Social phobia
Julia Dobmeier is currently completing her master's degree in clinical psychology.Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.
More about the experts All content is checked by medical journalists.Social phobia is one of the anxiety disorders. Those affected are afraid of embarrassing themselves in public or attracting attention. They suffer from the constant fear of being judged negatively by others. The social phobia is an enormous burden for those affected and, if left untreated, leads to social isolation. Read all the important information about social phobia here.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F40
Social phobia: description
People with a social phobia are very afraid of attracting attention, be it through their behavior or through symptoms of anxiety such as sweating or flushing (erythrophobia). They fear being watched, devalued or laughed at by others. Contact with other people is torture for them. This fear is particularly pronounced in contact with the opposite sex.
Avoiding social situations has far-reaching consequences. For example, people who are afraid of emptying their bladder in public toilets (Paruesis) often do not dare to leave their home for a long time. This phenomenon is also known as the "shy bladder" and occurs in many patients with a social phobia. Those affected live very lonely and hardly take part in leisure activities.
In many cases, the social phobia also has an impact on professional life. Opportunities for advancement or a change of job are not taken for fear of people who are strangers to you. Some people with social phobia can no longer work at all. If the social phobia is severe, it leads to complete social isolation.
Out of fear of other people's scrutinizing glances, those affected often behave strangely and attract what they least want: attention. For example, they fall silent in company or turn away to eat so as not to be watched. Your focus is on not embarrassing yourself and on the fear that physical symptoms might reveal your insecurity. Eating normally or giving a speech becomes impossible under these circumstances
How many people are affected by social phobia?
Around two percent of the population suffer from a social phobia. It occurs almost twice as often in women as in men. The social phobias usually begin in adolescence and young adulthood. A social phobia has nothing to do with "normal" shyness; the effects on the patient's social life are much more severe.
In about 60 percent of cases, a social phobia occurs in combination with other mental disorders. Those affected also suffer from other anxiety disorders, eating disorders or addictions. Half of them suffer from depression at the same time.
Social phobia: symptoms
According to the ICD-10 classification of mental disorders, the following symptoms are present in a social phobia:
Those affected are very afraid of being the center of attention or of embarrassing themselves. Therefore, they avoid situations in which the fears could become reality.
The fears relate to social situations such as eating out or speaking in public. They are afraid of having to join small groups, for example at parties or in classrooms, but also of meeting acquaintances in public.
Physical symptoms are: flushing or tremors, fear of vomiting, and strong urination or urination. People with social phobia are very concerned that others might notice these signs. Since they are very focused on the physical symptoms, they become even more pronounced.
Those affected suffer greatly from the symptoms of anxiety and the consequences of avoidance behavior. Although they know the fear is excessive, they cannot change their behavior on their own.
Social phobia: causes and risk factors
There are different explanations for how a social phobia develops. Ultimately, one can assume that many factors work together. Hereditary factors probably contribute a part. However, the environment has the greater influence on the development of a social phobia.
Social phobia: social anxiety as a learning process
Many of those affected describe that they were teased and publicly humiliated more often when they were young. In contact with other people, they are afraid of being devalued. A certain basic anxiety can also help you avoid such situations in the future. They keep withdrawing.
Children who are inhibited in their behavior also have a higher risk of developing a social phobia later on. Inhibited children are quickly overwhelmed by unknown situations and withdraw. Such behavior can also be adopted by the children from their parents. If the parents are rather anxious and live in isolation, the child learns early on to fear social contacts and unfamiliar situations. If the social phobia is common in families, it is difficult to determine whether social anxiety is inherited or learned.
Social phobia: negative thoughts
People with a social phobia are constantly preoccupied with their fears. They quickly feel that they are being observed and often suspect that the reactions of other people are a devaluation of their person. They see themselves overly critically. They often place high demands on themselves that they cannot meet. A common thought from people with social phobia is: "The other people see that I am clumsy / stupid / bad". Those affected overestimate the effect of situations perceived as embarrassing on others. For example, they assume that they are despised and that they will never be seen in front of a certain person again. Such negative thoughts can trigger and then perpetuate social anxiety.
Social Phobia: Traumatic Experiences
Traumatic experiences in childhood are fundamentally a risk factor for psychological problems. This also applies to social phobia. Early experiences of loss, such as the death of a parent or divorce, can contribute to the development of excessive anxiety. Neglect or abuse are other risk factors for a social phobia. Unfavorable coping mechanisms learned early on often persist into adulthood.
