Critical Analysis of Social Anxiety

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There are an increasing number of people who actually fear social engagement to the point they cannot live a productive and normal life. These individuals often fear for the worse and stay inside their homes. Some are so afraid they cannot obtain jobs, go to school, or even make friends. This condition is called social anxiety, medically referred to as social phobia (“Social Anxiety Disorder”). This sample psychology research paper from Ultius attempts to better understand this disorder which affects so many in modern society.

What is social anxiety?

Social anxiety is a medically defined form of anxiety. The National Institute of Mental Health (NIMH) defines social anxiety as:

"a strong fear of being judged by others and of being embarrassed."

It is the most common anxiety disorder and one of the most common psychiatric disorders, with 12% of American adults having experienced it (NIMH). And many researchers believe it is one of the most common forms of mental illness today.

Motivating the afflicted

There are several primary factors that cause these disorders, and there are several treatments that help patients overcome their fears and reenter society. The real test involves getting the patient to seek therapy rather than fear the therapist. But to understand what can cure social anxiety one must understand what the disorder is and how it is caused or encouraged. In the United States, epidemiological studies have recently pegged social anxiety disorder as the third largest psychological disorder in the country, after depression and alcoholism.  

It is estimated that about 7% of the population suffers from some form of social anxiety at the present time.  The lifetime prevalence rate for developing social anxiety disorder is 13-14% (Richards).

Identifiers of social anxiety

This fear can be so strong that it gets in the way of going to work or school or doing other everyday things (NIMH). It is an emotion characterized by a discomfort or a fear when a person is in a social interaction that involves a concern of being judged or evaluated by others (AADAA). This intense fear manifests itself through:

• Paranoia (i.e. fear of what others think about them)
• Influence (i.e. fear of what others may do to them)

These two fears are the primary identifiers to determine if a patient has a severe phobia or if it is just a normal discomfort of being around people (AADAA). But therapists and psychologists have to take caution when looking at the indicators. Some of the indicators can be misinterpreted, particularly the paranoia aspect (NIMH). Some of the fears of what people think are not legitimate fears while other times it may be a common life path that all people go through in the lives. For example, everyone has experienced fear of:

• Embarrassment
• Humiliation
• Criticism
• Rejection

Instead of social anxiety, these fears could be just normal everyday nervousness. 

Social anxiety often begins in youth

Another aspect of social anxiety is it typically occurs in childhood often as a result of trauma, but it is not always present (AADAA). This makes recognizing the determining factors and identifying whether the patient has social anxiety or a normal fear. Most children do not show signs of true social anxiety until they are older than eight-years-old (NIMH). This is because children don’t have the necessary social capacity to interact at younger ages, thus making it difficult to diagnose the disorder (Richards).

However, if a child is to show signs of social anxiety, most doctors agree the symptoms will manifest before prepubescent years . Doctors also argue whether diagnosing a child before they reach high school is not possible since these are the years children truly learn how to socialize, making earlier diagnosis a moot point. These doctors say since children do not truly communicate with their peers in a social setting until they reach high school a doctor cannot say they have a phobia (Richards).

Diagnosing social anxiety

Social anxiety is diagnosed like all other mental illnesses. A psychiatrist is called in to evaluate the patient and a psychologist performs psychological reasoning and analysis tests that suggest social anxiety concerning:

• Cognitive abilities
• Emotional state
• Potential social concerns (Smith and Jaffe-Gill)

However, only a psychiatrist or other medical doctor (MD) can diagnose this condition. Most psychiatrists look at the tests performed by the psychologists, analyze group and individual psychiatric therapy conducted by therapists and licensed counselors, and interview the patient before making a judgement.

Symptoms of social anxiety

Doctors look at physical symptoms that indicate social anxiety disorder, including the more common physical symptoms such as:

• Excessive blushing
• Excess sweating
• Trembling
• Palpitations
• Nausea

Other physical symptoms that are less common include:

• Stammering
• Rapid speech
• Panic attacks (Smith and Jaffe-Gill)

Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events (Social Anxiety Support). 

