Social phobia

Social phobia: description

People with a social phobia are very anxious to attract attention, be it through behavior or anxiety symptoms such as sweating or blushing (erythrophobia). They fear being watched, denigrated or laughed at by others. The contact with other people is a torment for them. This fear is especially pronounced in contact with the opposite sex.

Avoiding social situations has far-reaching consequences. For example, people who are afraid of emptying their bladders in public toilets (paruesis) often do not dare to leave their homes any longer. This phenomenon is also called “shy bladder” and occurs in many patients with a social phobia. The victims live very lonely and hardly participate in recreational activities.

In many cases, social phobia also affects working life. Opportunities for advancement or a change of job are not perceived for fear of people who are foreign to them. Some people with social phobia can not exercise a job at all. If the social phobia is pronounced, it leads to complete social isolation.

Out of fear of other people’s scrutinizing eyes, those affected often behave strangely and excite what they least want: attention. For example, they are silenced in society or turn to dinner so as not to be watched. Her concentration is focused on not embarrassing herself, as well as the fear that physical symptoms may reveal her insecurity. Eating normally or giving a speech becomes impossible under these circumstances

How many people are affected by social phobia?

In the population about two percent suffer from a social phobia. It is almost twice as common in women as it is in men. The social phobias usually begin in adolescence and young adulthood. A social phobia has nothing to do with “normal” shyness, the impact on the social life of the patient is much more difficult.

In about 60 percent of cases, social phobia combined with other mental disorders occurs. The sufferers also suffer from other anxiety disorders, eating disorders or addictions. Half suffer from depression at the same time.

Social phobia: symptoms

The following symptoms are present after the ICD-10 classification of mental disorders in a social phobia:

Those affected are very afraid of being the center of attention or embarrassing themselves. Therefore, they avoid situations in which the fears could become reality.

The fears relate to social situations, such as eating out or speaking in public. They are afraid to join small groups, for example at parties or in classrooms, but also to meet acquaintances in public.

Physical symptoms include blushing or shaking, fear of vomiting, and urinary or fecal urgency. People with social phobia are very worried that others might notice these signs. As they focus heavily on the physical symptoms, they become even stronger.

Those affected suffer greatly from the anxiety symptoms and the consequences of avoidance behavior. Although they know the fear is exaggerated, they can not change their behavior on their own.

Social phobia: causes and risk factors

How a social phobia arises, there are various explanatory approaches. Ultimately, one can assume that many factors interact. One part probably contributes to the hereditary traits. However, the environment has the biggest impact on the emergence of social phobia.

Social phobia: social anxiety as a learning process

Many sufferers describe that you were teased and publicly humiliated at a young age. In contact with other people, they are afraid to be devalued. A certain amount of anxiety may also help prevent future situations. They keep pulling back.

Even children who are inhibited in their behavior, later have a higher risk of developing a social phobia. Inhibited children are quickly overwhelmed by unknown situations and withdraw. Such behavior can also be taken over by the parents by the children. If the parents are rather anxious and live these isolated, the child learns early the fear of social contacts and unknown situations. Thus, when social phobia accumulates in families, it is difficult to determine whether social anxiety has been inherited or learned.

Social phobia: Negative thoughts

People with a social phobia are constantly dealing with their fears. They feel quickly observed and often suspect a devaluation of their person behind the reactions of other people. They see themselves as supercritical. They often make high demands on themselves, which they can not do justice to. A common thought of people with social phobia is, “The other people see that I’m awkward / stupid / bad”. The effect of embarrassing situations on others overestimates those affected. They assume, for example, that they are despised and that they will never again be able to face a particular human being. Such negative thoughts can trigger social anxiety and then maintain it.

Social phobia: traumatic experiences

Traumatic childhood experiences are basically a risk factor for mental health problems. This also applies to the social phobia. Early loss experiences, such as the death of a parent or divorce, can contribute to the development of excessive anxiety. Neglect or mistreatment are further risk factors for a social phobia. Early-learned unfavorable coping mechanisms then often persist into adulthood.

Social phobia: examinations and diagnosis

Social phobia has a very negative impact on those affected. Therefore, it is important to visit a doctor or psychologist or therapist in time. The doctor will first perform a physical examination to check if physical causes could be responsible for the symptoms.

