NationMaster - Encyclopedia: Social anxiety

Social anxiety is an experience of fear, apprehension or worry regarding social situations and being evaluated by others. People vary in how often they experience anxiety in this way or in which kinds of situations. Anxiety about public speaking, performance, or interviews is common. Social anxiety can be related to shyness. The experience is commonly described as having physiological components (e.g. sweating, blushing), cognitive/perceptual components (e.g. belief that one may be judged negatively; looking for signs of disapproval) and behavioral components (e.g. avoiding a situation). It can also be associated with Asperger's Syndrome. Social anxiety causes difficulty with social interaction. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // F00-F99 - Mental and behavioural disorders (F00-F09) Organic, including symptomatic, mental disorders (F00) Dementia in Alzheimers disease (F01) Vascular dementia (F011) Multi-infarct dementia (F02) Dementia in other diseases classified elsewhere (F020) Dementia in Picks disease (F021) Dementia in Creutzfeldt-Jakob disease (F022) Dementia in Huntingtons... // F00-F99 - Mental and behavioural disorders (F00-F09) Organic, including symptomatic, mental disorders (F00) Dementia in Alzheimers disease (F01) Vascular dementia (F011) Multi-infarct dementia (F02) Dementia in other diseases classified elsewhere (F020) Dementia in Picks disease (F021) Dementia in Creutzfeldt-Jakob disease (F022) Dementia in Huntingtons... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Fear is a powerful biological feeling of unpleasant risk or danger, either real or imagined. ... In psychology, apprehension (Lat. ... We dont have an article called Worry Start this article Search for Worry in. ... In humans, shyness is the feeling of apprehension or lack of confidence experienced in regard to social association with others, e. ... Asperger described his patients as little professors. Aspergers syndrome (AS, or the more common shorthand Aspergers), is characterized as one of the five pervasive developmental disorders, and is commonly referred to as a form of high functioning autism. ...

The remainder of this article concerns the diagnosis of social anxiety disorder (social phobia) rather than social anxiety in general.

Social anxiety disorder, also known as social phobia, is a diagnosis within psychiatry and other mental health professions referring to excessive long-lasting social anxiety causing relatively extreme distress and impaired ability to function in at least some areas of daily life. The diagnosis can be of a 'specific' disorder (when only some particular situations are feared) or a generalized disorder. Generalized social anxiety disorder typically involves a persistent, intense, and chronic fear of being judged by others and of potentially being embarrassed or humiliated by their own actions. These fears can be triggered by perceived or actual scrutiny by others. While the fear of social interaction may be recognized by the person as excessive or unreasonable, considerable difficulty can be encountered overcoming it. Approximately 13.3% of the general population may meet criteria for social anxiety disorder at some point in their lifetime, according to the highest survey estimate, with the male to female ratio being 1:1.5 respectively.^[1] Psychiatry is a medical specialty dealing with the prevention, assessment, diagnosis, treatment, and rehabilitation of the mind and mental illness. ... A mental health professional is a person who offers services for the purpose of improving an individuals mental health or to treat mental illness. ...

Physical symptoms often accompanying social anxiety disorder include excessive blushing, sweating (hyperhidrosis), trembling, palpitations, nausea, and stammering. Panic attacks may also occur under intense fear and discomfort. An early diagnosis may help in minimizing the symptoms and the development of additional problems such as depression. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. This article or section does not adequately cite its references or sources. ... Sweating (also called perspiration or sometimes transpiration) is the production and evaporation of a fluid, consisting primarily of water as well as a smaller amount of sodium chloride (the main constituent of table salt), that is excreted by the sweat glands in the skin of mammals. ... Primary hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature. ... For the film see Tremors (film). ... A palpitation is an abnormal, rapid beating of the heart, brought on by overexertion, disease or drugs. ... For the Beck song, see Nausea (song). ... Stuttering is a speech disorder in which pronunciation of the (usually) first letter or syllable of a word is repeated involuntarily. ... This article does not cite any references or sources. ... In general, a diagnosis (plural diagnoses) has two distinct dictionary definitions. ... Functional group of an alcohol molecule. ... For other meanings, see Drug (disambiguation). ...

A person with the disorder may be treated with psychotherapy, medication, or both. Research has shown cognitive behavior therapy, whether individually or in a group, to be effective in treating social phobia. The cognitive and behavioral components seek to change thinking patterns and physical reactions to anxious situations. Prescribed medications includes two classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Attention given to social anxiety disorder has significantly increased since 1999 with the approval and marketing of drugs for its treatment. Psychotherapy is an interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living. ... Cognitive therapy or cognitive behavior therapy is a kind of psychotherapy used to treat depression, anxiety disorders, phobias, and other forms of psychological disorder. ... Look up Cognition in Wiktionary, the free dictionary. ... For the Pet Shop Boys album of the same name see Behaviour Behavior or behaviour (see spelling differences) refers to the actions or reactions of an object or organism, usually in relation to the environment. ... A prescription drug is a medication that is regulated by legislation to require a prescription before it can be obtained. ... A recent form of antidepressant medication - Prozac Serotonin-norepinephrine reuptake inhibitor, Venlafaxine An antidepressant, in the most common usage, is a psychiatric medication taken to alleviate clinical depression or dysthymia (milder depression). ... Serotonin Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants used in the treatment of depression, anxiety disorders and some personality disorders. ... Serotonin Norepinephrine Serotonin-norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant used in the treatment of clinical depression and other affective disorders. ...

