Social anxiety disorder (SAD) or social phobia is an anxiety disorder characterized by extreme fear of getting involved in social situations. This fear causes considerable distress and disability in activities of daily living. Fear comes from the perception or reality of how others see us.
Examples of anxious situations :
- Speaking in public
- Performing something in public, such as reading in church or playing a musical instrument
- Eating with others
- Meet unknown people
- To hold a conversation
- Sign a document in front of witnesses
- Going to a public toilet...
And the list is not exhaustive !
The brain influences your reactions
Possible causes of social anxiety disorder include brain structure and hereditary traits . The amygdala , a part of the brain, is thought to play a role in controlling fear responses.
A person with an anxiety disorder experiences many physical, emotional, and behavioral symptoms. Although this disorder can become more serious, it can be overcome using many treatment techniques such as medications, cognitive behavioral therapies, or individual self-help practices that can be done at any time and place where the patient feels comfortable.
Risk factors for social anxiety disorder
Social phobia, a very common mental disorder, which begins in early to mid adolescence, but also sometimes in childhood as separation anxiety and/or school phobia .
Among the factors that increase the risk of the appearance of social phobia, we can cite the following:
A new social environment or workload: Meeting new people, giving a speech in public, etc., can usually trigger social anxiety disorder and these symptoms are the main causes in adolescents and elderly people.
One or more negative life experiences : A person who has experienced negative situations such as poor presentation, rejection, humiliation, etc. may be associated with social anxiety disorder.
Family history : If parents or siblings already suffer from social phobia, there is a slightly higher risk of developing this condition.
Basic temperament : A person who is shy, timid and reserved when faced with a new situation or new people is at higher risk.
Health condition : Anxiety about other people paying more attention to things like stuttering, facial mutilation, Parkinson's disease (a central nervous system disorder that affects movement) and other health conditions may give rise to increased feelings of embarrassment and may trigger the phobia.
Types of Social Anxiety Disorders
Social anxiety disorders are divided into two main categories , namely:
Performance-Based Social Anxiety Disorder : In this category, anxiety disorder can arise when presenting something in front of society. This could be, for example, a public speech, professional life, a sporting event, etc.
Social anxiety disorder based on social interaction : Anxiety disorder can occur during interaction with other people, for example when talking with new friends, fear of asking help, fear of eating with other people, fear of using public toilets, etc.
Social anxiety disorder prevents the individual from leading a normal life. The person tends to avoid situations that most people consider "normal" . Paralyzed by fear and shame, the subject can develop what we call "comorbidity", that is to say the presence of illnesses and/or various acute or chronic disorders adding to the initial illness, either “associated pathologies.”
15% of social phobics have a substance-related disorder. Among the different substances, alcohol seems particularly incriminated. Social phobia, like other anxiety disorders, promotes the appearance of alcohol abuse and dependence , with the anxiety disorder most often preceding these substance intakes.
The patients' stories seem to show that it is often the fortuitous discovery of the "therapeutic" effect of the product on social anxiety which leads to its repetitive consumption and the risk of abuse and dependence. With low self-esteem, the person may use substances such as alcohol or other drugs.
Consumption is often a self-medication for the discomfort induced by the anxiety disorder . So patients drink before situations (to reduce their fear) but also after (to drown their shame).
It is important to point out that the "anxiolytic" or "therapeutic" virtues of alcohol are only an illusion and that after an extremely short euphoric effect of alcohol, the latter on the contrary reinforces anxiety and thus aggravates the trouble. In the event of excessive consumption, alcohol abuse can also be the cause of depressive syndrome , complicating and increasing social phobia.
Other substances may also be involved and complicate the prognosis of the disease.
We will cite, among others, benzodiazepine -type anxiolytics frequently prescribed for symptomatic purposes in this pathology but which carry a real risk of abuse and dependence.
Let us also mention cocaine used for disinhibitory purposes but whose abuse and dependence generate significant complications and only aggravate the disorder.
Depression and other disorders
45% of social phobics have at least one major depressive episode during their life.
Social phobia most often precedes the onset of depression and can be considered a risk factor for depression. It is easy to understand that isolation, relational deprivations, the feeling of personal devaluation, the repetition of attacks of shame can be at the origin of real depressive episodes, other anxiety disorders such as panic disorder, agoraphobia or the appearance of OCD (Obsessive Compulsive Disorder).
If left untreated, social phobia often persists, causing many people to avoid activities they otherwise enjoy.
There exposure therapy is generally effective. But it is not always easy to arrange for the exposure to last long enough to allow the person to get used to the anxiety-provoking situation and eventually become comfortable with it. For example, a person who is afraid of speaking to their supervisor cannot necessarily organize a series of interviews with them.
A cognitive behavioral therapy may also prove useful. This therapy allows people to learn the following:
Antidepressants such as SSRIs and benzodiazepines (anxiolytics) are often effective in treating social phobia. SSRIs are generally preferred because, unlike benzodiazepines, they are not likely to interfere with cognitive behavioral therapy. Benzodiazepines act on the central nervous system (brain and spinal cord) and can cause drowsiness and memory problems.
Generally speaking, a healthy lifestyle is important in the treatment of social anxiety. Have regular rhythms of life: bedtime, fixed alarm clock, not too many naps in the afternoon (they promote depression). Added to this is moderate but regular sporting activity and a strict absence of alcohol and drugs.