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Social anxiety disorder (social phobia)

Social anxiety disorder (social phobia)

Social anxiety disorder, or social phobia, is one of the most common mental disorders. About thirteen percent of people experience social anxiety during their lifetime. Despite the worldwide spread nature of social phobias, the exact causes of social anxiety disorder remain unclear. _________________________________________________ Definition of social anxiety disorder or social phobia There is really nothing bad in feeling sometimes nervous or discomforted in certain specific social situations. Most people do feel this way when going to a job interview, a date, giving a new product presentation or holding a speech in front of important guests. However, when this ‘nervous feeling’ is replaced by social anxiety disorder – formerly termed “social phobia” – every normal social interaction causes an individual experience intense irrational social anxiety. _________________________________________________ What is social anxiety disorder or social phobia? Social anxiety is the intense feeling of discomfort, fear, or worry that some people experience when they face certain social situations that are mostly unfamiliar. Social anxiety is also the immense fear and concern that some individuals develop when interacting with other people. They experience so-called social anxiety at the thought of being possibly judged, evaluated or even looked down upon by the people standing around them.  During the interaction with other people, their social anxiety makes them develop feelings of self-consciousness, embarrassment and inferiority. Some people who also suffer from social anxiety disorder can also develop social anxiety in anticipation of a specific social occasion. Social anxiety disorder can make social situations extremely frightening. This anxiety can intensify to the point at which the person suffering from social anxiety disorder will do everything and find any excuse to avoid facing such social situations. Even when people suffering from social anxiety disorder realize that their fears of being scrutinized and judged are possibly somewhat irrational and overblown, they still cannot help feeling anxious. _________________________________________________ Symptoms of social anxiety disorder or social phobia It is obvious that the fact of getting occasionally nervous or discomforted in a specific social situation does not automatically mean that the person suffers from social anxiety disorder or social phobia. A lot of people may have moment during which they feel and cannot hide their shyness or self- consciousness. As long as these feelings occur only occasionally and do not influence their everyday functioning, there is no reason for them to worry; they are far away from suffering from social anxiety disorder or social phobia. For people suffering from social anxiety disorder or social phobia, the immense fear and concern that they develop when interacting with other people do interfere seriously in their daily routine and cause dreadful distress. Social anxiety disorder affects a person’s emotions, behaviour and thoughts. Social anxiety is often understood as a single concept; it is however often helpful to view social anxiety in terms of three distinct components that are interrelated and capable of strengthening one another and lead to a cycle of anxiety. Emotional signs and symptoms of social anxiety disorder may include: - The intense fear of interacting with new people, coming into a situation where one can be scrutinized or humiliated or where one cannot hide one’s anxiety, etc. - The extreme difficulty of talking with strangers, meeting people in authority, holding a speech, of making eye contact, performing on stage, going on a date, attending parties, etc. Behavioural signs and symptoms of social anxiety disorder may include: - The avoidance of situations where you are or might be the centre of attention or simply embarrassed, where you are watched doing something, etc.  - Avoiding social situations to the point at which they severely limit your activities or disrupt your life. Keeping quiet or hiding in the background in order to escape notice and embarrassment. - The need to always bring a person along with you, or to have a ‘comforting’ drink before a social situation in order to soothe your nerves Physiological signs and symptoms of social anxiety disorder may include: Experiencing intense fear, racing heart, nausea, cold and clammy hands, etc. Excessive sweating, turning red or blushing, shaking and trembling, swallowing with difficulty, etc. Getting a shaky voice, a dry throat and mouth, muscle twitches around face and neck, etc. _________________________________________________ Worrying about social anxiety disorder symptoms As a sufferer of social anxiety disorder, you may at some point realize that your social anxiety is somehow irrational and far to be in line with your actual situation. You are however so anxious about worsening your situation and developing any social anxiety disorder symptoms that you take all possible measures and find excuses not to be put into a situation that might trigger your social anxiety disorder. This is exactly the kind of behaviour that is adopted by many sufferers of social anxiety disease and also the ideal reaction at building up the vicious circle that will worsen your social anxiety disorder symptoms. _________________________________________________ When to see a doctor? If you start avoiding normal situations because you have experienced feelings of fear, embarrassment, worry or even panic, you should contact immediately your primary care doctor, alternative practitioner or therapist. If the described kind of anxiety is likely to disrupt your life, interfere seriously in your daily routine and cause dreadful distress, you may suffer from social anxiety disorder or another mental health condition that will require appropriate