Social Anxiety Disorder (Social Phobia) Explained

Social phobia, also known as a social anxiety disorder (SAD), is characterized by having severe persistent and irrational fears of social or performance situations in which embarrassment may occur. Many people feel uncomfortable in some social situations, but people with social phobia feel extreme levels of anxiety and fear when performing activities like public speaking, eating in public, or standing in a line.

Photo by Hello I’m Nik on Unsplash

DSM-5 identifies two types of social phobia based on the range of situations that the person fears or avoids. One type centers on performance situations like public speaking or singing, which is more general and focuses on general and non-performance situations like eating in public or standing in a line. People having the performance type of social phobia tend to have significant fears of most social situations and are often diagnosed with an avoidant personality disorder.

Approximately 12 percent of the population meets the diagnostic criteria for social phobia at some point in their lives (Kessler, Berglund, Demler, et al., 2005; Ruscio et al., 2008). Social phobia generally begins in adolescence or early adulthood. Surveys have found that 7.1 percent of people in the United States and other Western countries experience social phobia in any given year. Females are more likely to have social phobia, and about sixty percent of the sufferers are women. Around 12 percent develop this disorder at some point in their lives (Alfano & Beidel, 2011; Kessler et al., 2010).

Causes of social phobia

The exact cause of the social phobia is unknown. However, recent research shows that, like other psychological disorders, social phobia is caused by genetics, psychological, social, and cultural factors.

Biological Factors

Genetics

Social anxiety disorders (SAD) tend to run across families. Although the direct correlation between the SAD and genetic makeup is not yet discovered, some genetic components may have some role in causing anxiety disorders.

Brain Structure and Neurotransmitters

Amygdala, a structure found in the brain signals whenever a threat is present, plays a significant role in controlling the fear response. People with hyperactive amygdala may have elevated fear responses contributing to social anxiety disorders (SAD).

Imbalance in serotonin, a chemical found in the brain, may also contribute to SAD.

Environmental Factors

Learned  Behavior

Social anxiety disorder may be a learned behavior. People might develop this condition after facing an embarrassing social situation. Similarly, children who have controlling or overprotective or the children are more prone to social anxiety disorder. Negative experiences like teasing, bullying, or humiliation also may contribute to this disorder.

In collectivist cultures like Japan or Korea, people are fearful of offending or making other people feel uncomfortable rather than embarrassing themselves as in social phobia. This syndrome is taijin kyofusho and overlaps considerably with social anxiety disorder.

Psychological Factors

Cognitive Biases

Cognitive biases also play a role in the manifestation and maintenance of social phobia. Aaron T Beck and his colleagues in 1985 found that people with social phobia tend to expect that other people will reject or negatively evaluate them. Negative expectations might lead to a sense of vulnerability when they are around people who might pose a threat.

Temperament

Social phobia is also related to temperament. Behaviorally inhibited children who are shy, timid, avoidant, and easily distressed by unfamiliar stimuli are at risk of developing social phobia.

Treatment Approaches

The two most commonly used treatments for social anxiety disorder are cognitive behavior therapy or medications and often both.

Cognitive behavior therapy

Cognitive-behavioral therapy focuses on how a persons’ thought process affects their feelings and behaviors. Cognitive-behavioral therapy is found to be effective against social anxiety disorder. It can be conducted individually or in groups. In exposure-based cognitive therapy, the subject practices facing up to the situation that fears him/her the most in a safe environment.

This therapy aims to build confidence and teach skills that help manage situations that scare them most.

Medications

The physicians may prescribe antidepressants to treat anxiety. Medication is helpful when used in addition to psychotherapy and other self-help techniques that address the root cause of the disorder. Three types of medications used to help treat social anxiety disorder:

Antidepressants

Antidepressants are mainly used to treat depression but are also helpful to treat social anxiety disorder.

It is important to note that antidepressants are not a quick fix for anxiety. It needs about 2 to six weeks to take effect.

Anti-anxiety medications

They are only prescribed only when other medicines don’t work. As they are sedating and addictive, they are generally taken for a short period as the pateint can build up drug resistance if they are taken for a long time.

Beta-blockers

Beta-blockers are helpful to control the physical symptoms of anxiety-like hands or voice shaking, rapid heartbeat, sweating, and so on.

Apart from these, taking care of oneself like exercise, proper sleep, limiting caffeine consumption, help-seeking behavior, and building other healthy habits will help against social anxiety disorder.

References and further reading:

  1. Alfano, C. A., & Beidel, D. C. (Eds.). (2011). Social anxiety in adolescents and young adults: Translating developmental science into practice. American Psychological Association. https://doi.org/10.1037/12315-000
  2. Bhandari, S. (2019). What Are the Treatments for Social Anxiety Disorder? WebMD LLC. https://www.webmd.com/anxiety-panic/treatments-social-anxiety-disorder
  3. Butcher, J. N. (2016). Abnormal Psychology (17th ed.).
  4. Durand, M. V., & Barlow, D. H. (2012). Essentials of Abnormal Psychology (with CourseMate Printed Access Card) (PSY 254 Behavior Problems and Personality) (6th ed.). Cengage Learning.
  5. Kessler RC, Berglund P, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of GeneralPsychiatry 2005;62:593–602. [PubMed: 15939837]
  6. Kring, A. M., & Johnson, S. L. (2019). Abnormal Psychology: The Science and Treatment of Psychological Disorders, 14e WileyPLUS Card with Loose-Leaf Set (14th ed.). Wiley (WileyPLUS Products).
  7. NIMH » Social Anxiety Disorder: More Than Just Shyness. (2021, May 18). National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/
  8. Social anxiety disorder (social phobia). (2017). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/diagnosis-treatment/drc-20353567
  9. Sue, D., Sue, D. W., & Sue, S. (2008). Understanding Abnormal Behavior (9th ed.). Wadsworth Publishing.