Social anxiety disorder, formerly known as social phobia, is the intense fear or anxiety that a person experiences when in social situations where they may be exposed to the observation of other individuals. It occurs above all in the circumstances such as social interaction involving meeting strangers, being observed eating and drinking, or acting in front of people (for example, giving a talk).
Situations avoided by the person with social anxiety
Avoidance is the strategy that socially anxious people use to drive away their discomfort, and that can affect each person in very different situations, but the most frequent are:
- Talk to 2 or 3 people at a time.
- Eating and drinking in public.
- Sign in front of other people (a notary, for example).
- Arrange a romantic date.
- Look the interlocutors in the face.
- Enter public bathrooms if there are other people.
- Enter a classroom with the class started.
- Return an item to a store.
- Give talks, play an instrument, etc., in public.
- Be the centre of attention in any circumstance.
Criteria for Diagnosing Social Phobia
These are the initial guidelines of the DSM-5, the fifth edition of the North American Psychiatric Association manual, which is a world reference in the description of mental disorders. “For a person to be diagnosed with social anxiety, they would have to meet each one of the criteria that are exposed in the DSM-5, which include a part of the definition of social anxiety, such as the type of symptoms, situations, duration and impact on the life of the person”, explains Menchón.
In other words, it must be verified that the individual is afraid of acting in a certain way in public or showing symptoms of anxiety that others value negatively; that social situations always provoke anxiety or fear disproportionate to the real threat, and that these symptoms are persistent for at least six months or more. Therefore, isolated episodes of shyness or embarrassment in the face of a specific event, such as speaking in public, would not respond to the set of symptoms of social anxiety.
“Social phobia could be summed up in the fear or anxiety of being noticed that you are nervous, of doing or saying something inappropriate when you are in social situations, from a meeting with colleagues to a meal in a restaurant,” argues Menchón, insisting in the person’s fear of being negatively valued, of blushing, of sweating or shaking hands.
It’s not shyness but a mental health pathology.
Social phobia goes much further than the shyness of an individual; it is a pathological malaise that has more to do with the person’s insecurity than with their lack of self-esteem. The anxiety it produces is very marked and anticipatory of what is to come: the socially anxious person suffers long before that irremediable encounter with other people occurs and is also suffering during the time he is with them, thinking that his way of acting is generating a negative concept of him or her. However, a shy person can simply be silent throughout the meeting or answer with monosyllables without suffering or feeling judged by others. It is estimated that 12% of shy people are diagnosed with social anxiety.
The prevalence of this disorder is highly variable depending on the type of study. Still, it would be 7 per cent of the general population, 2 to 5 per cent in older adults, and 10 to 12 per cent in adolescents. According to another statistic, it would affect 9 per cent of women and 7 per cent of men. “This is according to studies carried out in the community, not only in diagnosed individuals since few patients consult for social anxiety. However, only 50% of those with a more intense phobia ask for professional help. At the same time, the rest manage to adapt life to their circumstances with avoidance behaviours and undertaking activities alone”, comments the psychiatrist.
Types of social phobia
It is known that social anxiety disorder is more frequent in relatives of affected people, so it is assumed that there are genetic factors that can predispose them to suffer from it. In other words, a certain family predisposition would be attributable to learning mechanisms within the family and genetic factors. “However, the genes that could be involved are not precisely known,” he says, adding that what appears in neuroimaging studies are “dysfunctions of the brain circuits related to fear and emotions that can also be observed in studies of other types of anxiety.
Social anxiety can be treated with various psychological therapies, including those based on virtual reality, and with antidepressant or anxiolytic medications prescribed by a psychiatrist adjusted to each case.
There are two types of social anxiety, although they appear to be the same. The most common is a generalised social anxiety disorder, which affects people emotionally in all social situations, plunging them into anguish and fear of being watched or involved in humiliating or highly embarrassing episodes.
The other type is the “performance” social anxiety disorder, which does not affect all the social dimensions of the person, but rather specific moments. It is a type of stage fright that causes typical symptoms of anticipatory anxiety. At the same time, the feared act is being executed, for example, an opposition exam or the public presentation of a work project.