the external environment and genes, but experts believe that the greatest weight is given in the experiences of patients. Only about 30% of cases have a genetic origin, the rest is due to complex experiences.
Heredity Having a family member with the disease slightly increases the chance of the individual also developing the same condition.
Trauma Experiences such as bullying , rejection, humiliation, abuse and family conflicts can influence insecurity and self-deprecation.
The family is the first social model that a child knows, if the coexistence is not harmonious this will reflect negatively on their development. The social phobia indexes increase according to the levels of protection and authoritarianism exercised by the parents, since the more they provide affection and healthy doses of autonomy to children, the smaller the chances of developing the disorder.
Coexistence must also be equally harmonious in the school environment, where maltreatment and provocations can occur that leave emotional – or physical – scars on the individual.
Excessive shyness Excessive shyness and restrained behavior since childhood can interfere when facing new situations or meeting new people, favoring isolation. Shy children can also suffer from teasing because they are quieter, as they can become withdrawn after being bullied.
Brain structure The cerebral amygdala is the brain structure that forms and controls emotions. The hyperactivity of this region makes the person more fearful and insecure in the face of moments of socialization.
Evolutionary cause There are studies that indicate that worrying about what others think of you has relevance for survival. In a primitive time, a person who was excluded from the social group had less chances of survival and reproduction, so the human being has evolved to avoid this, seeking to be socially accepted.
Self- esteem would then be a measure of social acceptability and threats to self-esteem would bring feelings of anxiety in response. Anxiety disorder, therefore, fits as a high social stress response to a situation that does not present this level of danger to self-esteem.
Social anxiety disorder usually manifests itself in childhood, but it can start in pre-adolescence or later in adulthood. People with the disorder are usually young and live in large cities, where social contact is theoretically greater. Studies show that women are more vulnerable to the disease than men.
Several factors increase the risk of developing the disorder, including:
Family history, as the individual is more likely to develop the disorder if his parents or biological siblings are also carriers; Shy or withdrawn children have a tendency to isolate themselves; Children and adolescents who suffer or have suffered bullying or other negative events in life, such as physical and psychological trauma associated with the family; Some individuals with some health condition that draws attention, such as facial disfigurement, stuttering and Parkinson’s disease, may suffer from self-judgment and isolation, leading to triggering the social anxiety disorder.
The first signs usually appear during childhood, when children show excessive concern about being away from their parents, only communicate with acquaintances, refuse to attend school or feel exaggerated anxiety on the eve of school projects or competitions.
Anxiety about interacting with adults or colleagues can be demonstrated by crying excessively, or “throwing a tantrum”, as is commonly known, clinging to parents and refusing to speak in social situations. Certain social events can be cited as triggers for a patient’s discomfort with social anxiety disorder:
Performance situations Speak publicly Eating or drinking in public Use bathroom or public transport Being seen performing a Acting on stage Be the center of attention Attend social events and parties Enter a room where people are already seated Be photographed or filmed Consult with professionals in Going to the home of friends and relatives
Interaction situations Speak on the phone Going on dates Going to stores or shopping Receive reviews Meet new people and / or make Speak with authority figures Start a conversation with someone Go and speak at meetings or job interview Receiving or giving gifts Maintain eye contact with Demonstrate your feelings, including to close friends
When left untreated, the disorder usually progresses gradually and can be diagnosed when the patient has seen the following symptoms for six months or more:
Physical symptoms In addition to daily nervousness, feelings of fear and anxiety are accentuated in a person with social phobia. The following physical symptoms can adversely affect your routine:
Palpitations and fast heartbeat; Shortness of breathe; Dry mouth; Stomach pain or nausea; Dizziness or vertigo; Feeling faint; Tremors; Reddish face; Sweat; Blurring of vision; Muscle tension; Shaky or stuttering voice; Excessive sweating; Feeling that the throat is blocked or difficulty swallowing; Forget what you were going to say momentarily; Exaggerated desire to go to the bathroom. Behavioral and emotional symptoms One of the essential symptoms is the feeling of inability to perform the social function by the individual believing that his behavior will be inappropriate for the occasion and, consequently, will suffer rejection or humiliation from acquaintances or strangers. Based on this idea, people with the disorder strengthen their anxiety in the expectation of making a good impression, and increase insecurity when they do not feel able to achieve that goal.
