Social anxiety

Social anxiety, also called “social phobia“, is a form of psychic distress that falls within the broad group of anxiety disorders, which also includes generalized anxiety disorder and panic attacks. Unlike the latter, which are often worse when you are alone, those who suffer from social anxiety find themselves in difficulty only in situations related to interaction with other people, especially if the attention of these people is focused on what you are doing or saying (or if you perceive it as such) and you feel exposed to the judgment of others.

To suffer from social phobia are mainly children in the first years of life and in particular in the first years of school, when they find themselves having to deal with peers, to speak in public and to establish the first interpersonal relationships outside the domestic environment, well known and reassuring, and far from the eyes of parents.

Social anxiety has a tendency to fade spontaneously with time, as the child grows and becomes familiar with the outside world, with the other children he gradually meets, with teachers and, therefore, gradually also with the “strangers” adults with whom he has the opportunity to interact in various situations and in any context.

In some cases, however, it is important for parents and teachers to pay a little more attention to children’s behavior and manifestations of fear and concern, because this process does not always happen spontaneously.

If the child’s shyness is objectively excessive and prevents him from interacting with peers, from attending school with good results, from participating in sports or other collective situations, this can result in a serious compromise of the quality of life and the possibility of serene psychological development, to the point of remaining as a social discomfort even in adulthood.

But how to understand if shyness and embarrassment are a normal expression of personality, common to many children, or if you are facing a real problem of social anxiety to be evaluated by a psychotherapist and to be addressed with specific therapies? Here are some factors to consider to guide the diagnosis of the disorder.

Social anxiety: what are the symptoms

The general criterion that must guide the recognition of social anxiety as a form of psychic distress is the level of interference that its presence has in the life of the subject who suffers from it.

If a person is shy, has a poor tendency to show himself and express his thoughts in public, assumes a worried and anxious attitude when he has to undergo an examination or present a project to work colleagues, but manages to manage and overcome the stress he experiences, then it is not social phobia, but only of insecurity due to modest self-esteem and low confidence in one’s abilities.

Conversely, it is very likely that a social anxiety disorder is present when a strong fear and excessive worry manifest themselves in situations that do not justify them and assume an intensity such as to prevent the “functioning” of the subject (ie his ability to face the task he has to perform), determining a real psychological and physical block and an irresistible desire for avoidance and escape. As if he were facing a danger or an undertaking absolutely beyond his strength.

In children, social phobia can express itself through the repeated and inexplicable refusal to go to school or even to leave the house; or it may be suspected when a child does not achieve academic results in line with their abilities, despite adequate commitment to study (for example, because they cannot answer questions when questioned, despite knowing the answers). Even a serious and persistent difficulty in approaching other children, alone or in groups, and making new friends is a sign of social anxiety, as well as the refusal to recite or play an instrument in public, participate in training and sports competitions, individual or team, even if you want it.

In adults, the persistence of social phobia can seriously compromise not only interpersonal relationships and the possibility of leading a peaceful life, but also professional success and personal fulfillment. In fact, this form of psychological distress leads to exclude all work activities that require showing oneself and exposing oneself to the judgment of others: from holding relationships and conferences to singing, playing or dancing in front of other people, from teaching to leading work groups, to carrying out activities in contact with the public.

In cases where the discomfort in social interaction is more marked, even participating in a business dinner or a conversation with people who know little to each other, expressing one’s opinion on a topic (especially if in contrast with that of the interlocutor), simply eating a sandwich or drinking a beer in a bar (especially alone) or feeling observed while attending a party or traveling by train becomes a difficult suffering to endure.

The psychological malaise generated by social anxiety and anticipatory anxiety that precedes situations considered difficult to deal with leads to avoid a large number of activities and opportunities for comparison with others, translating into a social withdrawal even extreme, which can facilitate the worsening of anxiety disorders, promote a negative attitude and increase the risk of developing other psychiatric problems, Like depression.

