Overview of Social Anxiety Disorder

In today’s society it is vital for one to have the proper social skills to navigate through a professional and social life in order to succeed. The biology of the human brain along with several other factors such as parenting styles, childhood traumas and the experience of socially traumatic events leads can lead to the development of Social Anxiety Disorder (SAD) in a large portion of the population. Sufferers of this psychiatric disorder have trouble establishing the interpersonal relationships that are expected from us to advance ourselves and become independent.

Several types of therapy exist today that have been shown to help individuals with SAD interact with others and create long lasting personal relationships in order for them to fit into society and succeed.

To fully understand the causes and treatment of SAD it is important to first learn what it is, its symptoms and its prevalence in certain age groups and gender. A wanting to remove oneself from social settings, a concern to be looked at in a negative light and being embarrassed or humiliated in front of others are some of the troubles that plague sufferers of SAD (KOÇ, KULOĞLU, YILDIRIM, ATMACA, 2018).

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The culmination of these symptoms affects the daily lives of many people and often leads to “…considerable distress and impaired functioning” (Heeren & McNally, 2018, p.103). Zanjani and colleagues show how people with SAD suffer from this distress and impaired functioning when socializing with others.

…because of the deficiency in establishing and maintaining interpersonal relationships and the difficulty in meeting social needs, it creates disruptions to academic performance and professionalism.

They regard themselves as insignificant and consider their value to be positively evaluated by others…They also believe that others see them as low-grade and these results in their negative evaluation as well as their judgment of others as threatening, extreme and catastrophic (2018, p.295).

In other words, those with SAD tend to be associated with having low self-esteem and having the inability to form proper relationships with others affects them not only in their personal lives but in their school and work life as well. Being placed among the most common of mental disorders in terms of its mental and physical effects, studies on twins have been shown to prove that traits of SAD can be passed down genetically (Stein & Stein, 2008). It can appear early on in childhood and its symptoms can worsen should the disorder not be treated professionally (Hidalgo, Barnett, Davidson, 2001). This disorder has also been shown to affect women at a much greater rate than the male population (Nordahl, Nordahl, Hjemdal, Wells, 2017).

When placed in a social setting there are several physical, mental and emotional indicators that emerge as a result of this disorder. “…blushing, not making eye contact…fear, heart racing, sweating, trembling, trouble concentrating” as well as a “…fear of being found out as unlikable stupid or boring” are all manifestations of SAD (Stein & Stein, 2008, p.1115). To be diagnosed as an individual suffering from SAD a few components must be fulfilled. “Social anxiety is now characterized as being excessive and unrealistic…In subjects under 18yr of age the duration of symptoms must be of at least 6 months. Neither medical illness nor the direct effect of a substance (i.e. medications, drugs) can be the cause of the social fear” (Hidalgo et al., 2001, p.280) This serves to prove that their symptoms are becoming chronic and that their line of thinking is a result of their own usual brain function and not an outside influence. To differentiate between Social Anxiety Disorder and other mental panic disorders it is important to note that those suffering from SAD know what exactly is causing the anxiety while sufferers of other panic disorders do not know the cause of their symptoms (Stein & Stein, 2008).

There are several biological and environmental factors that have been shown to lead to the development of Social Anxiety Disorder. A study done in the Anatolian Journal of Psychiatry shows that in relation to a healthy control group “The insula, a limbic region central to the integration of perceptual, emotional, and cognitive information into subjective experiences, has been shown to be hyperactive in SAD…”, leading many to believe there is an anatomical reason causing the overactive thinking and worrying associated with the disorder (KOÇ et al., 2018, p.151)

The way a child is raised and the traumatic events which they experience can both contribute to the acquisition of SAD throughout someone’s lifetime (Norton & Abbott, 2017). Over controlling parents tend to have children that display socially anxious behavior and are said to prevent their child from developing a sense of themselves as an individual in social settings (Norton & Abbott, 2017). When speaking of experiences with their parents, individuals suffering from SAD recall their parents as “rejecting, critical, shaming and less warm than individuals without SAD” further solidifying the correlation between parenting styles and SAD development (Norton & Abbott, 2017, p.748). Traumatic experiences such as any sexual, physical or emotional abuse have also been connected to SAD and have a greater effect on its development “when they are severe, are chronic, occur during critical stages of vulnerability and are social in nature” (Norton & Abbott, 2017, p.748). There may be a chance according to some studies that traumatic experiences in the past may not have unfolded as a SAD patient remembers. “SAD patients also endorsed significant re-experiencing symptoms in response to memories of socially traumatic events, and the authors suggest that these symptoms may be a ‘distorted recollection of the past event, potentially contributing to distorted beliefs and interfering with the processing of socially stressful events’...” (Norton & Abbott, 2017, p.749).

There is a relatively low amount of patients that go out and seek some sort of treatment for SAD symptoms, for reasons consisting of being ignorant of the fact that counseling can help or not realizing what the feelings they are experiencing are a problem in the first place (Chapdelaine, Carrier, Fournier, Duhoux, Roberge, 2018). Another reason for low numbers seeking treatment is “patients feeling uncomfortable or unwilling to talk about their emotional problems from fear of being stigmatized or negatively judged” (Chapdelaine et al., 2018, p.11). In other words, the very symptoms of SAD are keeping them from seeking help to rid themselves of these symptoms. When treatment is finally sought out it is said that Cognitive behavioral therapy (CBT) is the best sort of treatment and individual can reason outside of the realm of pharmaceuticals and drugs (Chapdelaine et al., 2018). CBT in itself provides SAD patients with various different methods to improve themselves including but not limited to, “psychoeducation, progressive muscle relaxation, social skills training, imaginal and in-vivo exposure, video feedback and cognitive restructuring” (Stein & Stein, 2008, p.1121). Group behavioral activation, another method used under the umbrella of CBT, has itself been shown to reduce a patient’s level of depression and anxiety while also improving their overall self-evaluation and “quality of life” (Zanjani, Jani, Amiri, 2018, p.294). The pharmaceutical approach to treating SAD has also been shown to have great effects, even faster than that of CBT, but it is argued that CBT has longer lasting effects (Stein & Stein, 2008). Although both pharmaceuticals and CBT show great effectiveness fighting SAD symptoms a study done out of the University of California San Diego show that there is “no clear evidence shows that combine pharmacological and cognitive behavioral treatment is more effective than single modality treatment” (Stein & Stein, 2008, p.1120)