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A Research Paper On Social Anxiety Disorder

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Introduction

According to the Anxiety and Depression Association of America, anxiety disorders are the most common mental illness in the United States, affecting almost 40 million adults or 18.1% of the total US population every year. Out of the 40 Million American adults with anxiety disorders, 15 Million of which or 6.8% of the US population are affected with Social Anxiety Disorder a.k.a. “Social Phobia”. These results make Social Phobia as one of the most common psychological disorders existing in the United States alone. But what exactly is Social Phobia?

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Feeling nervous and shy is a common reaction in human beings. However, Social Anxiety Disorder or Social Phobia is more than just “being shy”. It is a type of anxiety characterized by relentless fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others. When exposed to social or performance situation, the individual worries that he will act in a way that will be embarrassing and humiliating. People inflicted with social phobia experience a tremendous amount of fear in social situations and think that their fear is way beyond their control in such a way that it already interferes with their day-to-day activities. In most cases, people with social phobia end up avoiding places and/or events that they think might put them in an embarrassing situation. In some cases, however, people with social phobia are not anxious about social situations but rather on performance, like performing in front of an audience (i.e. giving speech, singing, dancing or playing a musical instrument on stage etc.).

Hence, this research paper aims to study what social phobia is, how it affects people and how it can be treated. Hopefully, this research paper can educate more people about social phobia so that those people who are afflicted with it and parents whose kids have social phobia will be able to find ways in order to treat or at least, control, the disorder.

Social Phobia

Description

Social anxiety disorder (formerly called social phobia) is characterized by extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others.

The heart of the fear and anxiety in social phobia is the person’s concern that he may act in humiliating or embarrassing way, such as appearing foolish, showing symptoms of anxiety (blushing), or doing or saying something that might lead to rejection (such as offending others). The kinds of social situations in which individuals with social anxiety disorder usually have problems with public speaking, having a conversation, meeting strangers, eating in restaurants, and, in some cases, using public restrooms (Spielman, 2017).

Symptoms

According to the National Institute of Mental Health (NIMH), when having to perform in front of or be around others, people with social phobia experience one or more of following symptoms:

  • Blushing, sweating, trembling, feeling a rapid heart rate, or feeing their “mind going blank”
  • Feeling nauseous or sick to their stomach
  • Showing a rigid body posture, making little eye contact, or speaking with an overly soft voice
  • Finding it scary and difficult to be with other people, especially those they don’t already know, and having a hard time talking to them even though they wish they could
  • Being very self-conscious in front of other people and feeling embarrassed and awkward
  • Being very afraid that other people will judge them
  • Staying away from places where there are other people.

DSM-V Criteria for Diagnosis

The Diagnostic and Statistical Manual Fifth Edition (DSM-5) of the American Psychiatric Association (APA) characterizes social anxiety disorder based on the following criteria:

  • Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. May include interaction, observation or performance situations.
  • Individual fears will act in a way or show anxiety that will lead to being negatively evaluated.
  • The social situations almost always provoke anxiety.
  • The social situations are avoided or endured with intense fear or anxiety.
  • The fear/anxiety is out of proportion to actual threat.
  • The fear/anxiety/avoidance has lasted 6 months or more.
  • The fear/anxiety/avoidance leads to significant distress or functional impairment.
  • The fear/anxiety/avoidance is not due to a medical condition/drug.
  • The fear/anxiety/avoidance is not due to another mental disorder.
  • The fear/anxiety/avoidance is either unrelated to, or excessive considering existing medical conditions.

Prevalence of the Disorder

In order to estimate the 12-month prevalence, severity and comorbidity of DSM-IV anxiety, mood, impulse control, and substance disorders in the recently completed US National Comorbidity Survey Replication, a nationally representative face-to-face household survey was conducted between February 2001 and April 2003 using a fully structured diagnostic interview. The survey was participated by 9,282 English-speaking respondents aged 18 years and older. Based on the results, social phobia garnered a prevalence rate of 6.8% placing it as the second most common mental disorder in the United States, next to specific phobia (Kessler, 2005).

Causes of the Disorder

While there is no specific cause of social phobia, the following are deemed essential in the development of social phobia in a person:

  • Genetic

A child who is born of a parent afflicted with social phobia is 2 to 6 times more likely to develop the disorder. Based on research, the hereditability rate of social phobia is estimated at around 30% to 40%, which means that roughly one-third of the underlying cause of social phobia is genetically related.