treatment to get better. It is obvious that the fact of being occasionally shy or discomforted in a specific social situation does not necessarily mean that the person suffers from social anxiety disorder or social phobia, especially if it is a child. The levels of comfort shown in specific situations are manifold as they differ for each individual; they are directly dependent from the personality traits and from the person’s life experience. While some people may be shy or naturally reserved, others might be more outgoing or extroverted. The big difference between a person suffering from social anxiety disorder and a person exhibiting everyday nervousness is that the first person’s symptoms are much more intense and severe, what makes him avoid any normal kind of social situations. People with social anxiety disorder commonly endure extreme difficulties with following everyday activities: returning items to a store, using a public telephone, initiating conversations, etc. A lot of people have moments during which they feel and cannot hide their shyness or self-consciousness. As long as these feelings occur only occasionally and do not influence their everyday functioning, there is no reason for them to worry: they are far away from suffering from social anxiety disorder or social phobia. At first glance, it may seem logical and understandable that strict avoidance of threatening situations will let a person feel better and that further help is not necessary. The contrary is however the case: the longer an individual uses this ‘self-help technique’, the more his or her social anxiety disorder will increase over times, if the person does not receive an appropriate professional treatment. _________________________________________________ Can Social Anxiety be a positive Trait? Most people automatically associate the term “social anxiety” with negative features. In fact social anxiety is quite a normal but also a very important and positive trait that allows people to build up relationships and to be sensitive to the feelings and wishes of others. Occasionally, social anxiety can be judged very positively when it helps people considering more carefully the many aspects of important issues, such as a new date, a job interview, etc. _________________________________________________ When can social anxiety or social phobia become a problem? Social anxiety disorder can become a serious problem when it makes people feel overwhelmingly anxious and excessively self-conscious in everyday social situations. It is obvious that the fact of getting occasionally nervous or discomforted in a specific social situation does not automatically mean that the person suffers from social anxiety disorder or social phobia. A lot of people may have moment during which they feel and cannot hide their shyness or self- consciousness. As long as these feelings occur only occasionally and do not influence their everyday functioning, there is no reason for them to worry; they are far away from suffering from social anxiety disorder or social phobia. For people suffering from social anxiety disorder or social phobia, the immense fear and concern that they develop when interacting with other people do interfere seriously in their daily routine and cause dreadful distress. Social anxiety disorder affects a person’s emotions, behaviour and thoughts. Social anxiety is often understood as a single concept; it is however often helpful to view social anxiety in terms of three distinct components that are interrelated and capable of strengthening one another and lead to a cycle of anxiety. There are two types of social anxiety disorder or social phobia: Generalized social anxiety disorder or social phobia I When a person suffers from generalized social anxiety disorder or social phobia, he or she fears to be scrutinized or humiliated, and consequently avoids, most social situations. Non-generalized social anxiety disorder or social phobia When a person suffers from non-generalized social anxiety disorder or social phobia, he or she is normally not excessively anxious unless put in particular types of social situations, such as talking to strangers, meeting people in authority, holding a speech, making eye contact, performing on stage, going on a date, attending parties, etc. _________________________________________________ Causes of social anxiety disorder (social phobia) Many experts do believe that social anxiety disorder or social phobia – like so many other mental health conditions – has both environmental and genetic causes. Social anxiety disorder is most likely the result of interactions between following factors. Genetic as a cause of social anxiety disorder or social phobia Social anxiety seems to run in families and tends to be passed from one generation to the next one. Children living in an anxious family usually behave accordingly and are susceptible to also suffer one day from social anxiety disorder. To date, it is still unclear how much social anxiety disorder is due to inherited traits and learned behaviour. Researchers have not found yet a specific social anxiety gene. Chemical as a cause of social anxiety disorder or social phobia Serotonin, a natural body chemical is believed to be a cause of social anxiety disorder in people that are extremely sensitive. Brain as a cause of social anxiety disorder or social phobia A part of the human brain called the amygdala is also said to possibly cause social anxiety disorder in people suffering from an overactive amygdala. Negative experiences as a cause of social anxiety disorder or social phobia Children who suffer from constant or repeated bullying, rejection, or humiliation are susceptible to developing social anxiety disorder. From the many children who experience dramatic family conflict, are early separated from parents, exposed to physical or sexual abuse, or have serious difficulties in school, a big number is expected to suffer one day from social anxiety disorder. Demographic as a cause