A phobia is an uncontrollable, irrational, and lasting fear of a certain object, situation, or activity.A much smaller number of people, who suffer severely around others, have social anxiety disorder (SAD), also called social phobia. SAD is more than exaggerated shyness.
The very commonness of fears, even severe fears, often causes people to trivialize the more serious psychological disorder known as a specific phobia. These phobias can be extremely disabling.
Diagnostic Criteria for Social Anxiety Disorder (Social Phobia)
A. Marked fear or anxiety about one or more social situation in which the person is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation; meeting unfamiliar people), being observed (e.g., eating or drinking), or performing in front of others (e.g., giving a speech).
B. The individual fears that he or she will act in a way, or show anxiety symptoms, that will be negatively evaluated (i.e., will be humiliating, embarrassing, lead to rejection, or offend others).
C. The social situations almost always provoke fear or anxiety. Note: in children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation, and to the sociocultural context.
F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
H. The fear, anxiety or avoidance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
I. The fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder (e.g., anxiety about having a panic attack) or separation anxiety disorder (e.g., fear of being away from home or a close relative).
J. If another medical condition (e.g., stuttering, Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety or avoidance is clearly unrelated or is excessive.
We seem to be prepared by evolution to fear certain wild animals and dangerous situations in the natural environment. Similarly, it seems we are also prepared to fear angry, critical, or rejecting people.
We learn more quickly to fear angry expressions than other facial expressions, and this fear diminishes more slowly than other types of learning. Socially anxious individuals more quickly recognized angry faces than “normals,” whereas “normals” remembered the accepting expressions.
A model of the etiology of SAD would look somewhat like models of panic disorder and specific phobia. Three pathways to SAD are possible.
- First, someone could inherit a generalized biological vulnerability to develop anxiety, a biological tendency to be socially inhibited, or both. The existence of a generalized psychological vulnerability. Such as the belief that events, particularly stressful events, are potentially uncontrollable would increase an individual’s vulnerability.
- Second, when under stress, someone might have an unexpected panic attack in a social situation. That would become associated (conditioned) to social cues. The individual would then become anxious about having additional panic attacks in the same or similar social situations.
- Third, someone might experience a real social trauma resulting in a true alarm. Anxiety would then develop (be conditioned) in the same or similar social situations. Traumatic social experiences may also extend back to difficult periods in childhood.
Treatment for Social anxiety (Phobia).
Effective treatments have been developed for SAD. Clark and colleagues (2006) evaluated a cognitive therapy program that emphasized real-life experiences during therapy to disprove automatic perceptions of danger. This outcome is the best yet for this difficult condition. It was significantly better than previous approaches to which it has been compared.
The treatment specifically targets the different factors that are maintaining the disorder. One important reason why SAD is maintained in the presence of repeated exposure to social cues. The reason is individuals with SAD engage in a variety of avoidance and safety behaviors to reduce the risk of rejection. And more generally, prevent patients from critically evaluating their catastrophic beliefs about how embarrassed and foolish they will look if they attempt to interact with somebody.
Several clinical trials have now compared individual and family-based treatment approaches for youth with social anxiety. While both treatment approaches appear to be equally efficacious, family based treatment appears to outperform individual treatment when the child’s parents also have an anxiety disorder.
Effective drug treatments have been discovered as well. For a time, clinicians assumed that beta-blockers (drugs that lower heart rate and blood pressure, such as Inderal) would work, particularly for performance anxiety. But the evidence did not seem to support that contention. The psychological treatment was substantially better at all times, with most patients cured or nearly cured with few remaining symptoms.