  • Environmental

Norton and Abbott discussed the role of environmental factors in the development of social anxiety disorder or social phobia. According to their journal, the following factors contribute to the development of social phobia among individuals:

Parenting Factor

Studies suggest that parent-child interaction may be an important factor that influences risk of developing social phobia. Key parental influences on the development of social phobia include behavioral modeling, parenting style, and attachment quality.

Behavioral Modeling

Observational learning and information transfer from parent to child regarding social concerns and social avoidance have been proposed to contribute to the development of social phobia. Parents of children with social phobia may exhibit social concerns, express fears of negative evaluation, and catastrophize potential social outcomes. Such modeling may build a perception of social threat and an expectation that others may judge them negatively.

Furthermore, individuals with social phobia are more likely to have anxious parents, who tend to be less socially active, more inhibited and less engaged with their children. In this way, anxious parents may model social avoidance, restrict or prevent social engagement or opportunities for the development of social skills, and this perpetuate a cycle of social fear.

Parenting Style

Parental over-control and over-protection have demonstrated a moderately consistent association with the development of anxiety disorders. Adults with social phobia tend to perceive their parents as being over-controlling and restricting of their autonomy.

Over-controlling and over-protective parenting may restrict the development of self-efficacy and social autonomy, in addition to reducing opportunities for the development of social skills. Such parenting also communicates to a child that they lack the capacity to cope with challenging situations and require protection from dangerous world.

Attachment

An insecure attachment style has been associated various types of mental disorder, including social phobia during childhood and adulthood. Securely attached individuals are more readily able to engage in positive relationships with peer and join social activities, whereas insecure individuals have weaker social and emotional competence, so they end up less socially engaged, positive and popular at school, as well as more socially anxious in later childhood.

Negative and Traumatic Life Experiences

Traumatic or difficult life experiences are another factor that has been linked to the development of social phobia. While negative experiences may trigger factors that immediately precede social phobia’s onset, studies suggest that such negative events increase the risk of developing many forms of mental disorder, including but not limited to, social phobia. Negative experiences are significant in the development of social phobia if they are social or relational in nature (i.e. parental marital discord, emotional, sexual or physical abuse). Moreover, persistent distress during sensitive developmental periods may increase the risk of development of social phobia via changes in the amygdala or enhanced cortisol reactivity to stress.

Other negative events that are social in nature have also been associated with the development of social phobia, like frequent reports of death of a parent(s), or other means of separation from parents, including parental marital discord, parental divorce or separation, lack of close relationship with an adult, and having to start a new school. Such negative relational experiences may be interpreted as indicating that others are dangerous, not trustworthy, or likely to humiliate, reject or ostracize, thereby heightening perceived social threat.

Aversive Social/Peer Experiences

Social and peer-related negative and traumatic events (i.e. bullying, humiliation, ostracism) are considered to be direct conditioning experiences associated with the onset and development of social phobia, including increased distress and avoidance related to social situations.

Aversive social conditioning experiences may be discrete humiliating events, but are often repetitive, cumulative experiences of chronic social trauma that threaten the basic human need for acceptance. Furthermore, traumatic conditioning may occur by witnessing or hearing about humiliating social experiences of another.

However, evidence show that relational victimization may be the strongest risk factor of social phobia. Relational victimization involves the use of relational assaults to harm peer (i.e. via exclusion from a social group, or emotional bullying).

Additionally, social phobia appears to be particularly associated with verbal bullying (i.e. teasing or name calling). Thus, adults with social phobia are more likely to report a history of frequent teasing which has been associated with greater social anxiety symptomatology. (Norton, 2017)

Psychological or Medical Treatment

Social phobia is generally a treatable condition. The most common means of treating social phobia are the following:

  • Psychotherapy

Psychotherapy is the treatment of mental disorders through psychological means. Cognitive-Behavioral Therapy is considered to be one of the most successful treatment for those suffering with social phobia. The American Psychological Association defines Cognitive Behavior Therapy as a form of psychotherapy that integrates theories of cognition and learning with treatment techniques derived from cognitive therapy and behavior therapy. It assumes that cognitive, emotional, and behavioral variables are functionally interrelated. Treatment is aimed at identifying and modifying the client’s maladaptive thought processes and problematic behaviors through cognitive restructuring and behavioral techniques to achieve change.

