12 March 2004

Social phobia is not just shyness

Social phobia affects between two and three percent of people and is one of the commonest mental disorders. Yet it is one of the least studied and most misunderstood of all the anxiety disorders. This week Healthy Mind focuses on social phobia.

Social phobia affects between two and three percent of people and is one of the commonest mental disorders. Yet it is one of the least studied and most misunderstood of all the anxiety disorders. The Depression and Anxiety Support Group tells us more about this disorder.

Social Phobia (Social Anxiety Disorder) is defined as an intense fear of scrutiny by other people in a social situation, or a fear of doing something embarrassing or humiliating in that situation. Social phobias may present as a fear of being around other people, or of presenting a speech, talking to an authoritarian figure, dating or signing cheques in public.

The most common social phobia is the fear of speaking in public. People suffering from social phobia tend to think that while they are not competent in public, every other person is. Small mistakes people generally ignore become exaggerated into anxiety-inducing events that create great embarrassment. Blushing - the body's natural response to embarrassment - becomes a painfully embarrassing event in itself.

Although social phobia is often thought of as shyness, the two are fundamentally different. While shy people may feel very uneasy in the presence of others, they do not experience the extreme anxiety in anticipating a social situation, nor do they necessarily avoid circumstances that may make them feel self-conscious. In contrast, people with social phobia aren't necessarily shy; they may be at case with people and fearful only of particular situations.

Sufferers of social phobia are aware that their feelings and thoughts are irrational, but are still prone to anxiety induced by the anticipation and dread of a social event. The fear of having to attend a social event can begin weeks ahead, with the result that the sufferer may actively avoid the event at all costs. Even after the event, unpleasant thoughts and feelings may linger as the person worries about the judgements and observations other people may have made about them.

If left unattended, social phobia may continue to hinder the sufferer's functioning throughout the rest of his or her life, and can lead to a high risk of substance abuse, morbidity and suicide. These severe consequences exert a heavy burden on not only the individual sufferers, but also on family, friends and society at large.

People with social phobia aren't necessarily shy at all. They can be completely at ease with people some of the time, but in particular situations, they feel intense anxiety.

Prevalence and causes
Social phobia affects between two and three people per hundred, of all races and social groups. The average age of onset is between 15 and 20 years, but the disease can often begin during childhood. Approximately 40 percent of patients develop social phobia prior to the age of ten years, and 95 percent before twenty years. The disease often runs in families and may be accompanied by alcoholism or depression. The early onset of the disease has several repercussions: most social phobia sufferers do not acquire important life and social skills and often develop other anxiety disorders as a result of their social isolation. Low educational levels as well as financial problems and poor coping skills aggravate the situation of many sufferers.

Traumatic events often trigger the development of specific phobias (phobias of specific locations, objects or situations). Research shows that social phobia may have a hereditary component, and that it occurs in equal proportions in men and women. Although the exact cause of social phobia remains unknown, there are specific chemical systems within the brain that may be responsible for the development of the disease.

Presentation, symptoms and diagnosis
People suffering from social phobia display three essential features - a fear of scrutiny by other people in social situations, a marked and persistent fear of performance situations in which embarrassment may occur as well as an active avoidance of the feared situations. Social Phobia may present as a generalised condition, where fears involve almost all social contacts, or non-generalised, where fears relate to specific social activities or performance situations.

The most obvious symptoms of social phobia are those brought on by the fear of becoming embarrassed in front of other people. People may have difficulty speaking, eating or writing in front of others. When exposed to the feared situation or location, sufferers will frequently experience somatic (physical) symptoms of anxiety, such as palpitations, trembling, sweating, tense muscles and headache. Additional symptoms include a sinking feeling in the stomach, hot and cold flushes as well as dry throat and mouth.

Physical symptoms of anxiety brought on by the event may occur before, during and after the actual event. The sufferer may be convinced that the secondary (somatic) symptoms of anxiety such as tremor, sweating and blushing are in fact the main problem and experience great self-consciousness, fear and apprehension because of them.

Comorbid conditions
Comorbidity is very common in social phobia, with over two thirds of Social Phobia sufferers experiencing an additional psychiatric disorder some time in their lifetime. Symptoms of social phobia generally present prior to those of the comorbid disorder, suggesting that social phobia itself precipitates the onset of other comorbid disorders. Panic attacks are often a very prominent feature of social phobia.

Other comorbid disorders commonly occurring with social phobia are agoraphobia, alcohol abuse, major depression and drug abuse. Since alcohol has some anti-anxiety effects, many patients with Social Phobia self-medicate with alcohol, leading to the development of alcohol abuse. An association between social phobia and the onset of eating disorders has also been demonstrated in research studies. Comorbid sufferers appear to suffer a greater degree of distress and are likely to suffer from the more serious consequences of the disease. Comorbid social phobia is more likely to lead to suicide than uncomplicated social phobia. A factor complicating the successful treatment of social phobia is the fact that patients are very likely to receive medical treatment for the second (comorbid) condition.

Still Unsure
If you are still unsure as to whether you may he suffering from social phobia or not, check if the following apply to you. They are situations that cause anxiety and are recognised in the Liebowitz Scale as possible symptoms of social phobia.

  • Working while being observed
  • Telephoning someone you don't know very well
  • Urinating in a public bathroom
  • Taking a test of your ability, skill or knowledge
  • Expressing disagreement or disapproval to someone you don't know very well
  • Giving a party
  • Entering a room where others are already seated

Consult your doctor if any of the above apply to you and you suspect you may be suffering from social phobia.

Information supplied by the Depression and Anxiety Support Group. Tel. (021) 783 1474/6

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