Tests for social anxiety disorder

The tests used to determine if a patient suffers from social anxiety are common standardized tests used to diagnose other mental illnesses such as schizophrenia. This includes:

• The Social Phobia Inventory
• The SPAI-B
• Liebowitz Social Anxiety Scale 

The Liebowitz social anxiety scale

The Liebowitz Social Anxiety Scale assesses the way that social phobia plays a role in the patient’s life and in a variety of situations. It is a survey-style ranking system that allows patients to give their own feedback and help doctors determine if they suffer from social anxiety (Smith and Jaffe-Gill). There are two parts to the test:

1. The first question asks how anxious or fearful patients feel in the situation
2. The second question asks how often patients avoid the situation (Smith and Jaffe-Gill)

The social phobia inventory

The Social Phobia Inventory is a questionnaire created by scientists in the department of Psychiatry and Behavioral Sciences at Duke University. It also is used for screening and measuring severity of social anxiety and whether a patient suffers from this disorder (Social Anxiety Support). The Social Phobia Inventory also relies on patients to accurately and honestly fill out the questionnaire for psychiatrists to use as a diagnosing tool. 

Treatment

Treating social anxiety is difficult because it is not likely the patient will participate in traditional group or individual therapy. In fact, many psychiatrists say this disorder is under reported because patients do not seek help nor are they diagnosed. Still, psychiatrists and mental health providers recommend standardized treatment approaches to this disorder. As with other mental illnesses such as PTSD, another form of treatment is medication.

While psychiatrists prefer the behavioral modification system over medication, it is helpful in the beginning stages of treatment to provide patients with medicine that helps relieve the symptoms caused by social anxiety (WebMD). However, there are no medications currently available that treat the cause of the disorder. Medications only help with the symptoms. Medications to help treat social anxiety symptoms include:

• Antidepressants (i.e. Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
• Monoamine Oxidase Inhibitors (MAOIs)
• Beta blockers
• Benzodiazepines (WebMD)

Behavioral modification

One of the most commonly used treatments to help patients with anxiety disorder is group and individual counseling (WebMD). This is called cognitive behavioral modification or therapy. Therapists and group members talk about their behaviors, daily activities, and thought process. In turn, group members and therapists help each other by recommending solutions that helped them. Individual counseling supplements the group therapy model. Counselors talk with patients about their fears and help find methods to reduce the discomfort.

Online counseling

In addition to in-office group and individual therapy, counselors have started offering online counseling as a door-opener for people who suffer from social anxiety. These practitioners believe this will increase the likelihood patients will come forward and seek help. However, counselors also say this is a temporary fix because the longer the patient chooses the online model the longer it will take to break the fear cycle and help reintroduce patients into society. For example, if a person is addicted to tobacco products tries nicotine patches to help them quit, the longer they use the patch the longer it takes to break the addiction. Counselors say this is similar to the fear experienced by patients suffering from social anxiety (WebMD).

Conclusion

Many people have stage fright or are uncomfortable in large groups. People just wanted to be by themselves with a good book or television. Some of these individuals never married or had children, and they do not have many friends. Most only have one or two close friends at the most. Several years ago, this was described as being unsocial or even antisocial, even though the true mental diagnosis never applied. While these individuals are far from crazy, or, rather, using the politically correct term emotionally disabled, they can and do live very normal lives. 

Many researchers, psychologists, psychiatrists, and counselors/therapists have questioned what makes a person’s fear of society and personal engagement so significant they cannot function, while those around them live normal, productive lives (NIMH). While these professionals cannot determine the root cause or differences, one thing stands out more than others. Patients who retreat from society become more susceptible to the causes of social anxiety (AADAA). With proper motivation, however, these fears can be overcome. 

Works Cited

Anxiety and Depression Association of America (AADAA). “Social Anxiety Disorder.” N.d. Web. 24 June 2015.

National Institute of Mental Health (NIMH). “What is Social Phobia (Social Anxiety Disorder)?” Social Phobia & Social Anxiety Disorders. N.d. Web. 24 June 2015.

Richards, Thomas A. “What is Social Anxiety?” Social Anxiety Institute. N.d. Web. 24 June 2015.

Smith, Melinda and Ellen Jaffe-Gill. “Social Anxiety Disorder and Social Phobia: Symptoms, Self-Help, and Treatment.” HelpGuide.org. June 2015. Web. 24 June 2015.

Social Anxiety Support. “Social Anxiety Disorder and Social Phobia.” N.d. Web. 24 June 2015.

-- “Liebowitz Social Anxiety Scale Test.” N.d. Web. 24 June 2015.

WebMD. “Social Anxiety Disorder.” Joseph Goldberg (ed.). 13 Feb. 2014. Web. 24 June 2015.