Many people give social phobia a romantic or mysterious aura, perceive it as something funny, as a character trait, and not a disease. However, this condition is very common (it is the third most common mental disorder after major depressive disorder and alcoholism), is chronic and can provoke other serious diseases. It has a destructive effect on a person’s life: it limits his intellectual and professional development, his personal life, and leads to the emergence of addictions.
Research shows that social phobia increases the risk of subsequent development of depression by 3–3.5 times, and suicide attempts in people under 24 years of age by 6 times. Children with this diagnosis are significantly more likely to drop out of school. In the United States, 70% of people with this mental disorder have a low socioeconomic status, and 22% are unemployed.
Social phobes are less likely to start families and do not fulfill their need for relationships. But emotional closeness and contact with family and friends prevent the development of the disease.
about the charm of social phobia are wrong: this disorder never gives a person uniqueness, on the contrary, it forces this uniqueness to be hidden. Social phobia, like any anxiety disorder, is a pathological condition that greatly interferes with life.
A social phobe is often called a person who is not interested in communication and therefore does not strive for it. In reality, a social phobe greatly needs contact with other people, but is very afraid that everything will turn out badly, and fences himself off from people not as something annoying, but as alluring, but unattainable. This is not a nice, modest guy who prefers to remain silent. Modesty is a character trait, and such a person takes longer to adapt to the situation and communicates less intensively, but this is not a problem. But for people with social anxiety, communication is a problem.
How my hand trembles: how social phobia differs from shyness
Social anxiety arises from the fear that others will not accept us. It is absolutely natural for all people: it is part of the fundamental biological human need to be loved. Psychological disorder begins when anxiety begins to greatly influence a person's behavior.
The difficulty is that it is impossible to accurately measure how much anxiety affects life - today more, yesterday less. It is especially difficult to determine this impact if the person has lived with the condition almost always. There is no standard for an acceptable level of social anxiety in certain situations. Is body trembling while speaking in front of colleagues normal or is it too much? What about the complete inability to talk to the person you like? Answer a simple question to the cashier?
People with phobic anxiety disorder develop a fear of situations that are not dangerous. This usually leads to the person beginning to systematically avoid these situations. So a social phobe refuses a number of social activities - for example, he may stop eating in public, using a public toilet, talking on the phone, going on dates or making friends. A person may oppose a wedding not only because he is afraid to start a relationship, but also because he is afraid to go to an event where he will be the center of attention. Many people with this disorder are very afraid of speaking in public.
Social phobia is called the disease of missed opportunities.
However, social phobics are not necessarily shy. Shyness is only one manifestation of the disorder; but different behavior patterns are possible. Such a person may give the impression of being touchy, gloomy, irritable, or, trying to hide his fears, he may act like a cheerful person who strives to please everyone.
“Am I living my life or is my life living me?”
Some tools for working on social phobia can be used outside of psychotherapy sessions. The most effective way to fight, according to Olga Razmakhova, is to begin to experience those situations that a person previously tried to avoid. “New social experiences help eliminate cognitive errors—stop thinking for others or allowing them to think whatever they want about me. In a situation of social phobia, a person cannot feel whole and comfortable, relying only on what he thinks about himself - the assessment of others is important to him. It is necessary to come to a certain emancipation: to build relationships with yourself and not depend on the opinions of society,” says Olga.
Another way to work with a phobia is to try to distance yourself from your thoughts. We can all think about our thinking: when anxiety arises, the technique suggests taking the position of an “impartial observer” in relation to our thoughts - that is, trying to look at them “from above” or “from the outside.” The task here is not to correct disturbing thoughts, but to change the attitude towards them. This helps to separate rational ideas from anxiety symptoms and not let the latter control us.
All this does not mean that a person will immediately stop experiencing anxiety and discomfort. First you need to perceive your feelings differently and start working with them. “I allow myself to feel anxiety and talk about it publicly - it helps a lot. When speaking at a scientific conference, I might start my speech like this: “As long as I talk about anxiety and panic attacks, I will become a clear example of what I am talking about.” This reduces the level of shame and allows you not to waste effort on hiding anxiety,” Olga Razmakhova shares her experience. It also helps to talk about your own experiences with a loved one.