Overview

According to the Diagnostic and Statistical Manual of Mental Disorders, social phobia is a persistent fear of one or more situations in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing. ^[2] For one to be socially phobic, exposure to the feared situation must provoke anxiety and the person must recognize this anxiety as irrational (although this may be absent in children). If another disorder is present, the social phobic fear is unrelated to it. For instance, if a person has a history of panic attacks, having a panic attack must not be the sufferer's fear. Sufferers are typically more self-conscious and self-attentive than others. ^[3] As a result, social phobics tend to limit or remove themselves from situations where they may be subject to evaluation. Sufferers often recognize their fear is excessive or irrational, yet can't seem to break out of the cycle. As such, the diagnosis of social phobia is made only when the fear leads to avoiding occupational functions, social activities, or relationships with others.^[4] The Diagnostic and Statistical Manual published by the American Psychiatric Association The poopDiagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States. ... A phobia (from the Greek Ï†ÏŒÎ²Î¿Ï‚ fear), is an irrational, persistent fear of certain situations, objects, activities, or persons. ... Humiliation is literally the act of being made humble, or reduced in standing or prestige. ... This article includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ...

Mental health professionals often distinguish between generalized and specific social anxiety disorders. People with generalized social anxiety have great distress with most or all social situations. A famous study by Stanford University established that distress was more likely when social encounters were unfamiliar, involved power or status differences, difference in gender, or the presence of a group of people. Those with specific social phobias may experience anxiety only in a few situations.^[5] For example the most common specific phobia is glossophobia, the fear of public speaking or performance, also known as "stage fright". Other examples of specific social phobias include fears of writing in public (scriptophobia) and using public restrooms (paruresis). Leland Stanford Junior University, commonly known as Stanford University (or simply Stanford), is a private university located approximately 37 miles (60 kilometers) southeast of San Francisco and approximately 20 miles northwest of San JosÃ© in Stanford, California. ... This article or section does not cite its references or sources. ... The English suffixes -phobia, -phobic, -phobe (of Greek origin) occur in technical usage in psychiatry to construct words that describe irrational, disabling fear as a mental disorder (e. ... Paruresis (IPA ), also known as pee shyness, shy kidney, bashful bladder, or shy bladder syndrome is a type of social anxiety disorder, that can affect both men and women, in which the sufferer is unable to urinate in the (real or imaginary) presence of others, such as in a public...

There is much debate concerning the relationship between social phobia and shyness. Shyness is not a criterion for social anxiety disorder. People with social anxiety disorder may be quite comfortable with certain people or many people, but still feel intense anxiety in specific social situations. Child psychologist Samuel Turner provides a summary between shyness and social phobia. Both share several features: negative cognitions in social situations, heightened physiological reactivity, a tendency to avoid social situations, and deficits in social skills. Negative cognitions include fear of negative evaluation, self-consciousness, devaluation of social skills, self-deprecating thoughts, and self-blaming attributions for social difficulties. Social phobia is distinct from shyness in that it has a lower prevalence in the population, follows a more chronic course, is more functionally debilitating, and has a later age of onset. There are problems with these kinds of comparisons. It may be that the differences between them are quantitative rather than qualitative.^[6] There are some that argue that shyness is mistakenly treated with medication intended for social phobia, effectively labeling the personality trait a mental illness.^[7] In humans, shyness is the feeling of apprehension or lack of confidence experienced in regard to social association with others, e. ... Developmental psychology is the scientific study of progressive psychological changes that occur in human beings as they age. ... Samuel Turner was an English recipient of the Victoria Cross, the highest and most prestigious award for gallantry in the face of the enemy that can be awarded to British and Commonwealth forces. ... Look up Cognition in Wiktionary, the free dictionary. ... This article or section does not cite any references or sources. ... Self-consciousness is the knowledge of ones own presence. ... It has been suggested that Blockbuster drug be merged into this article or section. ... Look up trait in Wiktionary, the free dictionary. ...

Social phobia should not be confused with panic disorder. Sufferers of panic disorder are convinced that their panic comes from some dire physical cause, and often go to the hospital or call for an ambulance during or after their attacks. Social phobics may experience a panic attack when triggered, but they are aware that it is extreme anxiety they are experiencing, and that the cause is an irrational fear. Few social phobics would willingly go to a hospital in that instance because they fear rejection and judgment by authority figures (such as the medical staff). The general form of social anxiety is sometimes incorrectly called generalized anxiety disorder. The principal difference between the two is that the social phobia deals with anxiety in a social setting, while generalized anxiety disorder is extreme anxiety for any situation (work, school, et al.), not necessarily one involving other people. Panic disorder is a diagnosed psychiatric mental condition that causes the sufferer to experience sporadic, intense, and often reoccurring panic attacks. ... This article needs additional references or sources to facilitate its verification. ...

