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Many people occasionally get nervous or self-conscious. A good example is when one is offering a speech or being interviewed for a job. However, social anxiety is beyond shyness or occasional nervousness. A person with social anxiety disorder suffers fear of being embarrassed in a very intense manner that he/she ends up avoiding situations that can cause the embarrassments. Therefore, social anxiety disorder or social phobia can be defined as anxiety disorder whereby the affected person experiences excessive and great social situations’ fear. The Anxiety arises from closely being judged, watched, or criticized and is capable of wreaking havoc on the victim’s life. Indeed, the disorder goes beyond normal shyness (Jacobs 55).
Among many types of anxiety disorder, Social anxiety disorder is ranked the second in popularity immediately after the specific phobias. It is also the third most popular mental disorder in the United States after depression and dependence of alcohol. Around 19.2 million Americans have recently been diagnosed to have social anxiety disorder. This disorder mostly affects the adolescents or the early adulthood. Nevertheless, Social anxiety disorder can take place at any age that is inclusive of early childhood. Women suffer this disorder more in comparison to men.
The greatest fear of a person suffering from social anxiety disorder is to make mistakes. They also fear to get any embarrassments, look stupid or bad, or feel humiliated in front of people. Lack of social skills or social situations’ experiences trigger fear, and in worse cases, the fear can lead to panic attacks. Due to the extreme fears a person can end up enduring social situations or can even decide to shun them completely. Majority of the patients of social anxiety disorder also end up suffering the anticipatory disorder where they become fearful of a situation even before it has taken place. Though the person may know that the fear is not reasonable, he still lacks the ability of overcoming it.
A person that is suffering from the social anxiety disorder will mostly have very distorted thoughts, he may have very false beliefs concerning social situations and worse gets negative beliefs concerning other people. This means that if such a person lacks treatment, his daily routine becomes influenced negatively. The daily routines may include relationships, work, school, and social activities. Besides fearing addressing people in the public, a person suffering from social anxiety disorder also suffers anxiety while drinking or eating in public, working or even writing in presence of other people, being a center of interest, being involved with people like dating or parties, giving reports or answering questions to a group of people, sharing public toilets, communicating through telephone among other social situations. The other mental illnesses that can be linked to social anxiety disorder include depression, obsessive compulsive disorder and panic disorder (Garcia 60).
Classification of Social Anxiety
Social anxiety is majorly classified into two; Development social anxiety and chronic social anxiety. The Developmental social anxiety takes place in early childhood but this is a normal development stage of the social functioning in children which they eventually outgrow. If this stage persists, then it develops and becomes chronic social anxiety. According to (Stein) Chronic social anxiety causes great distress and poor ability to properly function in some parts of their daily life hence causing the social anxiety disorder. This is an anxiety disorder that is common among psychiatric disorders and is experienced by about 12% of the general American adults.
Stages of social anxiety
Social anxiety begins at infancy whereby at that stage it is normal and a necessary emotion for effectual social functioning and proper developmental growth. Cognitive growth and pressures during late childhood and early adolescence end up causing repeated social anxiety. According to (Shield) most commonly identified anxieties that have been associated with adolescents are focused on relationships with their peers to whom they are attracted to. They also feel anxiety when it comes to fear of public speaking, peer rejections, self-consciousness, blushing, and past behavior. Most adolescents get past their fears. Majority of the children get diagnosed with social anxiety disorder something that if not monitored closely, leads to their failure in education. Social anxiety majorly is fear of criticism by peers. This brings a lot of distress to children in their daily activities like playing with the other kids, reading, or speaking. Nevertheless, some children who suffer social anxiety end up acting out as a result of their extreme fear. The greatest dilemma of identifying the social anxiety disorder in children is that it can be confused to basic shyness (Harold).
It is easier to identify and recognize social anxiety in adults since they shy away from social situations and love keeping such issues to themselves. The Common adult social anxiety forms include public speaking anxiety, performance anxiety, stage fright, as well as being timid, all of which can assume clinical forms hence become anxiety disorders. The criteria used to distinguish between the clinical and the nonclinical social anxiety forms include intensity and behavioral level and psychosomatic disruption and the anticipatory fear nature. Social anxieties can also be grouped in accordance to the level of the triggering social situations.