According to Olga, many clients turn to specialists with a request to relieve anxiety. “Therapists often follow this initial request. It turns out that we completely want to eliminate this emotion from our lives. But this is impossible and unconstructive. The story of conditional recovery here is not about erasing any emotion from yourself, but about learning to live with certain episodes with it. Besides, you can always look at anxiety from a different angle.
So, I can experience it before meeting a loved one or defending an important project - here it ceases to be a problem for me, but becomes a marker of a significant event. It is important for people with social phobia to have a similar experience: when I accept an emotion, it ceases to have power over me
This is a question of whether I am living my life or whether my life is living me,” says the psychotherapist.
It is indeed possible to combat the problem of social phobia. Olga suggests moving from the question “why”: first of all, it is worth figuring out what changes a person wants to bring into his life, and not what to remove from it. If he or she strives to build partnerships and romantic relationships with others, realizing one's values and gaining new communication experiences is quite possible.
Public culture is no less important in this sense, says Nika Wodwood: “Despite the fact that millions of people have mental disorders, and a large proportion of the population has the Internet, they don’t talk about it. This is kept secret. They are afraid of this. Stigma leads to dehumanization both from the outside - dismissals, bullying, ostracism, and from the inside, when a person cannot accept himself or seek help
Supporting any initiatives aimed at helping people with mental disorders, creating awareness and overcoming stigma is very important and a huge step forward, the results of which will affect absolutely each of us, directly or indirectly.”
Photos: Tamara Kulikova - stock.adobe.com, Tamara Kulikova - stock.adobe.com, Tamara Kulikova - stock.adobe.com, Tamara Kulikova - stock.adobe.com
What is a social phobe afraid of?
With social phobia, there are four main fears: being judged by others, being humiliated or disgraced, accidentally offending someone else, and being the center of attention.
A social phobe may realize that his fears are excessive and unreasonable, but this does not make it any easier to overcome them.
Manifestations of the disorder are divided into three groups: cognitive, behavioral and physiological.
Cognitive manifestations:
- tendency to see oneself in a bad light
- horror from the gaze of other people,
- constant focus on yourself,
- disturbances in concentration,
- inflated demands on oneself.
Physiological manifestations:
- shiver,
- lack of coordination
- nausea,
- difficulty breathing,
- sweating,
- muscle tension,
- redness or paleness of the skin.
Behavioral:
- fussiness,
- shyness,
- avoiding contact with people,
- desire to run away, hide, etc.
Social phobia manifests itself quite early, on average at 11 years of age. Such children are clearly uncomfortable communicating with teachers or classmates; they avoid eye contact, speak very quietly and unintelligibly, and blush or shake when communicating. They are often afraid of saying something “stupid” or appearing funny.
Children with social phobia may pretend to be sick to avoid activities and try to spend a lot of time at home. These seemingly innocent actions may indicate that the child is developing psychological attitudes that will greatly complicate his life in the future.
Each patient will have their own manifestations, and they do not necessarily have to be many. Based on this principle, there are two types of social phobia:
- generalized - a person is very afraid of many social situations (or even all). As a rule, this form of social phobia affects a person comprehensively, its consequences are more severe, and treatment is more difficult.
- specific - a person is afraid only of certain situations, and there are few options for the manifestation of anxiety. For example, social phobia can only manifest itself when communicating with a hint of romance, during which a person’s hands begin to shake uncontrollably, an obsessive desire to escape appears, and all attention is focused on these reactions.
Treatment
Conventionally, treatment methods for this phobia can be divided into 4 groups: individual psychotherapy, medication, group therapy, self-help or treatment from books, online consultations, etc.
However, the main method of treatment, which gives the highest percentage of positive results, is considered behavioral therapy. The essence of behavioral therapy is the formation of new mental attitudes in social phobics while assessing situations that cause anxiety, and relief from physical symptoms. The main acquisitions after cognitive therapy can be considered behavioral skills in various social situations, anxiety can go away on its own, a person behaves calmer in social situations, and self-learning skills.