Symptoms

Cognitive aspects

In cognitive models of Social Anxiety Disorder, social phobics experience dread over how they will be presented to others. They may be overly self-conscious, pay high self-attention after the activity, or have high performance standards for themselves. According to the social psychology theory of self-presentation, a sufferer attempts to create a well-mannered impression on others but believes he or she is unable to do so. Many times, prior to the potentially anxiety-provoking social situation, sufferers may deliberate over what could go wrong and how to deal with each unexpected case. After the event, they may have the perception they performed unsatisfactorily. Consequently, they will review anything that may have possibly been abnormal or embarrassing. These thoughts do not just terminate soon after the encounter, but may extend for weeks or longer.^[8] Those with social phobia tend to interpret neutral or ambiguous conversations with a negative outlook and although still inconclusive, some studies suggest that socially anxious individuals remember more negative memories than those less distressed.^[9] An example of an instance may be that of an employee presenting to his co-workers. During the presentation, the person may stutter a word upon which he or she may worry that other people significantly noticed and think that he or she is a terrible presenter. This cognitive thought propels further anxiety which may lead to further stuttering, sweating and a possible panic attack. In sociology and social psychology, impression management is the process through which people try to control the impressions other people form of them. ...

Behavioral aspects

Social anxiety disorder is a persistent fear of one or more situations in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing. It exceeds normal "shyness" as it leads to excessive social avoidance and substantial social or occupational impairment. Feared activities may include almost any type of social interaction, especially small groups, dating, parties, talking to strangers, restaurants, etc. Physical symptoms include "mind going blank", fast heartbeat, blushing, stomach ache. Cognitive distortions are a hallmark, and learned about in CBT (cognitive-behavioral therapy). Thoughts are often self-defeating and inaccurate.

The groundless fear of telephoning is typical, both calling somebody and answering the phone. It may appear early in childhood. This article or section includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ...

According to psychologist B.F. Skinner, phobias are controlled by escape and avoidance behaviors. For instance, a student may leave the room when talking in front of the class (escape) and refrain from doing verbal presentations because of the previously encountered anxiety attack (avoid). Minor avoidance behaviors are exposed when a person avoids eye contact and crosses arms to avoid recognizable shaking.^[9] A fight-or-flight response is then triggered in such events. Preventing these automatic responses is at the core of treatment for social anxiety. Burrhus Frederic Skinner (March 20, 1904 _ August 18, 1990) was an American psychologist and author. ... Escape response, escape reaction, or escape behaviour is a possible reaction in response to stimuli indicative of danger, in particular, it initiates an escape motion of an animal. ... An avoidance response is a form of escape behavior present in animals in which the subject evades an aversive event. ... The fight-or-flight response, also called the acute stress response, was first described by Walter Cannon in 1929. ...

Physiological aspects

Physiological effects, similar to those in other anxiety disorders, are present in social phobics. Faced with an uncomfortable situation, children with social anxiety may display tantrums, weeping, clinging to parents, and shutting themselves out.^[10] At adults, it may be lacrimation as well as experiencing excessive sweating, nausea, shaking, and palpitations as a result of the fight-or-flight response. It should be strongly emphasized that the term "lacrimation" refers to eye watering, not crying. The walk disturbance may appear, especially when passing a group of people. Blushing is commonly exhibited by individuals suffering from social phobia.^[9] These visible symptoms further reinforce the anxiety in the presence of others. A 2006 study found that the area of the brain called the amygdala, part of the limbic system, is hyperactive when patients are shown threatening faces or confronted with frightening situations. They found that patients with more severe social phobia showed a correlation with the increased response in the amygdala.^[11] A tantrum is an emotional outburst wherein higher brain functions are unable to stop the emotional expression of the lower (emotional and physical) brain functions. ... Tears trickling down the cheeks Lacrimation is the bodys process of producing tears, which are a liquid to clean and lubricate the eyes. ... Also see: Tears (song) by X Japan, or Tears (film) by Im Sang-soo. ... SWEAT is an OLN/TSN show hosted by Julie Zwillich that aired in 2003-2004. ... For the Beck song, see Nausea (song). ... For the film see Tremors (film). ... This article does not cite any references or sources. ... To blush is to display a marked redness of ones face; the term is seldom applied except when the redness is construed as a result of embarrassment, shame, or modesty. ... Italic text // ahh addiing sum spiice iin hurr`` For other uses, see Brain (disambiguation). ... Look up Amygdala in Wiktionary, the free dictionary. ... The limbic system (Latin limbus: border or edge) includes the structures in the human brain involved in emotion, motivation, and emotional association with memory. ... Hyperactivity can be described as a state in which a person is abnormally easily excitable and exuberant. ... Positive linear correlations between 1000 pairs of numbers. ...

Prevalence

When prevalence estimates were based on the examination of psychiatric clinic samples, social anxiety disorder was thought to be a relatively rare disorder. The opposite was instead true; social anxiety was common but many were afraid to seek psychiatric help, leading to an understatement of the problem.^[9] Prevalence rates vary widely because of its vague diagnostic criteria and its overlapping symptoms with other disorders. There has been some debate on how the studies are conducted and whether the illness truly impairs the respondents as laid out in the official criteria. Psychologist Dr. Ray Crozier argues, "it is difficult to ascertain whether the person being interviewed adheres to the DSM-III-R criteria or whether they are merely exhibiting poor social skills or shyness."^[12]

The National Comorbidity Survey of over 8,000 American correspondents in 1994 revealed a 12-month and lifetime prevalence rates of 7.9% and 13.3% making it the third most prevalent psychiatric disorder after depression and alcohol dependence and the most apparent of the anxiety disorders.^[13] According to U.S. epidemiological data from the National Institute of Mental Health, social phobia affects 5.3 million adult Americans in any given year. Cross-cultural studies have reached prevalence rates with the conservative rates at 5% of the population.^[14]^[15] However, other estimates vary within 2% and 7% of the U.S. adult population.^[16] The National Comorbidity Survey (NCS) was the first large-scale field survey of mental health in the United States. ... Epidemiology (Greek epi = upon, among; demos = people, district; logos = word, discourse), defined literally, is the study of epidemics in humans. ... The National Institute of Mental Health (NIMH) is one of 27 components of the National Institutes of Health (NIH), the United States federal governments principal biomedical and behavioral research agency. ...

