Social phobia is a common problem that affects many people around the world. It is an intense fear of being judged or negatively evaluated in social situations, which can lead to feelings of shame, anxiety and even depression. People suffering from social phobia may find it difficult to engage in activities with others, speak up in a group, or even make friends. What is social phobia and how can it be diagnosed? Find out if social anxiety affects you?
Social phobia is a disorder and not just shyness
Social anxiety is often misunderstood and confused with shyness. Almost everyone is a little anxious or embarrassed from time to time in the presence of other people. Sometimes, however, the anxiety can be so intense that it stops us from doing the things we want to do or begins to interfere with our daily lives.
Social phobia is a very real problem and a serious disorder. The symptoms of social phobia can vary in severity and type, the intensity can range from mild to severe. With untreated social phobia, one can function throughout his life. Anxiety disorders cause severe fear of contact with other people, long-term anxiety, tension, isolation and loneliness in social situations that make it difficult to meet our needs. Social phobia can affect our relationships and ability to achieve our life goals.
What is social phobia? Symptoms of the disorder, characteristics
Social anxiety (a.k.a. social phobia) is used to describe feelings of intense anxiety and fear that arise in response to social situations. Often, overwhelming anxiety occurs whenever we think about a social situation (just imagining the situation can cause anxiety) or recall previous events.
People with phobias experience a strong level of anxiety, disproportionate to the threat, in almost any situation involving social interaction often both predicted and real. Social anxiety can be associated with specific situations such as public speaking, as well as interpersonal situations such as new social contacts, social gatherings with friends. Patients tend to frequently avoid a particular anxiety-provoking situation.
According to the ICD 10 International Statistical Classification of Diseases, to definitively diagnose social phobia (F40.1), the symptoms of the disorder must meet the following criteria:
1.a significant fear of being the center of attention or a fear of behaving in a way that proves to be embarrassing or compromising,
2. marked avoidance of finding oneself in the center of attention or in a variety of situations associated with a fear of behaving in a way that will prove embarrassing or compromising.
B. At least two of the following symptoms of anxiety occur in fearful situations:
Autonomic arousal symptoms, vegetative symptoms:
- sensation of heartbeat or heaviness, or acceleration of heart rate,
- sweating,
- trembling of the hands or panting,
- dry mouth (not caused by medication or dehydration)
Chest and abdominal symptoms:
- difficult breathing,
- choking sensation,
- pain or discomfort in the chest,
- nausea or unpleasant abdominal sensations.
Symptoms involving mental status:
- dizziness, imbalance, sensation of fainting, feeling dazed,
10.a sense of unreality of objects (derealization) or distance or “unreality” of oneself (depersonalization),
- fear of losing control, “going crazy”,
- fear of death.
General symptoms:
- hot flashes, cold chills,
- sense of numbness, itching,,
C. Avoidance or anxiety symptoms, in the case of social phobia are judged by the patient to be excessive or irrational in nature and are the cause of significant emotional tension.
D. Symptoms occur exclusively or most often in fearful situations or as a consequence of thinking about such situations.
Causes of social phobia. Risk factors – social phobia
The first unpleasant symptoms appear during childhood and adolescence. Exacerbation of symptoms occurs in late adolescence or early adulthood. The exacerbation can be associated with new developmental tasks, such as the need for increased autonomy, independence from the family sphere, building the first meaningful relationships and connections.
Risk factors may be gender, with more women struggling with social phobia, and past experiences.
Negative past experiences related to a family environment that may have been punishing and controlling. The family environment was characterized by higher levels of isolation and distrust of others. People with social phobia often have aversive experiences with their peer group, and may have been victims of psychological and physical abuse.
Type of phobia, type of social anxiety
Isolated social phobia, is associated with one particular social situation or place, exacerbating the fear. Isolated phobia can be related to school, means of communication, public speaking. Isolated phobia can spread to other spheres of life and develop into generalized phobia.
Generalized social phobia is experiencing strong fear in many social situations and places. Social phobia has a much stronger impact on different aspects of life. In generalized phobia, disorders such as alcohol and drug addiction (psychoactive substances), depressive disorder, among others, masked depression, may co-occur much more often.
Online test- Leibowitz social anxiety scale
A commonly used scale for diagnosing social anxiety syndrome is the leibowitz social anxiety scale (the leibowitz social anxiety scale LSAS). A tool, the test consists of 24 questions, using the scale to determine the severity of symptoms, determine the extent of social situations feared and/or avoided. You rate each question on a scale from 0 to 3.
As with many tests, the social phobia test is not synonymous with a diagnosis of social phobia, rather it provides support towards a diagnosis. It is worth remembering that you should seek the help of a psychiatrist or psychologist to confirm the diagnosis.
Read the descriptions of all the situations shown in the table and answer two questions in each case:
- How strongly do I experience anxiety or fear in this situation ?
- How much am I inclined to avoid this situation ?
Use the following scoring:
Fear or anxiety:
0 = none
1 = mild
2 = moderate
3 = severe
Situation avoidance:
0 = never (0%)
1 = sometimes (1 – 33%)
2 = often (34% – 66%)
3 = always (67% – 100%)
| Situation | anxiety | avoiding the situation |
| 1. Talking on the phone in front of others | ||
| 2. Being in a small group of people | ||
| 3. Eating in a public place | ||
| 4. Drinking with others in a public place | ||
| 5. Talking to a superior, someone important | ||
| 6. Giving a speech, public speaking in front of any audience | ||
| 7. Going out to a party, a social gathering | ||
| 8. Working among people when someone may be watching you | ||
| 9. Writing among people when someone may be watching you | ||
| 10. Calling a person you don’t know well | ||
| 11. Talking to people you don’t know well | ||
| 12. Meeting strangers | ||
| 13. Using a public restroom | ||
| 14. Entering a room where others are already sitting | ||
| 15. Being the center of attention, interest | ||
| 16. Speaking at a meeting | ||
| 17. Taking some kind of knowledge or skills test | ||
| 18. Arguing with a person you don’t know well | ||
| 19. Looking into the eyes of people you don’t know | ||
| 20. Delivering a prepared lecture or report in front of a group of people | ||
| 21. Picking someone up | ||
| 22. Advertising merchandise in a store | ||
| 23. Hosting a party such as a birthday party | ||
| 24. Putting limits on an intrusive salesman | ||
| Total: | ||
| Total score: |
Then add up the scores from the “anxiety” column and the “avoidance” column to get a total score.
Score
0 – 54 = no social phobia
55 – 65 = mild social phobia
66 – 80 = moderate social phobia
81 – 95 = aggravated social phobia
96 and above = very severe social phobia
If the test results indicate that you suffer from social phobia, contact a psychologist or psychiatrist to confirm the diagnosis and plan appropriate treatment plans. A specialist therapist will advise whether psychotherapy or concurrent pharmacotherapy will be the optimal form. The good news is that there are proven protocols for working with social phobia. Research indicates that treatment of social phobia has a high success rate, and there are many effective techniques for reducing symptoms. One of the most popular therapeutic interventions is cognitive-behavioral therapy. With the right support and treatment, you can learn how to overcome your fears and lead a more fulfilling life.
Compiled from: Liebowitz MR. Social Phobia. Mod Probl Pharmacopsychiatry 1987;22:141-173