Drug treatment is used in cases where patients refuse psychotherapeutic treatment. However, the effectiveness of drugs is quite limited and is mainly aimed at eliminating symptoms such as stress and anxiety.
Drug therapy involves the use of drugs from groups such as antidepressants, beta blockers and benzodiazepines.
There are other methods, trainings and ways to get rid of this phobia. For example, the method of positive visualization, which consists of imagining a situation that provokes anxiety and nervousness, excitement, feelings of fear and living this situation with a positive attitude.
J. Bicom also developed training for overcoming social phobia, which consists of the opportunity to more impartially consider situations of interaction with society, track one’s irrational judgments and ideas, and develop more effective ways of interacting with the environment. Training to overcome social phobia is based on performing a variety of exercises that simulate various situations of everyday life. Many people who use training techniques have been able to significantly improve their condition.
Why does social phobia appear?
As is the case with other mental illnesses and disorders, social phobia can be triggered by psychological trauma, instilled norms of behavior, and heredity. Since social phobia usually manifests itself early, its origins should also be sought in childhood. This could be a traumatic experience, a blow to self-esteem, fear of anticipation, overprotective or rejecting parents, and even heredity.
Traumatic experience
Triggers for social phobia can include bullying, domestic violence, humiliation, or long-term rejection by peers.
70% of patients with general social phobia surveyed reported that they had been exposed to at least one type of violence in childhood.
46.2% of respondents said that they experienced violence from a relative at an early age (for comparison: in the control group of people without anxiety disorders, this figure was 16.5 times lower).
A blow to self-esteem
How are anxiety reactions formed in situations that are not dangerous in themselves? In a certain situation, a person receives a low assessment from those around him who are significant to him. Circumstances change, but the person continues to perceive others as a threat to self-esteem. A persistent fear is formed that in a similar situation people will speak out in the same negative way. A researcher on the condition, Scott Stossel, described anxiety as “a premonition of future suffering, a frightening premonition of an unbearable catastrophe that there is no hope of preventing.”
Fear of waiting
Social phobia grows when there is a conflict of needs and opportunities: I want to communicate, but for some reason I can’t. This chain closes:
a person is afraid that he will not be able to perform a social action that is important to him ↓ because of fear he really cannot do it ↓ he is even more afraid
Frustration increases - suffering due to the inability to get what you want. This contributes to the development of depression due to unmet important social and biological needs.
Psychiatrist Viktor Frankl described the mechanics of phobia development as follows:
“A symptom causes the patient to fear that it may happen again, and with this comes a fear of anticipation (phobia), which leads to the fact that the symptom actually appears again, which only increases the patient’s original fears.”
Overprotective or rejecting parents
Parents can play a significant role in the formation of social phobia if they instill in their child the extreme importance of external positive evaluations and fixation on themselves. Overprotection in the family or, conversely, rejecting behavior can also have an impact. In addition, researchers have found a relationship between socially anxious, avoidant behavior of parents and the development of social phobia in children.
Heredity
Social phobia can be caused not only by external factors, but also by physiological ones:
- anatomical features of the brain - the structure of the prefrontal cortex, increased sensitivity of the amygdala and hypothalamus (these are areas associated with the formation of anxiety and fear);
- genetic - similar chromosome features were found in people with anxiety and panic disorders.
Heredity increases the likelihood of developing not only social phobia, but also any anxiety or depressive disorder, but, according to various estimates, it is no more than 25–50%.
Why is social phobia often combined with other diagnoses?
All anxiety disorders are highly comorbid, that is, a person can simultaneously have several disorders that are pathogenetically related.
90% of social phobics have at least one other psychiatric diagnosis. Typically, social anxiety disorder appears first.
The most common accompaniments of social phobia are major depressive disorder (41.8%), panic disorders (5.5%), post-traumatic syndrome (5.4%), as well as alcoholism (48%) and drug addiction (18%). ). 25% of people with a first episode of psychosis have social phobia. In young people, addictions combined with social phobia are much more common - according to some data, in 85.2% of cases.
Comorbid disorders respond less well to treatment. For example, depression and bipolar disorder take longer to treat and are less effective if the patient also has an anxiety disorder.