The distorted thinking of being observed and the intense concern of being judged by others, especially strangers, is constant. The sociophobic constantly avoids situations that may be the center of attention, such as public speaking .
Read more: Tripophobia: what it is, symptoms and causes
Self-focused attention and negative self-judgment Individuals with social anxiety disorder have a negative belief related to devaluation, with excessive attention to their own behavior, forced self-confidence behaviors and unrealistic and perfectionist standards regarding their task performance.
It is common to fantasize about situations that make you feel sick or that the other person with whom you have a dialogue will notice your physical symptoms, such as the trembling of the hands, changes in the voice, flushing of the face, etc. Instead of interacting with another person, the social phobic is attentive to his own actions and to the negative evaluation he makes of himself. The assumption may be that it is also being evaluated pejoratively with those who socialize at the moment.
Safety behaviors Safety behaviors consist of actions taken to minimize the onset of anxiety and appear safe, such as crossing your legs and arms to cover up tremors, rehearsing phrases before speaking out loud, reciting a speech quickly to avoid long pauses, looking around at cover eye contact, use two shirts to hide sweat, among others.
Safety behaviors are intended to avoid embarrassment and judgment, but they can favor increased anxiety and feared physical symptoms.
Intense pre and post-event concern The person with the disorder tends to activate anxiety and avoid social events after resorting to memories of failures and rejections from the past. The concern may occur days, weeks or even months before the scheduled date.
After going through social situations it is common to have negative evaluations of yourself, devaluing the positive moments or gestures of acceptance made by other people. The individual mentally portrays the interaction, pointing out the failures and failures in a more negative way than may have occurred. The memory is added to the memory and influences the social phobic not to repeat any similar experience in the future.
Agoraphobia is an anxiety disorder characterized by fear of not being able to escape from a situation or fear of not being able to be rescued if necessary.
This condition includes dread of places and situations that can cause panic, embarrassment or impotence, such as a crowded tunnel, boat or bus, because they are difficult to leave if the person does not feel well. The disease generates progressive isolation due to the fact that the patient starts to avoid social life when he feels more secure at home, which causes similarities and confusion with social phobia.
The difference between the two is in the way they deal with the crowds. A person with social anxiety disorder avoids socializing for fear of being judged by acquaintances and strangers or becoming the center of attention for some audience.
The agoraphobic, however, does not fear the evaluation of others, but has no one to turn to in the event of a panic attack, which makes them more capable of coping with everyday situations if they are in the company of someone they trust.
Social anxiety disorder can be similar to other conditions that interfere with the patient’s socialization, such as shyness. It is natural for human beings to experience insecurity and fear of embarrassment in certain social situations. That is, at specific times, the individual may feel more shy, but this will not necessarily prevent him from reaching his goals or becoming familiar with the place after getting in touch with other people.
In social phobia, on the other hand, the fear of being ridiculed can extend to most social situations, prevent the person from reaching their goals and influence isolation by avoiding communication with other people. Anxiety is more intense and has a high degree of impairment in the individual’s social and professional life.
Differentiating disorders is often a conflict even for health professionals, but consultations with psychiatrists or psychologists are advised to receive appropriate diagnosis and treatment.
The disease cannot be detected by exams or blood samples and depends only on the diagnosis of the psychologist or psychiatrist through information provided during a clinical consultation. The patient must report what the symptoms are and how long he has been suffering from them. Generally, in order to have a complete diagnosis, anxiety is persistent and affects the individual for more than 6 months.
As it is a mental disorder, the diagnosis can be time-consuming, as the smallest details must be collected so that the disorder is not confused with other diseases.
The first step in treatment is to identify the experiences that influenced the development of the disease. In most cases, only specialized psychological counseling is enough to make the patient able to face, little by little, social situations that cause him extreme anxiety.
In severe conditions, there is more benefit to the patient through a joint method of psychological care and antidepressants.
The patient should not give up on treatment, even if it does not work quickly. For some people, the symptoms of the disease may disappear over time and the medications may be discontinued. However, others may need to take the medication for years to prevent a relapse.
Therefore, the individual must maintain consultations with the health professional and the consumption of the instructed medications, notifying the doctor if any changes in symptoms have occurred.
Treatment with Cognitive-Behavioral Therapy Of all the treatments available, cognitive-behavioral therapy is considered to be the most efficient. It is based on the premise that everything an individual thinks affects how he feels that successively affects his actions. Thus, the method encourages you to recognize the irrationality of your fear and negative thoughts about social situations that cause anxiety and to develop more confidence to act on a daily basis.
