Society is the foundation of human civilization and a significant part of human life. Now and then, we all engage in social interactions and situations. It is also true that some people do not like social situations or even fear them to a small extent. However, when this fear of social situations is too high, resulting in abnormal anxiety levels, it is a social anxiety disorder.
The American Psychological Association defines social anxiety disorder or social phobia as "an anxiety disorder characterized by extreme and persistent social anxiety or performance anxiety that causes significant distress or prevents participation in social activities. The feared situation is often avoided altogether, or it is endured with considerable discomfort or dread." Along the same lines is the definition of ICD-11 as well. Both these definitions point towards two things, i.e., there is anxiety, and it is in response to some social situation.
Given such a simple classification, it is often confused and interchangeably used with some other terms which may have similar characteristics but different conceptual understanding. Thus, it must not be confused with introversion, a personality type that comes under the normal side of the abnormal-normal continuum.
An introvert is a type of human personality (known as introversion), which describes that such (introvert) people are more comfortable staying alone or with one or two people. They enjoy spending time with their own ideas and thoughts and are hardly interested in knowing what is happening in the outside world.
Social anxiety disorder is a syndrome due to fear of social situations resulting in avoidance of such situations. The person fears social evaluation and not the people themselves. On the other hand, introversion is a personality dimension within the introversion-extraversion continuum. Introverts do not fear social situations but rather do not like them and are oriented towards themselves.
Social anxiety, like any other anxiety disorder, can be debilitating and hugely affect the everyday functioning of the sufferer. Clinicians suggest defining symptoms that can be used to diagnose and differentiate them from other similar disorders. Some of them, as enumerated by DSM, are−
Anxiety about one or more social situations, especially where one may be evaluated/ scrutinized.
Fear of being humiliated, embarrassed, or rejected due to one's action or anxiety.
Avoidance of social situation.
Physical symptoms like blushing, sweating, stumbling, or trembling may be reported rather than initially endorsing fears of negative evaluation.
It is a common understanding among psychologists and psychiatrists that social anxiety disorder, and for a matter of fact, any anxiety disorder, be diagnosed only after the symptoms have persisted for at least six months. Further, manifestations and thus the diagnosis of this disorder may differ for different age groups. For instance, children have attributed this disorder only if anxiety occurs beyond interaction with adults in peer settings. Further, unlike adults, the expression of anxiety in children will be through tantrums, crying, freezing, shrinking, and sulking.
Interestingly, it is not just the social situation that can be anxiety generating, but the anticipation of such events is very often reported to generate anxiety within the patient in the form of anticipatory anxiety. The symptoms and manifestation of this disorder can also be understood within the domain of cognitive, behavioral, and social symptoms as follows−
Cognitive symptoms− The cognitive symptoms include fear and thought of being judged negatively, fear of offending others, as well as catastrophization of negative effects of social situations.
Behavioral and physical symptoms− These include extended home stays, lack of assertiveness, increased submissiveness, and a high need for controlling conversations. Sufferers often show physical symptoms like rigid posture, reduced eye contact, and lower voice. Such individuals have also been reported to disclose less about themselves and avoid conversations.
Social symptoms − These include reduced social behavior and avoidance of social situations.
Disorders like social anxiety disorder show a huge variety in their symptomatic manifestations and risk and prognostic factors. While onset usually follows a socially stressful or humiliating event, it may also develop gradually. Beyond the triggering event and personal life experiences, the causes of this disorder may be embedded in one's psychological, environmental, and genetic characteristics.
Beyond the basic risk-factor analysis, social anxiety disorder has to be affected by culture, as it is a disorder that is closely related to society, and one of the main components of society is culture. Culture impacts this disorder's nature, identification, and manifestations very closely. Furthermore, cultural concepts of distress exist, like 'taijin kyofusho' in Japan. Interestingly, it has been reported that men are more often diagnosed with social anxiety disorder and are more prone to use substance abuse to relieve these symptoms.
The treatment of this disorder is as important as any anxiety disorder and sometimes even more given its exacerbating effects on one's life. Its onset age, i.e., between 8 and 15 years, further necessitates its diagnosis and treatment, as it affects the younger population more than any other age group. Additionally, it has often been associated with suicidal tendencies. The most popular treatment method for this disorder is psychological intervention involving psychotherapies. Some most commonly used psychological interventions are as follows−
Cognitive behavior therapy (like exposure therapy)
Systematic desensitization
Psychodynamic therapy
Family therapy and support group
Cognitive restructuring
Applied relaxation and social skills training
Associative therapy
Use of artificial intelligence and audio-visual methods (like virtual reality and films)
Graded self-exposure
Beyond the basic psychological intervention, pharmacological and mixed methods may be used when the disorder gets severe or unresponsive to these interventions. This disorder often occurs in co-morbid conditions and can ultimately affect one 'sone's physical health as well. Therefore, some physical health-related interventions may also be given, like regular exercise.
Social anxiety disorder impacts every sphere of a patient's life ranging from economic and work to personal, psychological, and social. Nonetheless, it also impacts one's overall well-being and quality of life. This disorder often goes unnoticed in individuals for long periods and can be even more harmful. Thus, psychoeducation is imperative to ensure that people can seek help in case of distress.
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