The manifestations of anxiety disorders may change over time - from natural causes (chronic illness, other diseases in the background) or due to medication, incomplete or inadequate treatment. A person may begin to be afraid of something else, become suspicious, the symptoms of the underlying disorder become stronger and stronger, and it may become chronic and resistant to therapy.
Definition of the concept
A social phobe is a person who experiences an inexplicable fear of various types of social interaction. Depending on the severity of social phobia, fear can be very strong and uncontrollable, or quite tolerable, but unpleasant. Naturally, such fear leaves a serious imprint on all areas of a person’s life, seriously reducing its quality. Therefore, social phobia is considered a pathological condition bordering on neurosis.
In addition, social phobia often provokes the development of other mental disorders, such as:
- depression;
- anxiety disorder;
- obsessive-compulsive disorder.
According to experts, social phobia affects from 2 to 13% of the world's population. This disease is more common among residents of developed countries, because higher requirements for success are initially set there. Women are more susceptible to this disorder, because by nature they are more impressionable and emotional.
Social phobia is a disease of developed countries
Social phobia is distributed very unevenly in different parts of the world. Research shows that in Western countries, 7–13% of people experience social phobia at least once in their lives, with the United States leading in the number of cases (12–13% of the population).
Social phobia is much more common in developed countries than in developing countries. In 2022, scientists surveyed 142 thousand respondents from 26 countries, 13 of which had a high standard of living, 7 - average, 6 - below average or low.
Countries with low living standards (Africa and the Eastern Mediterranean) had significantly fewer social phobics than countries where people earned a lot (North America and the Western Pacific).
On average, people experience social phobia during their lifetime:
- in high-income countries - 5.5% of the population,
- in countries with upper middle income - 2.9%,
- in low-income countries - 1.6%.
Stefan Hoffman, director of the Laboratory of Psychotherapy and Emotion Research at Boston University, believes that the prevalence of social phobia also depends on the type of society - collectivist or individualistic. Where the individual is less likely to be the center of attention, social anxiety tends to be less pronounced than in cultures that emphasize the uniqueness of everyone.
This is confirmed by the figures in the study mentioned above: in China, social phobia manifests itself throughout life in 0.5% of people, and in the USA - in 12.1%.
An Unidentified Disorder: Why Social Phobia Is Rarely Diagnosed
Scientists have calculated that, on average, social phobia lasts almost 23 years. Although it seriously affects all aspects of life, only about 20% of sufferers seek professional help, and usually only 15–20 years after the onset of symptoms. Less than 5% of people go to the doctor during the first year.
Often, such people consider social phobia to be a part of their personality that cannot be changed, or they look for the root cause of physiological symptoms.
Many children and teenagers are convinced that they will gradually outgrow this condition, but this is usually a misconception.
Social phobia is detected late and for other reasons:
- specialists do not always make the correct diagnosis;
- psychological help is stigmatized;
- the patient is afraid of being assessed by doctors;
- there is little information about effective treatment for social phobia;
- There are not enough therapeutic services.
Very often, social phobia is not diagnosed at all, and the person lives with this disorder all his life.
After the first manifestations of a phobia, a person (usually a child) subconsciously or consciously trains himself to avoid situations in which he becomes the center of attention and experiences severe anxiety. Due to this, the disorder is not so traumatic, but for the same reason it is less diagnosed. A person simply gets used to living with social phobia - to the detriment of self-realization.
Seeking help is also a social situation that the patient may avoid. Therefore, the disorder is often discovered when a person begins to treat a concomitant psychological condition that is more difficult not to recognize: addiction, panic attacks, depression.
If you think you may have social anxiety, take a test
to determine the level of social anxiety (Liebowitz scale).
help yourself
Since social phobia is not a severe mental disorder, an individual suffering from it is theoretically capable of self-healing. This, oddly enough, will be helped by one of the symptoms – criticality. To do this, a person should sort out his own life story and understand exactly which episode became fatal and analyze it.
Self-help can also be an option such as speaking. That is, after each alarming episode, the patient recounts what happened in great detail. If you do this every time after an incident, regularly and without fail, then, in the end, social anxiety will become less acute and will recede.
