Gaba Telepsychiatry

do you have social anxiety disorder or social phobia ?

Social Phobia Or Social Anxiety Disorder

What is the difference between social phobia and social anxiety disorder?

Social Phobia and Social Anxiety Disorder are both common terms but what do they mean?

Social Phobia was classified in the DSM IV (Psychiatric Diagnostic Manual Fourth Edition) as a specific anxiety disorder. Recently, social phobia was changed to Social Anxiety Disorder in the DSM V (Psychiatric Diagnostic Manual Fifth Edition). Shyness is the lay term for social phobia or social anxiety disorder but tends to apply to a milder presentation.

Do I have social phobia or social anxiety disorder?

People who have social phobia or social anxiety disorder are excessively fearful that others will criticize them, laugh at them, or view them as stupid, anxious or weak. Fear of disapproval from others can cause profound distress. They experience feelings of shame, humiliation, worry that they will say or do the wrong thing, or that they will embarrass themselves. They can view everyday social situations like saying ‘Good morning,’ to their colleague in the next desk as a ‘performance.’

You may have social phobia or social anxiety disorder if you:

  1. Feel an intense fear of social situations.
  2. Repeatedly avoid social situations.
  3. Are always afraid that others are judging your words, appearance, and actions.
  4. Believe you are perceived negatively by others, despite reassurance that your fears are excessive and unreasonable.

‘Why people with Social Phobia or Social Anxiety Disorder avoid social situations’?

People with social phobia or social anxiety disorder will seek ways to avoid situations where others can judge them. Even if they are not being judged they will perceive themselves to be judged by others. They feel significant anxiety long before the event, and continue experiencing anxiety and worry throughout the event. After the anxiety-provoking fact, a person with social phobia or social anxiety disorder will often analyze and relive the event. Then after thoroughly analyzing the event, they will negatively interpret the response of others. Even though the ‘performance’ might have been the simple act of introducing themselves to a new employee, or ordering their food at lunch, it is something that is often ruminated over.

Others may misunderstand people with a social anxiety disorder or social phobia

By avoiding speaking, a person with social phobia or social anxiety disorder may also come across as rude, arrogant, or willfully unsocial or just plain ‘weird.’ This can be a self-fulfilling prophecy and cause people with social phobia or social anxiety disorder to withdraw even further.

What situations are people with Social Phobia or Social Anxiety Disorder most afraid of?

Almost everyone with social phobia or social anxiety disorder fears public speaking. There are exceptions which are more comfortable with practiced speeches than spontaneous speech.

The four other top-ranking fears are:

  1. Eating in public
  2. Signing one’s name or writing in public
  3. Using public bathrooms – even with closed doors
  4. Being the Center of Attention

Can reassurance help people with a social anxiety disorder?

People with social phobia or social anxiety disorder usually do not respond to reassurance from others. They continue to fear that they will make a fool of themselves, bore others, offend others or be judged in a negative light by others. Even those who consciously believe that their fears are excessive and unreasonable will continue to experience intense anxiety while in the anxiety-provoking/performance related situation.

Social Phobia or Social Anxiety Disorder can feel like a panic attack

When facing a feared situation, a person with social phobia and social anxiety disorder experience many of the same physical symptoms as those during a panic attack:

  1. Sweating
  2. Palpitations or fast heart rate
  3. Blushing
  4. Stuttering ( specific to social situations ) as opposed to a chronic stutter
  5. Shaking or tremor
  6. Clumsiness, dropping things, spilling things, tripping

Some people, when they become extremely anxious, will feel as if they can’t move their body like they are frozen in one place. This is called ‘atonic immobility.’

Why should I receive treatment for Social Anxiety Disorder (Social Phobia)?

Having social anxiety disorder or social phobia can interfere with social and occupational functioning in many ways. Having Social anxiety disorder or social phobia can:

  1. Halt a person’s career progression. A person with social phobia or social anxiety disorder is less likely to network with colleagues, less likely to assert themselves, may appear less competent or less confident. They may be afraid to apply for a promotion, due to fear that the application will be rejected.
  2. Make it harder for people to make friends or form romantic relationships. They will not initiate friendships or relationships. They often withdraw from attempts made by others to engage or connect, due to fear of making a fool of themselves. They fear they will be perceived negatively, and that others will not want to interact with them.
  3. Cause significant distress to the affected individual.
  4. Make it difficult or impossible to enjoy everyday events such as a street party, lunch with colleagues, etc.
  5. Avoidance behaviors such as not initiating contact and refusing invitations can unintentionally offend people who do not understand the cause of the behavior.

What are the treatments for Social Phobia (social anxiety disorder)?

Treatments include:

  1. Cognitive Behavioral Therapy including Exposure Therapy.
  2. Psychodynamic psychotherapy in some cases, especially in those who are free of thought distortions, have good insight, euthymic mood and believe symptoms may be exacerbated by psychodynamic conflict, and early childhood experiences.
  3. Supportive Psychotherapy in some cases as an adjunct to Cognitive Behavioral Therapy when a person has a chronically depressed mood.
  4. Medications including Serotonin reuptake inhibitors, can in some cases dramatically reduce physiological anxiety symptoms and help with thought distortion. It is generally felt that a combination of medication plus cognitive behavioral therapy works better than medication alone, especially in terms of relapse prevention.
  5. Addressing exacerbating factors such as sleep deprivation, stimulant use, alcohol, and nicotine withdrawal.
  6. Addressing environmental factors such as hostile workplace environments, toxic relationships, and friendships which can re-enforce automatic negative thoughts about oneself.
  7. Nutritional supplements in some cases such as N- acetylene cysteine, Omega 3, VitaminD, folic acid, tryptophan which can help reduce anxiety, can sometimes help alleviate the intensity of symptoms.
  8. Address self medication with substances such as alcohol, nicotine, and marijuana which in the long run can make the problem worse.
  9. Group Psychotherapy – Treatment groups led by a psychiatrist or psychologist can be an effective treatment, both in terms of facilitating exposure to anxiety-provoking situations such as speaking in a group. Another benefit of group psychotherapy is having thought distortions challenged by others, such as ‘people find me boring’ while at the same time creating a safe environment, where a person can expect to be met with unconditional positive regard. Group psychotherapy can also help with feelings of isolation, as it is common to feel that you are the only one suffering from a particular condition.
  10. Peer Support Groups – Support Groups are not always led by a clinician. Websites such as ‘meet up‘ have led to an increase in the emergence of support groups, for many clinical conditions. Peer support groups are groups where individuals struggling with similar challenges meet for social events and offer others support, advice and access to resources.

Is Social Phobia (Social Anxiety Disorder) treatable?

Social phobia or social anxiety disorder is treatable. Medication such as serotonin reuptake inhibitors can provide immediate relief and help with preoccupation, rumination, cognitive distortion as well as physical symptoms. However, a combination of therapy and medication is thought to achieve much better results, especially with regards to relapse prevention than medication alone. Therapy for social anxiety or social phobia especially exposure therapy can be hard work and require dedication and commitment. Ongoing treatment is often necessary to achieve maximum benefit.