Onset of social phobia typically occurs between 11 and 19 years of age. Onset after age 25 is rare. Social anxiety disorder occurs in females nearly twice as often as males, although men are more likely to seek help.^[17] The prevalence of social phobia appears to be increasing among white, married, and well-educated individuals. As a group, those with generalized social phobia are less likely to graduate from high school and are more likely to rely on government financial assistance or have poverty-level salaries.^[18] Surveys carried out in 2002 show the youth of England, Scotland, and Wales have a prevalence rate of .4%, 1.8%, and .6%, respectively.^[19] The prevalence of self-reported social anxiety for Nova Scotians older than 14 years was 4.2% in June 2004 with women (4.6%) reporting more than men (3.8%).^[20] In Australia, social phobia is the 8th and 5th leading disease or illness for males and females between 15-24 years of age as of 2003.^[21] Because of the difficulty in separating social phobia from poor social skills or shyness, some studies have a large range of prevalence.^[22] Motto (French) God and my right Anthem No official anthem - the United Kingdom anthem God Save the Queen is commonly used England() â€“ on the European continent() â€“ in the United Kingdom() Capital (and largest city) London (de facto) Official languages English (de facto) Unified - by Athelstan 927 AD Area - Total 130... Motto (Latin) No one provokes me with impunity Cha togar mfhearg gun dioladh (Scottish Gaelic) Wha daur meddle wi me?(Scots)1 Anthem (Multiple unofficial anthems) Scotlands location in Europe Capital Edinburgh Largest city Glasgow Official languages English, Gaelic and Scots1 Government Constitutional monarchy - Monarch Queen Elizabeth II... This article is about the sub-division of the United Kingdom. ...

Comorbidity

There is a high degree of comorbidity with other psychiatric disorders. Social phobia often occurs alongside low self-esteem and clinical depression, due to lack of personal relationships and long periods of isolation from avoiding social situations. To try to reduce their anxiety and alleviate depression, people with social phobia may use alcohol or other drugs, which can lead to substance abuse. It is estimated that one-fifth of patients with social anxiety disorder also suffer from alcohol dependence.^[23] The most common complementary psychiatric condition is unipolar depression. In a sample of 14,263 people, of the 2.4% of persons diagnosed with social phobia, 16.6% also met the criteria for major depression.^[24] Besides depression, the most common disorders diagnosed in patients with social phobia are panic disorder (33%), generalized anxiety disorder (19%), post-traumatic stress disorder (36%), substance abuse disorder (18%), and attempted suicide (23%).^[25] In one study of social anxiety disorder patients who developed comorbid alcoholism, panic disorder or depression, social anxiety disorder preceded the onset of alcoholism, panic disorder and depression in 75%, 61%, and 90% of patients, respectively. Avoidant personality disorder is also highly correlated with social phobia.^[26] Because of its close relationship and overlapping symptoms with other illnesses, treating social phobics may help understand underlying connection in other psychiatric disorders. In medicine and in psychiatry, comorbidity is either The presence of one or more disorders (or diseases) in addition to a primary disease or disorder; or The effect of such additional disorders or diseases. ... In psychology, self-esteem or self-worth is a persons self-image at an emotional level; circumventing reason and logic. ... Clinical depression (also called major depressive disorder, or unipolar depression when compared to bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... Substance abuse refers to the overindulgence in and dependence on a psychoactive leading to effects that are detrimental to the individuals physical health or mental health, or the welfare of others. ... It is common to feel sad, discouraged , or down once in a while, and anyone in this state might say they are suffering from depression. ... Panic disorder is a diagnosed psychiatric mental condition that causes the sufferer to experience sporadic, intense, and often reoccurring panic attacks. ... This article needs additional references or sources to facilitate its verification. ... Post-traumatic stress disorder (PTSD) is a term for certain severe psychological consequences of exposure to, or confrontation with, stressful events that the person experiences as highly traumatic. ... Substance abuse refers to the overindulgence in and dependence on a psychoactive leading to effects that are detrimental to the individuals physical health or mental health, or the welfare of others. ... Suicide (Latin sui caedere, to kill oneself) is the act of intentionally taking ones own life. ... Avoidant personality disorder (APD or AvPD) [1] or Anxious personality disorder (APD) [2], is a personality disorder characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoiding social interaction. ...

There is research indicating that social anxiety disorder is often correlated with bipolar disorder[7]. Some researchers believe they share an underlying cyclothymic-anxious-sensitive disposition. [8] In addition, studies show that more socially phobic patients treated with anti-depressant medication develop hypomania than non-phobic controls[9][10], although this can be seen as the medication creating a new problem, and also has this adverse effect in a proportion of those without social phobia. For other uses, see Bipolar. ... Hypomania is a mood state characterized by persistent and pervasive elated or irritable mood, and thoughts and behaviors that are consistent with such a mood state. ...