Social phobia: examinations and diagnosis
The social phobia has very negative effects on those affected. It is therefore important to consult a doctor, psychologist or therapist in good time. The doctor will first do a physical exam to check whether physical causes could be responsible for the symptoms.
To diagnose a social phobia, the doctor or therapist will go through special questionnaires with the patient. He asks the patient a few questions for the external assessment process. The patient can complete self-assessment procedures alone. They give a comprehensive picture of the patient's complaints and help the therapist to make an accurate diagnosis. The doctor or therapist could ask the following questions:
- Are you afraid of speaking in public?
- Are you afraid of being the center of attention?
- Are you afraid of joining small groups?
- Are you afraid of blushing in front of other people?
After the diagnosis, the doctor or therapist informs the patient about the possible treatment methods with the help of psychotherapy and medication.
Social phobia: treatment
Social phobia is treated with psychotherapy and medication. Experts particularly recommend cognitive behavioral therapy. Psychodynamic psychotherapy can be used when cognitive behavioral therapy has not been successful.
Social Phobia: Cognitive Behavioral Therapy
At the beginning of the therapy, the patient is informed in detail about the social phobia (psychoeducation). The therapist explains to the person affected which factors contribute to the development and maintenance of the disorder and what role unrealistic claims and thoughts, as well as avoidance behavior, play.
Change negative thoughts
The next step of therapy consists of reviewing and changing unfavorable thoughts (cognitive restructuring). For example, the therapist questions the patient's thoughts related to the assessment by others. Can the person really know how other people think of them? Can he be sure that others will find his behavior embarrassing?
In many patients, such thoughts are automatic so that they are not aware of them. The therapist trains the patient to recognize unrealistic and frightening thoughts. Because only then can he change the mind. The therapist then motivates the patient to find realistic thought patterns that are less threatening.
Role play
In the further course of the therapy, the focus is on role-plays that serve to confront fears. Many of those affected have forgotten how to deal with others over time because they have avoided social situations. Real situations are simulated in role plays. A common practice is for the patient to give a speech in front of the other participants. In this way, the patient develops competencies that are intended to make him more confident in social interaction.
Confrontation with fears
The next level of confrontation with the patient's fears takes place outside of a clinic or practice (exposure therapy). In public, those affected should put themselves in uncomfortable and embarrassing situations. The challenges are slowly increasing.
When exposed, the patients often experience that the feared reactions do not occur. The other people react to them either neutrally or even positively. As with other anxiety disorders, the imagination and fearful thoughts are significantly worse than reality. With this knowledge, those affected can overcome the social phobia.
Social Phobia: Psychodynamic Psychotherapy
Psychodynamic psychotherapy focuses on unresolved conflicts that can contribute to the social phobia. Relationship conflicts in particular can be a trigger.
Those affected are looking for recognition, but they are so afraid of rejection and humiliation that normal contact becomes impossible. The fear of revealing their insecurity by blushing or trembling often leads to the breakdown of relationships. As part of psychodynamic psychotherapy, the therapist and patient research how this unfavorable relationship pattern came about and what purpose it served. In some patients, for example, it turns out that the origin lies in excessive demands of their own family. Failure to meet these demands can become a lifelong burden and spread to other people and situations.
Social phobia: medication
A social phobia is usually treated with selective serotonin or norepinephrine reuptake inhibitors (SSRIs / SNRIs), such as paroxetine or venlafaxine. They prevent the messenger substances serotonin or norepinephrine from being quickly withdrawn from their place of action. However, it takes about two to four weeks for an effect to be seen. After symptoms improve, the drugs are prescribed for a few more weeks to prevent relapse. Unwanted side effects include restlessness, nausea, and sexual dysfunction.
Social phobia: other treatments
Relaxation techniques help those affected to reduce their constant tension. Mostly Jacobson's progressive muscle relaxation is recommended. With this method, the entire body is actively relaxed through breathing exercises and the tensing and relaxing of muscles.
If patients have other mental illnesses such as depression in addition to the social phobia, these must also be treated.
Social phobia: disease course and prognosis
If left untreated, the social phobia is chronic in many cases. The earlier the social phobia developed, the worse the prognosis. Those affected then develop other mental disorders more often, especially depression and addictions. Both at work and in the private interpersonal area, a social phobia severely restricts those affected. If the level of suffering becomes too high, there is a risk that those affected will take their own lives.
With professional treatment, those affected have a good chance of a positive outcome. There is particularly good evidence of effectiveness for cognitive behavioral therapy, even if the social phobia has been around for some time.
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