Symptoms of Social Anxiety disorder
People suffering from social anxiety disorder will mostly feel like there is something not right about them, though they won’t identify the feeling as an illness sign. Some of the symptoms of social anxiety disorder include: Intense anxiety in any social situations, social situations avoidance, anxiety, confusion, heart pounding, muscle tension, shaking, sweating, blushing, stomach upset, and diarrhea. Children with social anxiety disorder can express anxiety through crying, clinging to people they know, or a tantrum throwing. These symptoms can be very extreme to the extent of disrupting daily life. Patients of Social anxiety disorder, engage in few or none romantic or social relationships. This makes them feel powerless, lonely, and experience a feeling of shame. Other common physical symptoms of social anxiety disorder include extreme blushing, trembling, palpitations and even nausea. People with this disorder sometimes stammer, while in other cases they may have very rapid speech.
When the anxiety is extreme, the people suffering the social anxiety get panic attacks, and discomfort. Some of the victims end up consuming alcohol and other related drugs as a way of reducing the fears and the inhibitions at the social events. It has also been proved that most of the sufferers of social anxiety disorder do self-medicate themselves. This happens mostly when they have failed to be diagnosed, they have not been treated, or both cases have occurred. Besides substance abuse, they may also develop some eating disorders or other forms of abuse. Social Anxiety disorder can also be viewed as a disorder of lost opportunities where the person suffering may end up making great life choices in order to accommodate the illness. In order to measure the severity of social anxiety in a person, Standardized rating scales like the SPAI-B, the Social Phobia Inventory, and Liebowitz Social Anxiety Scale can be used for screening.
Causes of Social Anxiety Disorder
There are no particular causes of social anxiety disorder that have been identified. Nevertheless, research has suggested that some biological, psychological, as well as environmental factors could be playing a major role in the development of the disorder.
Biological: Social anxiety disorder is at present thought to have some relation with abnormal brain circuits function that control emotion and "fight or flight" reaction center in a person’s brain. Genetic factors could also have a hand in this disorder since social anxiety has been proved to occur to a person whose first-degree relative like parent, sibling, or even child is suffering from the same.
Psychological: The progress of social anxiety disorder in a person can also develop from upsetting or embarrassing social experiences in past, like being bullied or abandoned by peers.
Environmental: A person suffering from social anxiety disorder can develop fear from seeing the behavior of other people or observing what happened to another person as a result of a certain behavior like being laughed at or being made fun of. Also, children who go through overprotection from their parents sometimes fail to get good social skills in their normal development.
Social Anxiety Disorder Diagnosis
Once a person is identified to have symptoms of social anxiety disorder, the doctor begins to perform an evaluation through asking questions about the patient’s medical history and physical exam performing. Even though there are no laboratory tests to purposely make a diagnosis on social anxiety disorder, the doctor can use a number of tests to ensure that a bodily illness is not the direct cause of the social anxiety symptoms.
If the doctor does not find any evidence of physical illness, the patient may then be referred to a psychologist, psychiatrist, or any other type of mental health expert who has particular training on diagnosing and treating mental illnesses. Psychiatrists as well as psychologists use particularly designed consultation and evaluation tools to assess a person for any anxiety disorder. The doctor then bases his diagnosis of the social anxiety disorder on the reports of intensity and symptoms, duration while also including functioning problems that could be caused by the disorder’s symptoms. The doctor further determines if this symptoms and the degree of dysfunction points to social anxiety disorder.
How Is Social Anxiety Disorder Treated?
When it comes to social anxiety disorder, the best and effective treatment that is currently available is the cognitive behavioral therapy (CBT). Medication can also be used to assist in easing the symptoms of the social anxiety disorder so as to ensure that CBT is more successful. Drugs can also be administered alone.
Cognitive-behavior therapy: The main goal of CBT is to lead the thoughts of the sick person in a rational direction and assist the person to stop avoiding the situations that are the cause of the anxiety. It also teaches people to respond differently to the state of affairs that triggers their symptoms of anxiety. Therapy could include real life exposure fearful situations or systematic desensitization. With the systematic desensitization, the affected person imagines about the frightening situation and works on his fears in a more safe and relaxed environment, like the therapist's office. Real life introduction gradually exposes this person to his feared situation but now with therapist’s support.
Medication: different types of drugs are used to treat the social anxiety disorder. This medication include: antidepressants, sedatives, like Klonopin beta-blockers, mostly used to care for heart conditions, may also be used to minimize certain physical symptoms of anxiety, such as trembling and quick heartbeat.