Causes and perspectives

Research into the causes of social anxiety and social phobia is wide-ranging, encompassing multiple perspectives from neuroscience to sociology. Scientists have yet to pinpoint the exact causes. Studies suggest that genetics can play a part in combination with environmental factors.

Genetic and family factors

It has been shown that there is a two to three fold greater risk of having social phobia if a first-degree relative also has the disorder. This could be due to genetics and/or due to children acquiring social fears and avoidance through processes of observational learning or parental psychosocial education. Studies of identical twins brought up (via adoption) in different families have indicated that, if one twin developed social anxiety disorder, then the other was between 30% and 50% more likely than average to also develop the disorder.^[27] To some extent this 'heritability' may not be specific - for example, studies have found that if a parent has any kind of anxiety disorder or clinical depression, then a child is somewhat more likely to develop an anxiety disorder or social phobia.^[28] Studies suggest that parents of those with social anxiety disorder tend to be more socially isolated themselves (Bruch and Heimberg, 1994; Caster et al, 1999), and shyness in adoptive parents is significantly correlated with shyness in adopted children (Daniels and Plomin, 1985); Observational learning or social learning is learning that occurs as a function of observing, retaining and replicating behavior observed in others. ...

Adolescents who were rated as having an insecure (anxious-ambivalent) attachment with their mother as infants were twice as likely to develop anxiety disorders by late adolescence,^[29] including social phobia.

A related line of research has investigated 'behavioural inhibition' in infants – early signs of an inhibited and introspective or fearful nature. Studies have shown that around 10-15% of individuals show this early temperament, which appears to be partly due to genetics. Some continue to show this trait in to adolescence and adulthood, and appear to be more likely to develop social anxiety disorder.^[30]

Social experiences

A previous negative social experience can be a trigger to social phobia.^[31] ^[32] perhaps particularly for individuals high in 'interpersonal sensitivity'. For around half of those diagnosed with social anxiety disorder, a specific traumatic or humiliating social event appears to be associated with the onset or worsening of the disorder;^[33] this kind of event appears to be particularly related to specific (performance) social phobia, for example regarding public speaking (Stemberg et al., 1995). As well as direct experiences, observing or hearing about the socially negative experiences of others (e.g. a faux pas committed by someone), or verbal warnings of social problems and dangers, may also make the development of a social anxiety disorder more likely.^[34] Social anxiety disorder may be caused by the longer-term effects of not fitting in, or being bullied, rejected or ignored (Beidel and Turner, 1998). Shy adolescents or avoidant adults have emphasised unpleasant experiences with peers^[35] or childhood bullying or harassment (Gilmartin, 1987). In one study, popularity was found to be negatively correlated with social anxiety, and children who were neglected by their peers reported higher social anxiety and fear of negative evaluation than other categories of children.^[36] Socially phobic children appear less likely to receive positive reactions from peers^[37] and anxious or inhibited children may isolate themselves.^[38]

Social/cultural influences

Cultural factors that have been related to social anxiety disorder include a society's attitude towards shyness and avoidance, impacting ability to form relationships or access employment or education. One study found that the effects of parenting are different depending on the culture - American children appear more likely to develop social anxiety disorder if their parents emphasise the importance of other's opinions and use shame as a disciplinary strategy (Leung et al., 1994), but this association was not found for Chinese/Chinese-American children. In China, research has indicated that shy-inhibited children are more accepted than their peers and more likely to be considered for leadership and considered competent, in contrast to the findings in Western countries.^[39] Purely demographic variables may also play a role - for example there are possibly lower rates of social anxiety disorder in Mediterranean countries and higher rates in Scandinavian countries, and it has been hypothesised that hot weather and high-density may reduce avoidance and increase interpersonal contact.

Problems in developing social skills, or 'social effectiveness', may be a cause of some social anxiety disorder, through either inability or lack of confidence to interact socially and gain positive reactions and acceptance from others. The studies have been mixed, however, with some studies not finding significant problems in social skills^[40] while others have.^[41] What does seem clear is that the socially anxious perceive their own social skills to be low. It may be that the increasing need for sophisticated social skills in forming relationships or careers, and an emphasis on assertiveness and competitiveness, is making social anxiety problems more common, at least among the 'middle classes'.^[42] An interpersonal or media emphasis on 'normal' or 'attractive' personal characteristics has also been argued to fuel perfectionism and feelings of inferiority or insecurity regarding negative evaluation from others. The need for social acceptance or social standing has been elaborated in other lines of research relating to social anxiety^[43]

Evolutionary context

A long-accepted evolutionary explanation of anxiety is that it reflects an in-built 'fight or flight' system, which errs on the side of safety. One line of research suggests that specific dispositions to monitor and react to social threats may have evolved, reflecting the vital and complex importance of social living and social rank in human ancestral environments. Charles Darwin originally wrote about the evolutionary basis of shyness and blushing, and modern evolutionary psychology and psychiatry also addresses social phobia in this context.^[44] It has been hypothesised that in modern day society these evolved tendencies can become more inappropriately activated and result in some of the cognitive 'distortions' or 'irrationalities' identified in cognitive-behavioural models and therapies^[45] For other people of the same surname, and places and things named after Charles Darwin, see Darwin. ... Evolutionary psychology (abbreviated ev-psych or EP) is a theoretical approach to psychology that attempts to explain certain mental and psychological traitsâ€”such as memory, perception, or languageâ€”as evolved adaptations, i. ...

