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Are you red when you think that someone is looking at you and is definitely judging you? Do you fear meeting strangers? Even being in a small group of people you know, do you feel uncomfortable that you will say something stupid? It could be a social anxiety disorder. We ask psychiatrist Sławomir Murawiec, MD, Ph.D. about how to recognize it and how to treat it.
Zuzanna Opolska: Doctor, how does social phobia differ from shyness?
dr Sławomir Murawiec, psychiatrist: First of all, it differs in the way of thinking. A shy person may feel fear of judgment and, therefore, behave in a certain way, e.g. talk little or avoid meetings. On the other hand, a person with social anxiety disorder is not as afraid of failing as they already know.
Assumes a negative upfront assessment?
Yes, she is convinced that she will be considered inferior, dumber and less valuable. They may experience anxiety when entering a room where others are, driving communication, and even being in a small group of people they know. Even when shopping at a local store, she is convinced that others are watching and judging her every behavior. Perhaps she chose the wrong butter, or maybe her shoes are dirty. When this distinctive way of thinking is triggered, the Leibowitz Social Anxiety Scale (LSAS) is well illustrated. There are many more such situations: public appearances, but also simply speaking with friends, talking on the phone in front of others, eating and drinking in public places, social meetings, visiting a restaurant, refusing the seller, advertising defective goods. For a person with social phobia, these events are real torture …
Can you live with overwhelming fear?
You can try. The so-called avoidance behaviors. If a person with social phobia experiences anxiety while riding the subway, he tries to focus on something else and, for example, browses the phone or looks at advertisements, but when the anxiety becomes too strong he gets off at the nearest station. Most often, he avoids parties, meetings and keeps going out of the house to a minimum. He does shopping in the evening in a specific store, in a restaurant he chooses a table off the beaten track …
If the activities of everyday life are already a problem, how do patients function in the private or professional sphere?
Paradoxically, a person with social phobia may appear in public, provided that he / she properly prepares for it. So he will go on stage and perform a piece mechanically, but will not talk to the audience anymore. During the interview, he will answer questions about education, but if the recruiter asks a non-standard question, he will probably withdraw. Even the message “You said it too softly, repeat it” will be perceived as criticism and negative evaluation. For such a person, a simple, neutral statement means that they must have done something wrong.
Do people with social anxiety disorder simply don’t think too much?
They think in a certain way.
But they analyze every situation?
No, they anticipate a situation before it happens and come to the same conclusions every time.
Characteristically, are they self-centered?
I would say that people with phobias are focused on being negatively judged by others.
Have a low self-esteem?
In a way, yes, but that’s not all. After all, I can feel worthless and continue to calmly travel with communication or do shopping …
What do they think about others?
They think they are doing everything right. Especially those who appear self-confident and exude an aura of complacency.
The Internet seems to be an ideal place for people with social anxiety …
Yes, on the web we have a greater possibility of creating our own image and a lower risk of direct assessment.
Does this mean that the person with a phobia is more likely than other users to pretend to be someone he is not?
This is not about pretending, but about bypassing the basic element, which is negative evaluation. In addition, on the Internet, a person with a phobia feels safer. When the anxiety levels get high, he might just shut down the computer.
Where is it coming from? Are we born phobics or do we become phobics in life?
We can talk about various neurobiological, genetic and environmental factors. Research in the 80s shows that a child’s risk of developing a phobia increases significantly if one of the parents has struggled with this anxiety disorder. In this case, two dimensions of inheritance are important: biological and behavioral. If someone has an anxious parent, first of all, they are more prone to developing anxiety. Second, such a parent communicates to a child a threatening vision of the world. The initial symptoms of social phobia usually appear in adolescence, i.e. when the element of social evaluation becomes important. I can enter into peer relationships with the conviction that I am cool, smart and liked. Or, conversely, that I’m no good for anything, and when I say something, everyone will find out that I’m stupid. Paradoxically, this negative self-conviction often concerns loved ones, i.e. a group of friends.
Is childhood trauma a risk factor?
Yes, but traumatic events are not specific. This means that people who have experienced physical abuse, sexual harassment or rape in the past may struggle with various disorders such as depression, phobias or anxiety …
What about negative experiences in life? Rejection not once, not twice, but several times in a row?
It all depends on how you interpret the event. Not everyone who is fired or abandoned by their partner becomes phobic or depressed. I can assume that the reason I lost my position is the restructuring of the company. Or to believe that my incompetence, ineptitude or lack of intelligence is behind the dismissal.
Does social phobia go hand in hand with other disorders?
Yes, anxiety disorders intertwine frequently. Social phobia may be accompanied by generalized anxiety disorder, depression, dysthymia, which is a type of depression characterized by a chronic depressed mood with a milder course, or the fear of being outdoors, the so-called agoraphobia.
And the attraction to alcohol?
Indeed, some people try to overcome social anxiety with the help of alcohol and psychoactive drugs. Then they become bolder and pay less attention to judgment.
Is social anxiety a frequently diagnosed disorder?
Yes, in the general population it affects 7-9%. society. US figures say it is in third place for mental disorders after depression and substance abuse. The problem is that many people with social anxiety disorder don’t even know it. Patients often consider somatic symptoms such as reddening, sweating, urgency, trembling hands, and stuttering to be their main problem. It is these symptoms that cause behaviors that are incomprehensible to others and may force us to withdraw from a situation in which we feel uncomfortable. As long as a person does not associate redness or excessive sweating with social anxiety, instead of seeing a psychiatrist, they may go to a dermatologist, for example.
Does it mean that the patient may not find out what is wrong all his life? Apparently, George VI Windsor, the protagonist of the film “How to become king” had an undiagnosed social phobia …
Yes, the key is to realize that trembling hands and urge to urinate are the result, not the cause of our problems. Perhaps in the case of the British monarch, stuttering was a somatic symptom of social anxiety.
What is the treatment like?
Currently, the dominant methods of treatment are cognitive-behavioral psychotherapy and pharmacotherapy based on antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs), mainly paroxetine. Behavioral therapy involves a gradual confrontation with the anxiety-provoking situation and exposure to the stimulus. This means that if a patient has arachnophobia, he first imagines a spider, then we show him a picture of it, or possibly a live specimen. Showing the social situation is much more difficult, so now we have attempts to treat social phobia with the use of virtual reality. This way we can speed up the healing process.
Are patients already treated in this way in Poland?
We are currently preparing such a program. The work has been going on for many months and I hope that it will soon be possible to introduce a completely innovative method of treating social phobia.