However, it should be understood that not everyone will be able to bring themselves back to normal “with their own hands.” Moreover, self-medication does not at all guarantee that traumatic circumstances will ever make themselves felt again in a more negative way. So it is more advisable to contact a specialist - a psychotherapist or psychologist.
In Russia, according to the latest data, about 5–10% of the population suffer from social phobia at different stages of life. Most of them attribute their condition to excessive timidity and other personal shortcomings. Only some people a little under 30 years old are aware of their problem when other neurotic disorders join it. At first they try to solve it on their own, but, having suffered a fiasco, they decide to ask for help from those who know how to help them normalize their social potential. It is important for them to know any information about social phobia and methods of getting rid of it.
Why face fear: therapy for social phobics
Social phobia is a chronic disease with a high risk of relapse. A Harvard University study confirms that it is also one of the most persistent mental disorders.
Scientists observed for 12 years how anxiety and affective disorders developed in 711 patients. At the start of the study, participants had remained diagnosed for an average of 19 years. Without treatment, 37% of participants recovered from social phobia during the experiment—this was the lowest rate among other mental illnesses studied. For comparison, generalized anxiety disorder went away on its own in 58% of participants, major depressive disorder in 75%, and panic disorder in 82%. However, with regular and long-term help, social phobia is highly treatable.
The disorder is based on a lack of social support and experience, and this cannot be compensated for with drugs alone.
At the same time, any psychotherapeutic practices are very effective: when a person discusses with a specialist for a long time what is bothering him, he feels better.
The task of a psychotherapist in the treatment of social phobia is to help the patient correct their dysfunctional thinking styles and irrational attitudes (for example, that failures in communication are inevitable) and learn to cope with traumatic situations. Due to this, a person should regain his self-esteem and develop the correct attitude towards the reactions of others. As a result, he will also get rid of the physiological manifestations of social phobia.
One of the most effective methods of treating social phobia is the cognitive-behavioral approach. This is the name given to a group of psychotherapy methods that are designed to change a person’s thoughts and/or behavior. It is believed that maladaptive behavior is often associated with a way of thinking and, if you change your thinking, you can influence problematic reactions.
Diagnostics
If you are asking the question: “Is social phobia a mental illness or not?”, I will answer briefly and to the point: “Yes!” At the same time, only a psychotherapist can correctly diagnose social phobia and prescribe the correct treatment. Although recently more and more people are independently diagnosing themselves. They actively share problems on social networks and participate in chats about social phobia.
In most cases, their diagnosis is not confirmed. People confuse social phobia with other phobias, mental disorders, and even with simple shyness. Many introverts call themselves social phobics. But there are significant differences between these concepts.
An introvert is already born this way. From early childhood he prefers solitude. He is comfortable alone with himself. This is inherent in his character. A social phobe was different before he developed a phobia, as a result of some kind of psychological trauma. And he remembers it very well. Loneliness gives an introvert joy, peace, and the opportunity to relax and recharge with energy. Therefore, he refuses noisy events. A social phobe would be happy to have fun in a big company, but he is terribly scared. He is afraid that he will be rejected, mocked, or not even notice his presence. Therefore, he chooses boring, but at the same time calm loneliness. All introverts are good communicators. Although they love privacy, they also have developed social skills. It is not difficult for them to start a conversation, join in the conversation, and defend their opinion. The same cannot be said about a social phobia. For him, communication turns into torture. He speaks very quickly or too quietly, hides his eyes and tries to run away. For an introvert, it is of great importance what family and friends think about him. They are not interested in the opinions of others around them
The attitude of absolutely everyone is important to a social phobe. Whether it's a saleswoman in a store or a stranger with the wrong number
It seems to him that everyone around him thinks badly of him. He is sure that he does not correspond to the society in which he finds himself. Perfectionism is at the root of social dysfunction. A social phobe believes that he must be perfect. Then he will be accepted and will not be criticized. Even in line for bread, he mentally rehearses what he will say to the seller. An introvert does not suffer from perfectionism. He accepts himself as he is.