Neurochemical and neurocognitive influences

Some scientists hypothesize that social phobia is related to an imbalance of the brain chemical serotonin. Sociability is also closely tied to dopamine neurotransmission. Low D2 receptor binding is found in people with social anxiety.^[46] The efficacy of medications which affect serotonin and dopamine levels also indicates the role of these pathways. There is also increasing focus on other candidate transmitters, e.g. Norepinephrine, which may be over-active in social anxiety disorder, and the inhibitory transmitter GABA. Serotonin (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system (CNS) and enterochromaffin cells in the gastrointestinal tract of animals including humans. ... Sociability is the ability to be fond of the company of others, people who are sociable are inclined to conversating with others. ... Dopamine is a phenethylamine naturally produced by the human body. ... Chemical structure of D-aspartic acid, a common amino acid neurotransmitter. ...

Individuals with social anxiety disorder have been found to have a hypersensitive amygdala, for example in relation to social threat cues (e.g. someone might be evaluating you negatively), angry or hostile faces, and while just waiting to give a speech.^[47] Recent research has also indicated that another area of the brain, the 'Anterior cingulate cortex', which was already known to be involved in the experience of physical pain, also appears to be involved in the experience of 'social pain', for example perceiving group exclusion.^[48] Look up Amygdala in Wiktionary, the free dictionary. ... Grays FIG. 727â€“ Medial surface of left cerebral hemisphere. ...

Psychological factors

Research has indicated the role of 'core' or 'unconditional' negative beliefs (e.g. I am inept) and 'conditional' beliefs nearer to the surface (e.g. If I show myself, I will be rejected). They are thought to develop based on personality and adverse experiences and to be activated when the person feels under threat.^[49] One line of work has focused more specifically on the key role of self-presentational concerns.^[50]^[51] The resulting anxiety states are seen as interfering with social performance and the ability to concentrate on interaction, which in turn creates more social problems, which strengthens the negative schema. Also highlighted has been a high focus on and worry about anxiety symptoms themselves and how they might appear to others.^[52] A similar model^[53] emphasises the development of a distorted mental representation of their self and over-estimates of the likelihood and consequences of negative evaluation, and of the performance standards that others have. Such cognitive-behavioral models consider the role of negatively-biased memories of the past and the processes of rumination after an event, and fearful anticipation before it. Studies have also highlighted the role of subtle avoidance and defensive factors, and shown how attempts to avoid feared negative evaluations or use 'safety behaviours' (Clark & Wells, 1995) can make social interaction more difficult and the anxiety worse in the long run. This work has been influential in the development of Cognitive Behavioural Therapy for social anxiety disorder, which has been shown to have efficacy.

Treatment

Arguably the most important clinical point to emerge from studies of social anxiety disorder is the benefit of early diagnosis and treatment. Social anxiety disorder remains underrecognized in primary care practice, with patients often presenting for treatment only after the onset of complications such as major depression or substance use disorders. Improvement is lower for those with more severe social phobia and with comorbid disorders, such as avoidant personality disorder and depression.^[54] The patients who achieve full resolution are usually far fewer; there are still many who, after receiving treatment, are unable to function in the long-term without anxiety symptoms.

Research has provided evidence for the efficacy of two forms of treatment available for social phobia: certain medications and a specific form of short-term psychotherapy called cognitive-behavioral therapy (CBT), the central component being gradual exposure therapy.

Pharmacological treatments

SSRIs

Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, are considered by many to be the first choice medication for generalised social phobia. These drugs elevate the level of the neurotransmitter serotonin, among other effects. The first drug formally approved by the Food and Drug Administration was paroxetine, sold as Paxil in the US or Seroxat in the UK, Compared to older forms of medication, there is less risk of tolerability and drug dependency.^[55] However, their efficacy and increased suicide risk has been subject to controversy. Serotonin Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants used in the treatment of depression, anxiety disorders and some personality disorders. ... FDA logo The Food and Drug Administration (FDA) is an agency of the United States Department of Health and Human Services and is responsible for regulating food, dietary supplements, drugs, biological medical products, blood products, medical devices, radiation-emitting devices, veterinary products, and cosmetics in the United States. ... Paroxetine or paroxetine hydrochloride is a selective serotonin reuptake inhibitor (SSRI) antidepressant. ... Paroxetine (paroxetine hydrochloride; trade names Paxil® (United States), Seroxat® (UK), Aropax® (Australia)) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) type. ... Paroxetine (paroxetine hydrochloride; trade names Paxil® (United States), Seroxat® (UK), Aropax® (Australia)) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) type. ... Efficacy is the ability to produce a desired amount of a desired effect. ...

In a 1995 double-blind, placebo-controlled trial, the SSRI paroxetine was shown to result in clinically meaningful improvement in 55% of patients with generalized social anxiety disorder, compared with 23.9% of those taking placebo.^[56] An October 2004 study yielded similar results. Patients were treated with either fluoxetine, psychotherapy, fluoxetine and psychotherapy, placebo and psychotherapy, and a placebo. The first four sets saw improvement in 50.8 to 54.2% of the patients. Of those assigned to receive only a placebo, 31.7 percent achieved a rating of 1 or 2 on the Clinical Global Impression-Improvement scale. Those who sought both therapy and medication did not see a boost in improvement.^[57] The double blind is ray charles is ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesof the scientific method, used to prevent research... â€œPlacebo effectâ€ redirects here. ... See drugs, medication, and pharmacology for substances that treat patients. ... Lilly branded Prozac package Fluoxetine hydrochloride (Prozac) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. ... The Clinical Global Impression (CGI) is a scale to assess treatment response in patients with mental disorders. ...