of social anxiety disorder or social phobia People living in ‘warm-weather’ countries are less likely to suffer from social anxiety disorder than those living in ’cold- weather’ countries. A possible reason may be found in the fact that warner temperature increases significantly interpersonal contacts and leaves little chance to social anxiety disorder to develop. _________________________________________________ Risk factors of social anxiety disorder (social phobia) Social anxiety disorder (or social phobia) belongs to the most common mental disorders. Although social anxiety disorder can sometimes begin in childhood, it usually appears in the early to mid-teens or in adulthood. The many causes of social anxiety disorder are not yet fully understood, but a wide range of risk factors for social phobia have been clearly identified. When a person realizes that he or she has several risk factors of social anxiety disorder, it does not mean that the person will automatically develop social anxiety disorder; it only gives an indication that he or she has a slightly higher chance of developing social phobia at times. Following factors can increase the risk of developing social anxiety disorder: Age – a risk factor of social anxiety disorder Social anxiety disorder can strike any person regardless of age, but typically begins in childhood or early adolescence. Social anxiety disorder seldom develops after age 25. Gender – a risk factor of social anxiety disorder Women have usually higher rates of social anxiety disorder than men. However, men are said to seek treatment more often than women for their social anxiety disorder symptoms. Family history – a risk factor of social anxiety disorder Some causes of social anxiety disorder may sometimes have a genetic component. People are more likely to develop social anxiety disorder if their biological parents or siblings have or have had the condition. Biology – a risk factor of social anxiety disorder Some biological factors are believed to increase the risk of social anxiety disorder. Surveys focusing on the brain imaging of social anxiety patients have shown that those people who suffer from social anxiety disorder have an overly active amygdala. These surveys also found out that the prefrontal cortex of the people suffering from social anxiety disorder with an overactive amygdala is less active. A disproportion in neurotransmitters is likely to generate social anxiety, too. Imbalances in neurotransmitter – brain chemicals responsible for cell communication – are also suspected to be responsible for both depression and social anxiety disorder, since some disproportions in neurotransmitters, such as dopamine, GABA and serotonin, have been found in social anxiety patients. Environment – a risk factor of social anxiety disorder Certain environmental factors can significantly increase the risk of suffering from social anxiety disorder. People who suffer from constant or repeated bullying, rejection, or humiliation are susceptible to developing social anxiety disorder. From the many children who experience dramatic family conflict, are early separated from parents, exposed to physical or sexual abuse, or have serious difficulties in school, a big number is expected to suffer one day from social anxiety disorder. Social anxiety disorder may also be a so-called ‘learned’ behaviour. For instance, a child will gradually ‘learn’ to become socially anxious if he lives with a parent suffering from social anxiety disorder – by watching and mimicking the parent’s anxious reactions and behaviour. A certain association is also to be made between social anxiety disorder and parents who are more controlling or protective of their children. Temperament – a risk factor of social anxiety disorder Shyness is also believed to be another risk factor directly connected with social anxiety disorder. Shy, timid, and withdrawn children are much more susceptible of developing social anxiety symptoms than those that are more extroverted. Emotion and behaviour – a risk factor of social anxiety disorder The intense fear of interacting with new people, coming into a situation where one can be scrutinized or humiliated or where one cannot hide one’s anxiety, etc. may generate social anxiety disorder symptoms. Health condition – a risk factor of social anxiety disorder A person’s health condition may also be a serious risk factor of social anxiety disorder. Most health conditions that draw attention, such as Parkinson’s disease, facial disfigurement, handicaps etc. can cause social anxiety disorder in some people. _________________________________________________ Complications of social anxiety disorder or social phobia The overwhelming distress generally associated with social anxiety or social phobia can easily lead to further psychological complications including other anxiety disorders, major depressive disorder, and substance-related disorders. Some people try to self-medicate their social anxiety disorder with alcohol, marijuana, and other mood-altering substances. This ‘self-help treatment’ tends to complicate seriously both the course and prognosis of their social anxiety disorder. Personality disorders are also reported to be associated with social anxiety or social phobia and are therefore another complicating factor. If left untreated, social anxiety disorder can be devastating and affect severely a person’s quality of life. The degree and intensity of social anxiety disorder may increase and eventually run his or her life. Social anxiety or social phobia can interfere at anytime and anywhere with a person’s school, work, relationships, etc. and make him or her leave school, quit job or lose friends. The most common complications associated with social anxiety disorder or social phobia are: Depression Many people with social anxiety disorder or social phobia also suffer depression.  