Social Anxiety Disorder / Social Phobia
Some people have a hard time in social situations because they fear them to the point where they can be diagnosed with Social Anxiety Disorder, also known as Social Phobia. You could think of Social Phobia as more typical shyness turned up to 11. The big difference is that the anxiety becomes a lot more prominent as a problem.
When someone is shy they may feel uncomfortable or hesitant around certain people, but they're not as physically nervous and keyed up as a person with social anxiety. Also, when someone is shy they may worry about being seen as quiet or boring. Someone with Social Anxiety Disorder may worry about that too, but also about coming across as obviously anxious and uncomfortable, which they believe that will lead to them being rejected and embarrassed. Because it is more severe, Social Anxiety Disorder also has more of a negative effect on people's lives. Someone who is a little shy may still be able to go to a party, but they'll hang back. A person with a bad case of Social Phobia may feel too nervous around people to be able hold down a job.
Criteria for Social Anxiety Disorder / Social Phobia
Below are two sets of criteria for diagnosing someone with Social Anxiety Disorder. The descriptions below come from two sources, the Diagnostic and Statistical Manual, 4th Edition (DSM-IV), and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). The DSM-IV is published by the American Psychiatric Association. The ICD-10 is based on classifications from the World Health Organization.
If you actually have Social Phobia you probably already know all about it. If not, this may be interesting reading. I'd caution anyone not to try and diagnose themselves or anyone else just based on some descriptions. A qualified professional has to make that call. Also, lots of people can read the criteria for various mental health issues and see little pieces of themselves in them, but that's usually a far cry from being officially diagnosable.
DSM-IV Criteria For Social Phobia
A. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.
Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.
B. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.
C. The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.
D. The feared social or performance situations are avoided or else are endured with intense anxiety or distress.
E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
F. In individuals under age 18 years, the duration is at least 6 months.
G. The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., Panic Disorder With or Without Agoraphobia, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).
H. If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e.g., the fear is not of Stuttering, trembling in Parkinson's dsease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa.
Specify if: Generalized: if the fears include most social situations (also consider the additional diagnosis of Avoidant Personality Disorder)
ICD-10 Criteria for Social Phobia:
Social phobias often start in adolescence and are centred around a fear of scrutiny by other people in comparatively small groups (as opposed to crowds), leading to avoidance of social situations. Unlike most other phobias, social phobias are equally common in men and women. They may be discrete (i.e. restricted to eating in public, to public speaking, or to encounters with the opposite sex) or diffuse, involving almost all social situations outside the family circle. A fear of vomiting in public may be important. Direct eye-to-eye confrontation may be particularly stressful in some cultures. Social phobias are usually associated with low self-esteem and fear of criticism. They may present as a complaint of flushing, hand tremor, nausea, or urgency of micturition, the individual sometimes being convinced that one of these secondary manifestations of anxiety is the primary problem; symptoms may progress to panic attacks. Avoidance is often marked, and in extreme cases may result in almost complete social isolation.
Diagnostic Guidelines
All of the following criteria should be fulfilled for a definite diagnosis:
(a) the psychological, behavioural, or autonomic symptoms must be primarily manifestations of anxiety and not secondary to other symptoms such as delusions or obsessional thoughts;
(b) the anxiety must be restricted to or predominate in particular social situations; and
(c) avoidance of the phobic situations must be a prominent feature.
Includes:
- anthropophobia
- social neurosis
Differential Diagnosis
Agoraphobia and depressive disorders are often prominent, and may both contribute to sufferers becoming "housebound". If the distinction between social phobia and agoraphobia is very difficult, precedence should be given to agoraphobia; a depressive diagnosis should not be made unless a full depressive syndrome can be identified clearly.
As the criteria above mention, there are two sub-types of social anxiety disorder. The first is generalized and much more detrimental. It's when someone is anxious in most social situations. The second is when someone functions well on the whole, but fears specific situations such as eating or writing in front of people, or using a urinal when someone else is nearby.
Another thing I'll draw attention to is how depression or other anxiety problems often occur alongside social anxiety. It's totally understandable how someone could also be depressed if they were super nervous around people and their life suffered as a result. People with Social Anxiety Disorder may be anxious in other ways as well. They may have other fears, a general level of background anxiety, or worries about having panic attacks.
There's another way Social Phobics can be divided into two types. Some people with this problem don't feel great in social situations, but they manage to function in them anyways. They have a group of friends and do things with them. They may not be operating at 100%, but they get by. The second type are people who don't have much of a social life because their nerves are too much for them to rein in. They're lonely and unhappy and isolated.
Treating Social Anxiety Disorder
There are effective treatments for Social Anxiety Disorder, though it's not something that can be fixed overnight. People can work on their social anxiety on their own, but working with a therapist, either in one-on-one or group sessions is often helpful. My own philosophy is that if you have access to that kind of resource than why not take advantage of it? Seeing a professional is also the only way to access medication, which some people find helpful in treating the condition.
Exposure therapy
From what I've researched on the topic, the most effective treatment for Social Phobia is for people to gradually and systematically face their social fears. This is something a person with Social Anxiety Disorder could do on their own, or with a counselor's guidance. They could also join a treatment group that would provide a safe environment and plenty of opportunities to get used to being in social situations, through structured role-plays, and also just by the members talking to and learning from each other.
I wrote two articles on the importance of facing fears and how to go about doing it.
Social skills training
Pretty much everyone agrees about the importance of the 'facing your fears' piece. There are two other treatments that have a lot of support as well. If they are used in formal therapy then they'll likely be blended into the main exposure treatment. The first is social skills training, which can be helpful in certain cases. Like with shyness, some people with Social Anxiety have decent social skills. Their anxiety gets in the way though, and prevents their skills from coming out properly. Other people with social anxiety have rusty or underdeveloped interpersonal skills. The fact that they know they're awkward around people may contribute to their nervousness. Improving their people skills can help them feel more confident and capable in social situations.
Naturally, I think this site is a good resource for advice on social skills. Teaching and practicing social principles can also be part of a treatment group.
Cognitive restructuring
There's also a good amount of evidence to support this as an affective treatment for social anxiety. People with the condition tend to think in ways that exaggerate the danger of social situations and downplay their ability to cope with them. If they learn to identify and disarm their maladaptive thoughts, they can reduce their nervousness. I wrote a couple of articles on this area:
Challenging Negative Thoughts
Accepting And Rolling With Negative Thoughts
Common Worries Shy Or Insecure People Have
Reduce anxiety and depression in general
Aside from handling their more specific social difficulties, it can help to make lifestyle changes that turn down their overall anxiety levels. It can also be useful to learn general strategies for coping with anxious feelings and fears. I discuss that in these articles:
Lifestyle Changes That Can Improve Mood
Overall Attitudes For Handling Anxiety
Coping With Anxiety In The Moment
