Specific social phobia

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Mental health professionals often distinguish between generalized social phobia and specific social phobia. [1] People with generalized social phobia have great distress in a wide range of social situations. Those with specific social phobia may experience anxiety only in a few situations. [1] The term "specific social phobia" may also refer to specific forms of non-clinical social anxiety.

Contents

The most common specific social phobia are glossophobia (the fear of public speaking) and stage fright (the fear of performance). Others include fears of intimacy or sexual encounters, using public restrooms (paruresis), attending social gatherings, using telephones, and dealing with authority figures.

Specific social phobia may be classified into performance fears and interaction fears, i.e., fears of acting in a social setting and interacting with other people, respectively. The cause of social phobia is not definite. [2]

Symptoms of social phobia can occur in late adolescence when youths highly value the impressions they give off to their peers. Clinical experience of the prognosis of social phobia shows that it can prolong for many years but that it improves by mid life. [3]

Treatment

Treatment of social phobia usually involves psychotherapy, medication, or both.

Psychotherapy

Cognitive behavioral therapy (CBT) is commonly used to treat social phobia. [4] CBT uses various techniques in order to improve the individual (diagnosed with social phobia), ways of thinking, behaving and coping in social situations that lead the individual to distress.  [5] CBT aims to make improvement in the individual's distress, fear, and anxiety through a social focus and environment. CBT is typically done through individual sessions, but group sessions have been completed through CBT. [6]

Medication

Anti-anxiety and antidepressant medication is commonly prescribed for treatment of social anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, fluvoxamine and paroxetine are sometimes used for treating social phobia, but are not known to be very effective. The MAOI Nardil (phenelzine sulfate) works extremely well in treating social phobia and is often referred to as the "gold standard" for social phobia due to its unique mechanism on increasing GABA. [7]

Patients who have avoided certain situations should make a big effort to become exposed to these situations while at the same time taking antidepressant medication. Anxiolytic medication aids a patient to handle social or professional situations before more lasting treatment has had an effect and therefore it is a provider of short term relief, but anxiolytics have a risk of dependence. Beta-adrenergic antagonists help to control palpitations and tremors unresponsive to the treatment of anxiolytic medication. One must read the precautions of these drugs outlined in the manufacturer's literature and be careful to watch out for the contraindications of these drugs. [8]

Prevalence

In the past, when the prevalence was estimated by sampling the psychiatric clinical cases, social phobia was thought to be a rare disorder. It is now recognized that this way of estimating is inappropriate, because people with social phobia rarely seek psychiatric help by the very nature of their disorder. A more reliable source used now is community surveys. [9]

Various surveys show that the syndrome of glossophobia is the most prevalent type. An article based on a National Comorbidity Survey reported that 1/3 of people with lifetime social phobia had glossophobia [10] Another survey of a community sample from a Canadian city reported that of people who believed being anxious in one or several social situations 55% feared speaking to a large audience, 25% feared speaking to a small group of familiar people, 23% feared dealing with authority, 14.5% feared social gatherings, 14% feared speaking to strangers, 7% feared eating and 5% feared writing in public. [11]

Related Research Articles

An anxiolytic is a medication or other intervention that reduces anxiety. This effect is in contrast to anxiogenic agents which increase anxiety. Anxiolytic medications are used for the treatment of anxiety disorders and their related psychological and physical symptoms.

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

<span class="mw-page-title-main">Phobia</span> Anxiety disorder classified by a persistent and excessive fear of an object or situation

A phobia is an anxiety disorder, defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, often found in agoraphobia and emetophobia. Around 75% of those with phobias have multiple phobias.

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatiguability, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

<span class="mw-page-title-main">Agoraphobia</span> Anxiety disorder

Agoraphobia is a mental and behavioral disorder, specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. These situations can include open spaces, public transit, shopping centers, crowds and queues, or simply being outside their home on their own. Being in these situations may result in a panic attack. Those affected will go to great lengths to avoid these situations. In severe cases, people may become completely unable to leave their homes.

<span class="mw-page-title-main">Panic attack</span> Period of intense fear

Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losing control. Typically, symptoms reach a peak within ten minutes of onset, and last for roughly 30 minutes, but the duration can vary from seconds to hours. Although they can be extremely frightening and distressing, panic attacks themselves are not physically dangerous.

Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.

Emetophobia is a phobia that causes overwhelming, intense anxiety pertaining to vomit. This specific phobia can also include subcategories of what causes the anxiety, including a fear of vomiting or seeing others vomit. Emetephobes might also avoid the mentions of "barfing", vomiting, "throwing up", or "puking."

<span class="mw-page-title-main">Generalized anxiety disorder</span> Long-lasting anxiety not focused on any one object or situation

Generalized anxiety disorder (GAD) is a mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning, and individuals with GAD are often overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties. Symptoms may include excessive worry, restlessness, trouble sleeping, exhaustion, irritability, sweating, and trembling.

Selective mutism (SM) is an anxiety disorder in which a person who is otherwise capable of speech becomes unable to speak when exposed to specific situations, specific places, or to specific people, one or multiple of which serving as triggers. This is caused by the freeze response. Selective mutism usually co-exists with social anxiety disorder. People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment.

Mysophobia, also known as verminophobia, germophobia, germaphobia, bacillophobia and bacteriophobia, is a pathological fear of contamination and germs. It is classified as a type of specific phobia, meaning it is evaluated and diagnosed based on the experience of high levels of fear and anxiety beyond what is reasonable when exposed to or in anticipation of exposure to stimuli related to the particular concept. William A. Hammond first coined the term in 1879 when describing a case of obsessive–compulsive disorder (OCD) exhibited in repeatedly washing one's hands.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed for studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), and specific phobias.

Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

<span class="mw-page-title-main">Thalassophobia</span> Fear of the sea or large open water

Thalassophobia is the persistent and intense fear of deep bodies of water such as the sea, oceans, or lakes. Though very closely related, thalassophobia should not be confused with aquaphobia which is classified as the fear of water itself. Thalassophobia can include fear of being in deep bodies of water, fear of the vast emptiness of the sea, of sea waves, aquatic creatures, and fear of distance from land.

<span class="mw-page-title-main">Interoceptive exposure</span>

Interoceptive exposure is a cognitive behavioral therapy technique used in the treatment of panic disorder. It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle tension, and in the process removing the patient's conditioned response that the physical sensations will cause an attack to happen.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Depression is a mental disorder characterized by prolonged unhappiness or irritability, accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement. low self-regard/worthlessness, difficulty concentrating/indecisiveness, or recurrent thoughts of death or suicide. Depression in childhood and adolescence is similar to adult major depressive disorder, although young sufferers may exhibit increased irritability or behavioral dyscontrol instead of the more common sad, empty, or hopeless feelings seen with adults. Children who are under stress, experiencing loss, or have other underlying disorders are at a higher risk for depression. Childhood depression is often comorbid with mental disorders outside of other mood disorders; most commonly anxiety disorder and conduct disorder. Depression also tends to run in families. In a 2016 Cochrane review cognitive behavior therapy (CBT), third-wave CBT and interpersonal therapy demonstrated small positive benefits in the prevention of depression. Psychologists have developed different treatments to assist children and adolescents suffering from depression, though the legitimacy of the diagnosis of childhood depression as a psychiatric disorder, as well as the efficacy of various methods of assessment and treatment, remains controversial.

<span class="mw-page-title-main">Social anxiety disorder</span> Anxiety disorder associated with social situations

Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impairing ability to function in at least some aspects of daily life. These fears can be triggered by perceived or actual scrutiny from others. Individuals with social anxiety disorder fear negative evaluations from other people.

<span class="mw-page-title-main">Panic disorder</span> Anxiety disorder characterized by reoccurring unexpected panic attacks

Panic disorder is a mental and behavioral disorder, specifically an anxiety disorder characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something terrible is going to happen. The maximum degree of symptoms occurs within minutes. There may be ongoing worries about having further attacks and avoidance of places where attacks have occurred in the past.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Separation anxiety disorder (SAD) is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment. Separation anxiety is a natural part of the developmental process. It is most common in infants and little children, typically between the ages of six to seven months to three years, although it may pathologically manifest itself in older children, adolescents and adults. Unlike SAD, normal separation anxiety indicates healthy advancements in a child's cognitive maturation and should not be considered a developing behavioral problem.

References

  1. 1 2 Crozier, W. Ray; Alden, Lynn E. International Handbook of Social Anxiety: Concepts, Research, and Interventions Relating to the Self and Shyness. New York John Wiley & Sons, Ltd. (UK), 2001. ISBN   0-471-49129-2.
  2. ↑ Hitchcock, Carla A.; Chavira, Denise A.; Stein, Murray B. (2009). "Recent Findings in Social Phobia among Children and Adolescents". The Israel Journal of Psychiatry and Related Sciences. 46 (1): 34–44. ISSN   0333-7308. PMC   2925835 . PMID   19728571.
  3. ↑ de Lijster, Jasmijn M.; Dierckx, Bram; Utens, Elisabeth M.W.J.; Verhulst, Frank C.; Zieldorff, Carola; Dieleman, Gwen C.; Legerstee, Jeroen S. (April 2017). "The Age of Onset of Anxiety Disorders". Canadian Journal of Psychiatry. 62 (4): 237–246. doi:10.1177/0706743716640757. ISSN   0706-7437. PMC   5407545 . PMID   27310233.
  4. ↑ Otte, Christian (December 2011). "Cognitive behavioral therapy in anxiety disorders: current state of the evidence". Dialogues in Clinical Neuroscience. 13 (4): 413–421. doi:10.31887/DCNS.2011.13.4/cotte. ISSN   1294-8322. PMC   3263389 . PMID   22275847.
  5. ↑ Priyamvada, Richa; Kumari, Sapna; Prakash, Jai; Chaudhury, Suprakash (2009). "Cognitive behavioral therapy in the treatment of social phobia". Industrial Psychiatry Journal. 18 (1): 60–63. doi: 10.4103/0972-6748.57863 . ISSN   0972-6748. PMC   3016703 . PMID   21234166.
  6. ↑ "Social Anxiety Disorder: More Than Just Shyness". National Institute of Mental Health (NIMH). Retrieved 2021-12-04.
  7. ↑ "Nardil Social Anxiety & Depression Information -". nardil.org. Retrieved 2021-02-17.
  8. ↑ Michael G. Gelder; Richard Mayou; John Geddes (2005). Psychiatry. Oxford University Press. ISBN   978-0-19-852863-0 . Retrieved 4 November 2010.
  9. ↑ M. B. Stein and J. M. Gorman, "Unmasking social anxiety disorder", J Psychiatry Neurosci. 2001 May; 26(3): 185–189.
  10. ↑ Ronald C. Kessler, Ph.D., Murray B. Stein, M.D., and Patricia Berglund, M.B.A. Social Phobia Subtypes in the National Comorbidity Survey, Am J Psychiatry 155:613-619, May 1998
  11. ↑ A survey by Dan Stein et al., as described in: Carlos Blanco, Carolina Garcia, Michael R. Liebowitz, "Epidemiology of Social Anxiety Disorder", in: Dan J. Stein, Borwin Bandelow (Eds.) "Social Anxiety Disorder", ISBN   0-8247-5454-9, p.38
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