These people exhibit persistently low mood, hopelessness about the future, feelings of worthlessness and certain physical symptoms, such as sleep and appetite disturbance. Some do even experience thoughts of suicide. Alcohol problems People with social anxiety disorder or social phobia often consume alcohol to cope with anxiety during social events. Alcohol abuse is one of the main additional problems for people with social anxiety disorder or social phobia. Benzodiazepine dependence Benzodiazepines such as diazepam are often prescribed to treat social anxiety disorder or social phobia and other anxiety disorders. They are highly addictive and cause serious withdrawal symptoms when the drug is stopped. Further complications Complications such as substance abuse, misuse of prescription and non-prescription drugs, isolation from family, friends and community, difficulty in forming and maintaining relationships, etc. are also associated with social anxiety disorder or social phobia. _________________________________________________ Your Appointment with a Professional for Social Anxiety Disorder Taking the decision to seek help for your social anxiety disorder or social phobia and making a first appointment with your primary care doctor is most probably the most important step you can make in this connection to improve your condition. Your doctor will most probably refer you to a specialist, a mental health provider, who will diagnose you and work out an appropriate treatment plan for your specific social anxiety disorder. It is always a good idea to get prepared for your appointment and to bring along with you your “Social Anxiety Disorder Diary” in which you have written down – as detailed as possible – when and under which circumstances both physical and psychological symptoms have occurred, how you have tried to deal with them, and what results you have obtained. It is also recommended to make a check list of all of your key personal information, possible stresses, and important recent changes in your life and to describe shortly how badly and when your “social anxiety disorder” has affected you. To complete the picture, you can work out a list of all your medications, inclusive dosages and directions and ask a trusted family member or friend to accompany you to your appointment, and help you remember all information you will receive to cope and treat your social anxiety disorder. _________________________________________________ Tests and diagnosis Seeking treatment for your social anxiety disorder symptoms, you have finally made an appointment with a recommended health care provider. He or she will make you pass a thorough physical exam to find out if your social anxiety symptoms are possibly triggered by any physical causes. He or she will also let you answer a lot of question to find out about your present psychological state and your social anxiety disorder. As laboratory tests to diagnose social anxiety disorder or social phobia do not exist yet, you will be asked by your doctor or mental health provider to describe your social anxiety symptoms as accurately as possible, i.e. in what precise situation or environment they occur and also how often. Your doctor or mental health provider will most probably ask you to fill in a few psychological questionnaires to allow determine a correct diagnosis. In accordance with the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, following criteria have to be met for a person to be diagnosed with social anxiety disorder or social phobia: Criteria to be diagnosed with social anxiety disorder or social phobia 1. You must suffer from a persistent fear of situations in which you firmly believe that unfamiliar people will scrutinize you and/or you will show anxiety symptoms that will be most embarrassing or humiliating. 2. The exposure to the feared social situation always causes you a great deal of anxiety. 3. You recognize that the fear level is excessive and not in line with the actual situation. 4. You avoid or endure the feared social situations. 5. Your distress or anxiety interferes seriously with your normal activities. Social anxiety disorder also exhibits certain symptoms that are typical for a few other psychological disorders. As social anxiety disorder and other anxiety disorders have some symptoms in common, it is not surprising that your mental health provider will want to check and determine if you suffer from social anxiety disorder or if you also suffer from another mental health disorder in addition to your social anxiety disorder. Sometimes, social anxiety disorder is combined with other mental health conditions, such as depression, alcohol and substance abuse, and body dysmorphic disorder (BDD). _________________________________________________ Treatments for Social Anxiety Disorder or Social Phobia Research has made it possible for sufferers of social anxiety to have several treatment options available for controlling and removing their social anxiety disorder and social phobia. Psychotherapy and medications are both appropriate options to treat effectively social anxiety disorder or social phobia. Depending on the history, the severity and intensity of the person’s social anxiety disorder, the doctor or other health care provider will suggest applying the psychotherapy treatment, the medication one or possibly both of them. Psychotherapy treatment for social anxiety disorder or social phobia Psychotherapy – sometimes called “therapy” for short – is best indicated to treat effectively people who suffer from social anxiety disorder. Through psychotherapy people learn to better understand and identify their personal life problems and events that have led to their social anxiety disorder or social phobia disorder. Through psychotherapy people learn how to change the negative thoughts they used to have about themselves. Cognitive behavioural therapy is said to be the most commonly applied one for social anxiety disorder; its objective is to make people learn – using their own experience – that their own thoughts, and not other people or situations, such as social