Cognitive-behavioral therapy focuses on the following main points:
Self-management techniques When you are anxious, rapid breathing is one of the first symptoms to manifest. Hyperventilation causes an imbalance of oxygen and carbon dioxide in the body, motivating the characteristics of anxiety, such as dizziness, increased heart rate, feeling of suffocation and muscle tension.
The self-management process promotes eye work to develop attention, assertiveness tactics, social expression, positioning and self-centering (instructions for the patient to focus inside) and breathing and relaxation techniques to reduce the physical symptoms of anxiety. As an example, the following breathing exercise can help the individual to calm down in times of crisis:
Sit with your back straight and your shoulders relaxed. Place one hand on your chest and the other on your stomach. Inhale slowly and deeply through your nose for 4 seconds. Hold your breath for 2 seconds. Exhale slowly through your mouth for 6 seconds, releasing as much air as possible. Continue breathing through your nose and exhale through your mouth. Maintain a slow pattern of 4 seconds inhaling, 2 maintaining and 6 exhaling. Exercise with cognitive distortions It is common for patients suffering from the disease to have distorted and exaggerated thoughts that raise anxiety. The exercise aims to analyze negative thoughts to help the patient gradually build a clearer, more objective and positive view of the social situations that trigger their anxiety. It is up to the therapist to promote a real perception of the patient’s beneficial and harmful points, which tends to only list negative points about himself.
Exposure techniques and systematic desensitization To increase internal tolerance to physical and psychological signs of anxiety, these techniques constantly expose the patient to social situations that cause fear and apprehension.
The treatment is usually carried out in group therapies and aims to face the events through real or simulated exhibitions with the aid of Role Playing – a psychodrama technique in which the participant pretends to be someone else or interprets himself when performing the staging of a problem.
Treat the traumas associated with the condition If the patient has suffered any trauma that contributed to the development of social phobia, identification and psychological work should be carried out on these negative events. As the suffering occurs in social situations, the disease is directly influenced by previous experiences that may have shaken the person’s security and confidence to face socialization environments.
An analysis of these events is essential for the patient to be able to overcome this state of intense social anxiety.
Virtual reality treatment One of the most effective techniques for treating social anxiety disorder is the exposure technique, which, based on more recent research, can also be performed in the imagination. In therapy, the patient experiences some situation that he fears within a fictitious scenario, projected from a virtual reality. The treatment consists in the continuous confrontation of these situations exposed in three-dimensional (3D) images on the computer, with the use of glasses and headphones.
The study was carried out at the Psychiatry Institute of Hospital das Clínicas de São Paulo (HC-FMUSP) and showed an average of more than 70% patients who reported a reduction in anxiety symptoms.
Alternative treatments Several natural medicines have been studied as treatments for anxiety, but they do not have guaranteed efficacy or precise studies of possible adverse effects. Before taking, the patient is advised to seek the assistance of a health professional.
Kava ( Piper methysticum ) A traditional extract of Kava , a medicinal plant from the South Pacific, is effective in reducing anxiety. However, there are reports of possible liver damage, even with short-term use. The use of this plant should be avoided if the patient has liver problems or if he uses other medications that affect this organ.
Valerian ( Valeriana officinalis ) In addition to sleeping pills, the use of valerian reduces anxiety and stress and acts as a brain stimulant. The plant can be used as tea, tablets, capsules and in drops. Although it is generally well tolerated, the individual should talk to his doctor before using, as there are reports of patients who developed liver problems after taking preparations with valerian in their composition.
If the patient is under treatment with valerian and wants to stop taking it is recommended that the use be reduced gradually to avoid withdrawal symptoms.
Passion Flower ( Passiflora incarnata ) Passiflora , or Passion Flower, is a medicinal plant that has a calming and sedative effect against nervousness, anxiety and sleep disorders. It is found in capsules, chewable tablets or infusion, and is combined with other herbs in various medications. The plant is considered safe, but some studies report that it can cause drowsiness, dizziness and confusion.
Omega 3 Omega-3 fatty acids are believed to help brain health and can improve mood and the ability to deal with anxiety. The best options are: fish (salmon, sardines, anchovies), seaweed, flaxseed and nuts.