According to (Hoffman), the most common treatment for social anxiety disorder is the cognitive behavioral therapy that is Medications are recommended mostly only on people who do not want to go through the therapy. Cognitive behavioral therapy is much effective in the treatment of social anxiety disorder, whether delivered to an individual or in a group of people. The cognitive components seek to modify thought patterns and bodily reactions to situations that induce anxiety. The attention that is given to the social anxiety disorder has considerably increased since 1999 with approval and drugs’ administering for treatment. Counseling has also been used to improve people’s self-esteem and also social skills. Relaxation techniques like deep breathing are also helping people to deal with the social anxiety disorder.
Breathing exercises used to deal with social anxiety
Sitting comfortably with one’s back straight and shoulders relaxed. The person should then put one hand on the chest and the other on the stomach. A person can also inhale gradually and intensely through the nose for four seconds. The hand on the stomach should rise, while the one on the chest should only move a little. The person should then hold the breath for two seconds, then slowly through the mouth exhale for six seconds, pushing as much air as possible. The hand on the stomach should move inwards during the exhaling exercise. The person should continue breathing in through the nose and breathing out through the mouth. During this exercise it is important that the person focus on keeping low and steady pattern of breathing with 4-inhale, 2-hold, and 6-exhale. (Stein)
Common social anxiety triggers
Even though the person suffering social anxiety may feel like he is the only one with the problem, social anxiety is actually a very common problem. Many people are currently struggling with different forms of fears. Situations that trigger the social anxiety disorder symptoms are actually different (Pilling). Some are a result of social and performance circumstances, a condition called generalized social anxiety disorder. For others the anxiety is connected to specific social circumstances, like verbal communication to strangers, eating in public places, or going to social parties. The social phobia that is most popular is the fear of public speaking or performance in front of big audience.
Minimizing internal focus on social interactions
A socially anxious person tends to spend too much time concentrating bodily sensations in social interactions. The reason of this internal focus is fear that their anxiety is noticeable to other people. Even though they may try a number of ways to ensure that they are not visibly anxious, their strategy ends worsening the situation. Nevertheless, there are a number of steps that can be applied to ensure good social interaction and at the same time minimize internal focus.
During social situations, a person should ensure that he/she does not spend a lot of time focusing on personal physical symptoms. The person should keep in mind that anxiety is not so visible. A person feeling anxiety should know that anyone can get anxious and it is not a sign of weakness, the person should also know that though he/she could be anxious, it is not an indication of poor performance. It is also important to note that he/she is not actually the point of attention; besides him/her, people have a lot of other things to discuss and think about. It is also crucial for a person to concentrate on the conversation going on, rather than concentrating on how they are performing or how they appear.
Another way a person can overcome the internal focus that elevates social anxiety, is through following the conversation carefully without having to replay it in mind. The person should ensure he/she is very natural and not seeking to be very brilliant or achieve high standards. It is also necessary to know silences in conversations are okay and there should never be too much tension of trying to feel them. Finally, a person should know that not everybody likes him/her, hence in case of negative responses one should know that it is not necessarily an indication that there is something wrong with him/her.
The outlook for people with social anxiety disorder is actually good with treatment. Most of the people improve and begin to enjoy more dynamic lives. It is unfortunate that social anxiety disorder cannot possibly be prevented; nevertheless, seeking help soon after the symptoms surface can assist in making the treatment more effectual.
Garcia, Lopez. "Tratando...trastorno de ansiedad social/Treating...social anxiety disorder" Madrid: Piramide. (2013).Pp 36 -60
Harold Leitenberg. "Handbook of Social and Evaluation Anxiety", ISBN 0-306-43438-5(2010) pp 23 -43
Hofmann, Smits. "Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials". The Journal of clinical psychiatry . (2011) pp 621–632.
Pilling, Clark. "Recognition, assessment and treatment of social anxiety disorder: summary of NICE guidance.".BMJ (Clinical research ed.). (20103)pp346- 350
Jacobs, Andrew ."Social Anxiety Disorder and Social Phobia" (2007).pp 56 – 65
Stein , Bill. Social anxiety disorder.Lancet. (2008). 15-25.
Stein, Murray. "Unmasking social anxiety disorder"(PDF).Journal of Psychiatry & Neuroscience. (2014)185–189.
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