  • Support Groups

Joining and participating in support groups prove to be an effective means to treat social phobia. Having people who suffer the same disorder as you, you can expect an honest and unbiased feedback on how other people perceive you. As a result, it gives one an idea that his fear of judgment and rejection is distorted. At the same time, by participating in a support group, one is able to share his feelings and learn from others’ experience which could serve as a helpful tool in overcoming social phobia.

  • Medication

The 3 types of medications used to treat social phobia are the following:

  • Selective Serotonin Reuptake Inhibitors (SSRIs) and venlafaxine

The neurotransmitter serotonin is integral to brain circuits involved in regulating mood, sleep, appetite, and pain sensation. SSRIs increase the availability of serotonin. Whereas, the Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) venlafaxine targets not only serotonin, but also norepinephrine (also known as adrenaline), which is involved in the regulation of fear conditioning and stress response.

  • Beta Blockers

Although typically prescribed for patients with heart disease, beta blockers can help to counter symptoms of social phobia, such as sweating, rapid heartbeat, or shortness of breath. Several studies suggest that taking this type of drug about an hour before encountering anxiety-producing situation (i.e. Public speaking) helps patient with specific social phobia.

  • Benzodiazepines

The medications boost the activity of gamma-aminobutyric acid which is an “inhibitory” neurotransmitter. It suppresses signals that are traveling down a neural pathway, which results to the calming of anxiety symptoms.

Long Term Prognosis

Social Phobia is among the most common and disabling mental disorders. It can be chronic, and access to treatment is often delayed or avoided. About 70% to 80% of cases have a lifetime history of concurrent anxiety, depression, and/or substance abuse-related disorders. Effective management requires early detection, education, and delivery of evidence-based pharmacotherapy and/or cognitive behavioral therapy (CBT). Long-term treatment is often recommended due to relapse potential. Relapse may occur in 30% to 50% of patients following medication discontinuation. Relapse rates may be attenuated in those who have received elements of CBT. In addition, it appears that the probability of relapse may be reduced following periodic ‘booster’ CBT sessions.

Failure to respond to initial treatment should prompt reconsideration of diagnosis and evaluation of other medical conditions that may be contributing to the clinical presentation. Treatment-resistant patients should be referred to a mental health professional with expertise in the management of anxiety disorders. Hesitation in accepting a psychiatric referral should be discussed with the patient, and they should be provided with corrective information and motivational enhancements where indicated.

R
  1. Facts & Statistics. (n.d.). Retrieved from https://adaa.org/about-adaa/press-room/facts-statistics.
  2. American Psychiatric Association (APA) (2013) DSM-V Diagnostic and Statistical Manual of Mental Disorders. 5th Edition, American Psychiatric Association, Washington, DC.
  3. Spielman, R. M., Dumper, K., Jenkins, W., Lacombe, A., Lovett, M., & Perlmutter, M. (2017). Psychology. Houston, TX: OpenStax, Rice University.
  4. U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (2016). Social Anxiety Disorder: More Than Just Shyness. (NIH Publication No. 19-MH-8083). Bethesda, MD: U.S. Government Printing Office.
  5. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617. doi:10.1001/archpsyc.62.6.617
  6. Cuncic, A. (2019, June 24). Understanding the Causes of Social Anxiety Disorder. Retrieved from https://www.verywellmind.com/social-anxiety-disorder-causes-3024749
  7. Norton, A., & Abbott, M. (2017). The Role of Environmental Factors in the Aetiology of Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature. Behaviour Change, 34(2), 76-97. doi:10.1017/bec.2017.7
  8. APA Dictionary of Psychology. (n.d.). Retrieved from https://dictionary.apa.org/cognitive-behavior-therapy
  9. Harvard Health Publishing. (2010, March). Treating social anxiety disorder. Retrieved from https://www.heal>th.harvard.edu/newsletter_article/treating-social-anxiety-disorder
  10. Social anxiety disorder. (n.d.). Retrieved from https://online.epocrates.com/diseases/112051/Social-anxiety-disorder/Prognosis

09 March 2021

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