General side-effects are common during the first weeks while the body adjusts to the drug. Symptoms may include headaches, nausea, insomnia and changes in sexual behavior. Treatment safety during pregnancy has not been established.^[58] In late 2004 much media attention was given to a proposed link between SSRI use and juvenile suicide. For this reason, the use of SSRIs in pediatric cases of depression is now recognized by the Food and Drug Administration as warranting a cautionary statement to the parents of children who may be prescribed SSRIs by a family doctor.^[59] Recent studies have shown no increase in rates of suicide.^[60] These tests, however, represent those diagnosed with depression, not necessarily with social anxiety disorder. However, it should be noted that due to the nature of the conditions, those taking SSRIs for social phobias are far less likely to have suicidal ideation than those with depression. Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... For the Beck song, see Nausea (song). ... This article is about the sleeping disorder. ... Teenage suicide is the self-killing of a teenager. ...

Other drugs

Although SSRIs are often the first choice for treatment, other prescription drugs are also commonly issued, sometimes only if SSRIs fail to produce any clinically significant improvement.

In 1985, before the introduction of SSRIs, anti-depressants such as monoamine oxidase inhibitors (MAOIs) were frequently used in the treatment of social anxiety. Their efficacy appears to be comparable or sometimes superior to SSRIs or Benzodiazepines. However, because of the dietary restrictions required, high toxicity in overdose, and incompatibilities with other drugs, its usefulness as a treatment for social phobics is now limited. Some argue for their continued use, however, or that a special diet does not need to be strictly adhered to.^[61] A newer type of this medication, Reversible inhibitors of monoamine oxidase subtype A (RIMAs) inhibit the MAO enzyme only temporarily, improving the adverse-effect profile but possibly reducing their efficacy. Monoamine oxidase inhibitors (MAOIs) are a class of antidepressant drugs prescribed for the treatment of depression. ... In nutrition, the diet is the sum of food consumed by a person or other organism. ... Toxic redirects here, but this is also the name of a song by Britney Spears; see Toxic (song) Look up toxic and toxicity in Wiktionary, the free dictionary. ... Rima leaps into action in this panel from RIMA THE JUNGLE GIRL #6 by artist Nestor Redondo, published by DC Comics, 1975 Editor/Cover Art: Joe Kubert Assistant Editor: Alan Asherman For the Icelandic rÃma poetry see rÃmur. ... Ribbon diagram of the enzyme TIM, surrounded by the space-filling model of the protein. ...

Benzodiazepines are a short-acting and more potent alternative to SSRIs. The drug is often used for short-term relief of severe, disabling anxiety. Although benzodiazepines are still sometimes prescribed for long-term use in some countries, there is much concern over the development of drug tolerance, dependency and recreational abuse. Benzodiazepines augment the action of GABA, the major inhibitory neurotransmitter in the brain; effects usually begin to appear within minutes or hours. Alprazolam 2mg tablets The benzodiazepines (pronounced , or benzos for short) are a class of psychoactive drugs considered as minor tranquilizers with varying hypnotic, sedative, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties, which are brought on by slowing down the central nervous system. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Drug tolerance occurs when a subjects reaction to a drug (such as a painkiller or intoxicant) decreases so that larger doses are required to achieve the same effect. ... A chemical dependency is such a strong dependency on a substance that it becomes necessary to have this substance just to function properly; The need of a substance developed from abusing the substance, requiring the substance for survival, like the need for food, or water See also: addiction drug tolerance... This article does not cite its references or sources. ... Gaba may refer to: GabÃ¢ or gabaa (Philippines), the concept of negative karma of the Cebuano people GABA, the gamma-amino-butyric acid neurotransmitter GABA receptor, in biology, receptors with GABA as their endogenous ligand Gaba 1 to 1, an English conversational school in Japan Marianne Gaba, a US model...

Some people with a form of social phobia called performance phobia have been helped by beta-blockers, which are more commonly used to control high blood pressure. Taken in low doses, they control the physical manifestation of anxiety and can be taken before a public performance. Beta blockers (sometimes written as Î²-blockers) are a class of drugs used for various indications, but particularly for the management of cardiac arrhythmias and cardioprotection after myocardial infarction. ...

A novel treatment approach has recently been developed as a result of translational research. It has been shown that a combination of acute dosing of d-cycloserine (DCS) with exposure therapy faciliates the effects of exposure therapy of social phobia (Hofmann, Meuret, Smits, et al., 2006). DCS is an old antibiotic medication used for treating tuberculosis and does not have any anxiolytic properties per se. However, it acts as an agonist at the glutamatergic N-methyl-D-aspartate (NMDA) receptor site, which is important for learning and memory (Hofmann, Pollack, & Otto, 2006). It has been shown that administering a small dose acutely 1 hour before exposure therapy can facilitate extinction learning that occurs during therapy.