anxiety disorders, decide how they are supposed to behave or react. Even when people realize that a given situation is not going to change, they are still capable of changing the way they think and behave. An exposure therapy can also be part of your cognitive behavioural therapy. Exposure therapy makes you face the many situations responsible for your social anxiety disorder and teaches you gradually how to react normally in order not to trigger related social anxiety symptoms. Your mental health provider will teach you relaxation techniques to regain comfort and confidence in yourself, and to better cope with social anxiety disorder. Medication treatment for social anxiety disorder and social phobia Medication can also be an option to help control or reduce temporarily the intensity of a few symptoms of social anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs) belong to the medications that are prescribed in first line by doctors and mental health provider to treat relentless symptoms of social anxiety disorder. Medications that have shown to be effective in ‘managing’ social anxiety symptoms include Paroxetine (Paxil), Sertraline (Zoloft), and Fluvoxamine (Luvox). These three antidepressants have been approved by the U.S. Food and Drug Administration for the treatment of social anxiety disorder and social phobia. _________________________________________________ Further medication options for the treatment for social anxiety disorder and social phobia Other types of anti-depressants Several other types of anti-depressants can also be recommended to treat social anxiety disorder. They are prescribed to increase effectiveness and reduce negative side-effects. Anti-anxiety medications Anti-anxiety medications, such as benzodiazepines, can also be recommended – for short-term use – to treat social anxiety disorder. Beta blockers. Beta blockers can also be recommended – for infrequent use – to treat social anxiety disorder. They block the stimulating effect of epinephrine (adrenaline) and can be used in special situations to control a person’s social anxiety symptoms. Beta blockers are not indicated for general treatment of social anxiety disorder. _________________________________________________ Recommendations Even if you do not see any quick improvements in the treatment of your social anxiety disorder, do not be disappointed and do not give up. It can sometimes last for weeks or months before the appropriate medication for your social anxiety disorder is found. With their symptoms of social anxiety disorder declining over time, some people may stop taking their medications while others suffering from similar social anxiety disorder may have to continue in order to avoid a relapse. We can but recommend to all sufferers of social anxiety disorder to make sure that they respect their medical and therapy appointments, and that they take their medications as advised and behave in accordance with the psychotherapist’s instructions, in order to maximise their chance for a successful treatment of the social anxiety disorder. _________________________________________________ Prevention for Social Anxiety Disorder and Social Phobia We are often asked the question: “Can social anxiety disorder or social phobia be prevented?”  There is of course no sure way yet to prevent social anxiety disorder to occur or to foretell what situation is likely to cause a person to develop social anxiety disorder.  However everybody can take self- care steps in order to minimize the impact of social anxiety symptoms: Getting early help is most important Seeking help as early as possible is by far the most important step a sufferer of social anxiety disorder or social phobia can do – for himself. The longer a person waits before beginning treating social anxiety disorder, the more difficult and the longer the disorder can last. Keeping a “Social Anxiety Disorder Diary” Keeping such a diary up-to-date will be a great help for your mental health provider to identify the situations that cause your social anxiety disorder. Setting priorities in your everyday life Setting priorities is another important issue that can reduce significantly your social anxiety disorder by appropriate scheduling your time and energy. Creating achievable goals Creating several small achievable goals, such as initiating greetings, complimenting a person, returning an item to a store, using a public telephone, initiating conversations, etc. is extremely important for your self-esteem and will help you reduce gradually your social anxiety disorder. Getting adequate sleep Getting enough sleep will help you stay calm in many social situations. People who are deprived of sleep lose energy, become quick tempered and are basically more vulnerable to social anxiety disorder Avoiding alcohol and drugs Avoiding or at least limiting alcohol, drugs, caffeine, nicotine, foods high in sugar and other unhealthy substances will be beneficial as all these products can aggravate your social anxiety disorder. Strongly addicted people should see their doctor or join a support group. Practicing relaxation Practicing relaxation techniques, such as yoga or meditation, are valuable techniques that you can use when facing situations that could cause social anxiety disorder. Controlling your breathing Doing deep-breathing exercises will teach you how to react and calm down when your social anxiety disorder starts. Exercising regularly Exercising regularly will help you burn your stress-related chemicals and remain calm in many situations that would usually trigger social anxiety disorder. Creating achievable goals Living a healthy life-style means doing regularly exercises, having a well-balanced diet, and sleeping enough has a positive effect on your condition. The contrary is true for low blood sugar level and repeated sleep deprivation that tend to worsen social anxiety disorder. _________________________________________________
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