. Therefore, a possible deterioration can never be completely ruled out, even in the case of a successfully treated person who has been able to be emotionally stabilized.
During behavioral aftercare, the patient deepens his knowledge of how to better integrate his phobia into everyday processes. At the same time, the psychologist explains what behavior is helpful in acute anxiety situations. The person concerned should be encouraged to visit the therapist outside of regular office hours, particularly in the event of such events.
The therapist’s address has the function of a ‘protective island’. If the patient is no longer able to pursue his previous job due to the phobia, the psychologist will also look after him in this case. There is a very high risk that the inability to work will develop into depression in addition to the phobia. This unfavorable course of the disease is counteracted during follow-up care.
You can do that yourself
A confrontation with the anxiety-triggering situations, as used in behavioral therapy, can also be carried out by those affected themselves. Self-help books and exercise books can be helpful. Although self-help books aren’t enough for every social phobic to completely conquer social anxiety, for some people they can make a significant difference.
People with social phobia can also find support online. Various online groups in the form of forums, apps and social media groups can help those affected not to feel alone with their fears. When the online self-help group works together to reduce avoidance behavior and other symptoms, it can also make tangible progress. However, most forums and online groups focus more on mutual relief than on a (self-)therapeutic approach.
Another possibility for self-help is offered by groups that meet in real life. However, many social phobics get in the way of their fears because they do not dare to meet a group of strangers in an unfamiliar environment.
Mindfulness can help reduce stress symptoms and also improve the specific symptoms of social phobia. Above all, mindfulness is a supplement to other methods.