To reduce the risk of side effects, the healthcare professional may indicate a low dose and gradually increase the prescription to a full dose. It can take from weeks to months of treatment for the patient to notice improvement in symptoms. The drugs generally indicated for the treatment of social phobia are:
Zyvifax ( Venlafaxine Hydrochloride ); Zoloft ( Sertraline Hydrochloride ); Prozac ( Fluoxetine Hydrochloride ); Rivotril ( Clonazepam ); Olcadil ( Cloxazolam ); Stugeron ( Cinnarizine ); Lexapro ( Escitalopram Oxalate ); Cebrilin ( Paroxetine) . Attention !
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Overcoming social phobia takes time and patience is needed, so the patient can adopt, together with the treatment indicated by the doctor, some tips to reduce anxiety levels:
Avoid or reduce caffeine Caffeine stimulates the increase of anxiety symptoms, so it is indicated to reduce the consumption of coffee, tea, soft drinks with caffeine, energy drinks and chocolate.
Quit smoking Smoking increases anxiety levels, in addition to causing other complications. Thus, it is recommended that the patient seek medical help to receive tips on how to reduce the use of cigarettes gradually.
Avoid or reduce alcohol consumption Alcoholic beverages can temporarily calm the nerves, but they increase the risks of a long-term anxiety attack. Consumption should be carried out sparingly.
Perform physical exercises The patient must perform exercises of at least 30 minutes a day. The body releases levels of endorphins after physical activity, which alleviates the level of stress and anxiety.
Sleep well Nights with few hours of sleep can leave the body vulnerable to anxiety. Sleeping well can help the patient to calm down more easily in situations of stress and distress.
Perform techniques in everyday life As the treatment is slow, the patient must face the situations little by little and not try to overcome all his fears at the beginning. For that, it is recommended to use the tactics taught to control the breath and challenge negative thoughts.
All techniques should serve to weaken the fear of social situations, which indicates that the patient may still experience unpleasant reactions, especially in the face of the most feared events, but to a lesser extent. Bearing in mind that social phobia will never end is essential for the patient not to neglect himself and consequently strengthen his illness again.
Fear and the inability to socialize, even if you want to, can interfere with an individual’s academic, professional and loving life.
People with social phobia commonly drop out of school. Those who are able to work or study seek professions where social exposure is minimal or occurs at night. Over time, the idea may arise that they do not need other people and gradually start to avoid all social situations.
During social events, the person with the disease tends to face high levels of anxiety, which are gradually relieved after moving to a place that causes him comfort. The very expectation of facing occasions of social interaction can activate their fears and lead to isolation to avoid the return of suffering.
Negative self-assessment and safety behaviors can influence an unfriendly impression from other people, who can distance themselves and contribute to the isolation of the patient. Thus, living with the problem without seeking any medical help harms the individual’s social interactions , shakes his self-esteem and contributes to the development of depression and other anxious conditions.
The abuse of alcohol and other drugs is frequent among those who suffer from the disease, as they are usually used to encourage or help cope with social events. Other related complications are hypersensitivity to criticism, problems with low self-esteem and suicide. Research shows that suicide attempts reach up to 14% of untreated patients.
Complications after treatment It is observed that when treatment is started after marriage, marital conflicts may arise. This occurs because the healthy part is used to domination and the sociophobic one to submission, which slowly dissolves after the procedures followed by the health professional.
Of course, conflicts can arise that require cooperation and understanding from the healthy spouse to be overcome. While the patient is under the treatment of social phobia, psychotherapy between couples may be indicated to overcome this period together.
Treatment may be less effective if the disease is diagnosed in adulthood, so prevention consists of being aware of signs of excess isolation and anxiety since childhood. Children of phobic-social patients constitute the largest risk group for sharing the genetic load and the environment they live in, something that influences the child’s upbringing and behavior.
Prevention can also be carried out in schools, with support for young people and children to report on possible intimidation and criticism they have suffered. Projects can be done to bring together the most timid with extroverts, so that they naturally acquire social skills that cannot be taught.
People with social anxiety disorder rarely seek help from a health professional for fear of being judged before a stranger. However, not carrying out the treatment leads to the evolution of the disease and isolation, which restricts and damages the person’s social, professional and academic relationships.
If you identify with the symptoms see a specialist doctor, as he is able to indicate the best treatment for those who suffer from the disorder. If you think someone you know may be suffering from the disease, share this article to also encourage them to seek help!