Psychotherapy

Research has shown that a form of psychotherapy that is effective for several anxiety disorders, particularly panic disorder and social phobia^[62] is cognitive-behavioral therapy (CBT). It has two main components. The cognitive component helps people become aware of and to change thinking patterns that keep them from overcoming their fears. A person with social phobia might be helped to question how they can be so sure that others are continually watching and harshly judging him or her. The behavioral component of CBT seeks to change people's reactions to anxiety-provoking situations. A key element of this component is gradual exposure, in which people confront the things they fear in a structured, sensitive manner. The aim is also to learn from acting differently and observing reactions (behavioral 'experiments'). This is intended to be done with support and guidance when the therapist and patient feel they are ready. Cognitive-behavior therapy for social phobia also includes anxiety management training, which may include techniques such as deep breathing and muscle relaxation exercises, which may be practiced 'in-situ'. CBT may also be conducted partly in group sessions (Cognitive behavioral group therapy), facilitating the sharing of experiences, a sense of acceptance by others and undertaking behavioral challenges in a trusted environment (Heimberg). Psychotherapy is an interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living. ... Cognitive therapy or cognitive behavior therapy is a kind of psychotherapy used to treat depression, anxiety disorders, phobias, and other forms of psychological disorder. ... In situ is a Latin phrase meaning in the place. ... The sixth studio album by alternative rock band Concrete Blonde, after their break-up and reunion. ...

Some studies have suggested social skills training can help with social anxiety (Mersch et al., 1991). Whether specific social skills techniques and training are required, rather than just support with general social functioning and exposure to social situations, does not seem to be clear (Stravynski & Amado, 2001).

Interpersonal Therapy has been shown to have efficacy for depression and a small study of the therapy in the treatment of social phobia suggests it may also work with social phobia (Lipsitz et al, 1999).

History

Literary descriptions of shyness can be traced back to the days of Hippocrates around 400 B.C. Charles Darwin wrote about the physiology and social context of blushing and shyness. The first mention of a psychiatric term, social phobia ("phobie des situations sociales"), was made in the early 1900s. Psychologists used the term "social neurosis" to describe extremely shy patients in the 1930s. After extensive work by Joseph Wolpe on systematic desensitization, research in phobias and their treatment grew. The idea that social phobia was a separate entity from other phobias came from the British psychiatrist, Isaac Marks in the 1960s. This was accepted by the American Psychiatric Association and was first officially included in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The definition of the phobia was revised in 1989 to allow comorbidity with avoidant personality disorder, and introduced generalized social phobia. ^[9] Social phobia had been largely ignored prior to 1985. After a call to action by psychiatrist Michael Liebowitz and clinical psychologist Richard Heimberg, there was an increase in research and attention on the disorder. The DSM-IV gave social phobia the alternative name Social Anxiety Disorder. Research in to the psychology and sociology of everyday social anxiety continued. Cognitive Behavioural models and therapies were developed for social anxiety disorder. In the 1990s, paroxetine became the first prescription drug in the US approved to treat social anxiety disorder, with others following. Image File history File links Michael_R._Liebowitz. ... Image File history File links Michael_R._Liebowitz. ... Dr. Michael R. Liebowitz is a Columbia University psychiatrist and founder of the Anxiety Disorders Clinic, the first of its kind, at the New York Psychiatric Institute. ... Richard Heimberg is a researcher, psychotherapist, and current professor at Temple University. ... Hippocrates of Cos II or Hippokrates of Kos (ca. ... Joseph Wolpe (1915-1997) was born in Johannesburg, South Africa in 1915, but became an American citizen later in his life. ... Systematic desensitization is a type of behavioral therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders. ... Image:IsaacMarks. ... Due to the epidemic of medical errors, readers are cautioned to be aware that the American Psychiatric Association isnt immune to this. ... Avoidant personality disorder (APD or AvPD) [1] or Anxious personality disorder (APD) [2], is a personality disorder characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoiding social interaction. ... Dr. Michael R. Liebowitz is a Columbia University psychiatrist and founder of the Anxiety Disorders Clinic, the first of its kind, at the New York Psychiatric Institute. ... Clinical psychology is the application of psychology to mental illness or mental health problems. ... Richard Heimberg is a researcher, psychotherapist, and current professor at Temple University. ... Paroxetine or paroxetine hydrochloride is a selective serotonin reuptake inhibitor (SSRI) antidepressant. ...

Criticisms

Many professionals and sufferers continue to criticise a perceived underdiagnosis and undertreatment of Social Anxiety Disorder and associated disability, and that not enough is being done to overcome the barriers faced by this group (e.g. Olfson et al., 2000) Image File history File links Unbalanced_scales. ...

By contrast, others are critical that the diagnostic boundaries have been stretched too far and that clinical and media work is promoting the idea that any problems with shyness or social worries are a pathological medical condition requiring medical treatment. Some see this as being driven by pharmaceutical companies, either by direct advertising to the public or their financial influence on psychiatry.^[63] This view can be associated with, but is not exclusive to, anti-psychiatry. A pharmaceutical company is a licensed drug company, licensed to discover, develop, markets and distribute drugs. ... Beginning in the 1960s, a movement called anti-psychiatry claimed that psychiatric patients are not ill but are individuals that do not share the same consensus reality as most people in society. ...

Some argue that problems with social anxiety in individuals can be seen as indicating problems with society – for example a competitive culture, power imbalances, lack of care or social education in families and communities – and are critical of focusing disorder and treatment only on individuals.

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