To diagnose a social phobia, the doctor or therapist will go through special questionnaires with the patient. He asks the patient a few questions for the third-party assessment procedure. Self-assessment procedures can be completed by the patient alone. They provide a comprehensive picture of the patient’s complaints and help the therapist to make an accurate diagnosis. The following questions could ask the doctor or therapist:

• Are you afraid to speak in public?
• Are you afraid to be the center of attention?
• Are you afraid to join small groups?
• Are you afraid to blush in front of other people?

After the diagnosis, the doctor or therapist informs the patient about possible treatments using psychotherapy and medications.

Social phobia: treatment

A social phobia is treated by psychotherapy and medication. Experts especially recommend Cognitive Behavioral Therapy. Psychodynamic psychotherapy can be used if Cognitive Behavioral Therapy was unsuccessful.

Social phobia: cognitive behavioral therapy

At the beginning of the therapy, the patient is informed extensively about the social phobia (psychoeducation). The therapist explains to the affected person which factors contribute to the development and maintenance of the disorder and which role unrealistic demands and thoughts as well as the avoidance behavior play.

Change negative thoughts

The next step of the therapy is the review and modification of unfavorable thoughts (cognitive restructuring). For example, the therapist scrutinizes the patient’s thoughts relating to the evaluation by others. Can the person really know how other people think about him? Can he be sure that others find his behavior embarrassing?

In many patients, such thoughts automatically expire, so they are unaware of them. The therapist trains the patient to recognize unrealistic and anxiety-related thoughts. Only then can he change his thoughts. The therapist then motivates the patient to find realistic thought patterns that are less threatening.

role playing

In the further course of therapy, the focus is on role-plays, which serve the confrontation with fears. Many sufferers have forgotten how to deal with others over time because they have avoided social situations. Roleplaying recreates real situations. A common practice is that the patient should give a speech in front of the other participants. In this way, the patient develops competencies that should make him safer in social interaction.

Confrontation with fears

The next stage of confrontation with the patient’s fears takes place outside a clinic or practice (exposure therapy). In public, the victims should go in unpleasant and embarrassing situations for them. The challenges are slowly being increased.

In the exposure, patients often experience that the feared reactions do not occur. The other people react either neutral or even positive to them. As with other anxiety disorders, the idea and anxiety thoughts are far worse than the reality. With this realization, those affected can overcome the social phobia.

Social phobia: psychodynamic psychotherapy

Psychodynamic psychotherapy focuses on unresolved conflicts that can contribute to social phobia. Especially relationship conflicts can be a trigger.

Although those affected are seeking recognition, they are so afraid of rejection and humiliation that normal contact becomes impossible. The fear of revealing their insecurity by blushing or trembling often leads to a relationship break. As part of a psychodynamic psychotherapy, therapist and patient explore how this unfavorable relationship pattern emerged and what purpose it has fulfilled. Some patients, for example, show that the origin lies in the excessive demands of their own family. Failure to meet these demands can become a lifelong burden and spread to other people and situations.

Social phobia: medicines

Social phobia is usually treated with selective serotonin or norepinephrine reuptake inhibitors (SSRIs / SNRIs), such as paroxetine or venlafaxine. They prevent the messengers serotonin or norepinephrine from being quickly removed from their place of action. However, it takes about two to four weeks to show an effect. After improving the symptoms, the medication will be prescribed for several more weeks to prevent relapse. Unwanted side effects include restlessness, nausea and sexual dysfunction.

Social phobia: other treatments

Relaxation techniques help those affected to reduce their constant tension. Mostly, Jacobson’s progressive muscle relaxation is recommended. In this method, the entire body is actively relaxed by breathing exercises and the relaxation and relaxation of muscles.

If patients suffer from other mental illnesses such as depression besides social phobia, they also need to be treated.

Social phobia: disease course and prognosis

Left untreated, social phobia is chronic in many cases. The earlier the social phobia has developed, the worse the prognosis. Affected then develop more common mental disorders, especially depression and addictions. Both professionally and in the private interpersonal sector, a social phobia severely limits those affected. If the suffering is too high, there is a risk that those affected take their own lives.

With a professional treatment, those affected have a good chance of a positive course. Especially for cognitive behavioral therapy, there are good evidence of efficacy, even if the social phobia has existed for some time.