In addition to mental and behavioral symptoms, social anxiety causes characteristic physical signs, such as:

• increased heart rate and heartbeat changes (tachycardia, palpitations, etc.)
• tremors (especially in the hands and legs)
• hot flashes, redness of the face and neck
• excessive sweating and/or chills
• dry mouth sensation
• difficulty speaking (up to stuttering) and temporary change in tone of voice
• throat discomfort, coughing and difficulty breathing
• stomach cramps, nausea, abdominal pain and intestinal disorders (attacks of colitis, diarrhea, bloating and flatulence)
• muscle tension and contractures
• Drop in pressure and mental confusion
• difficulty falling asleep and insomnia, even in the face of considerable psychophysical fatigue.

In children, physical signs of social phobia are also desperate and apparently unmotivated crying, agitation and physical restlessness or, conversely, refusal to move, rigidity and apathy in the face of the invitation to participate in activities and situations that are perceived as dangerous and unpleasant and cause considerable anticipatory anxiety and discomfort.

Regardless of age, in order to be able to issue a diagnosis of social anxiety, the symptoms mentioned must be present continuously (almost every day) for more than six months and must not depend on the intake of drugs or active substances on the central nervous system (alcohol, drugs, etc.), nor be attributable to another psychiatric disorder already present, to an organic pathology (such as, for example, Parkinson’s or Alzheimer’s disease) or recent traumatic experiences (a car accident or at work, an assault, etc.).

The symptoms experienced, their intensity and combination may change over time, in relation to the activities carried out, the living environment and, in children, the process of growth and psychoemotional and cognitive development.

Causes of social anxiety

The exact causes of social anxiety are not known, but in all probability the origin of the disorder is multifactorial and determined by the interaction between individual predisposition to anxiety disorders, unfavorable environmental factors and life experiences that have led to develop a negative approach to social situations and interaction with other people, especially if strangers.

To date, there are no known specific alterations or genetic variants that can justify a greater probability of developing social anxiety, but the disease shows a certain family recurrence. On the other hand, this association could also depend on behavioral elements acquired by parents in the first years of life, or on the type of relationship that is established between parents and children.

In particular, a home climate characterized by excessive control over children, with punishment or blame in case of failure to achieve the goals desired by family members, can generate a strong sense of inadequacy, low self-esteem and difficulty in confronting the judgment of others, as well as the belief of not being up to it and not being accepted and loved by others as imperfect.

Even a loving parent or grandparent who is not particularly demanding, but definitely too anxious, who transfers his excessive concern for every activity and circumstance on his children / grandchildren can favor the onset of social phobia even in children who may not have developed it to a pathological level if they had found themselves in a more serene and relaxed environment.

In childhood, negative experiences lived in public, between adults or peers, perceived as frustrating and humiliating by the subject who experiences them, can have a negative impact on subsequent psychosocial development and, if not addressed and managed in a timely and correct manner, can affect the behavior of that person even in adulthood. This can happen to victims of bullying, physical abuse, domestic violence (even if only psychological), but also to children who make too early and intense use of social networks, without parental guidance.

Research conducted in the field of neuro-psychology has also shown that the structure and functioning of specific areas of the brain can also contribute to making the development of social anxiety more likely. In particular, it has been observed that people with social phobia tend to present neuronal hyperactivity at the level of the amygdala, the brain region that controls emotions, fear and escape behavior.

How to defeat social anxiety

As with all physical and mental illnesses, also for social anxiety the rule is that prevention is the best “cure” and that dealing promptly with the situation, as soon as you realize that there is some problem in the behavior or reactions of the child, is preferable to waiting to see how the picture evolves.

In particular, when recognizing the symptoms of a possible social phobia it is important to seek the help of a specialist in anxiety disorders and evaluate with him if it is appropriate to start a psychotherapy, possibly associated with pharmacological treatment in the most compromised cases, or if it is a transient discomfort that does not require the intervention of a psychotherapist.

In the case of children, in the first instance it is good that the parents (preferably both) undergo an interview to present and evaluate the problem. This will allow the psychotherapist to get an idea of the psychological profile of the couple, the relational dynamics and the family context. Only at a later stage, the child will also be evaluated.

In the case of an adult with social anxiety, the search for help can be more complex and late, since it must arise from a precise need of the subject who suffers from it, who must also find the strength to expose himself to the “judgment” of the psychotherapist. In general, the stimulus to do so comes from the presence of a strong malaise, often endured for years, or from the presence of performance anxiety that limits success and professional growth.

In all cases, the most used approach to dealing with social phobia is based on cognitive-behavioral therapy, individual or in groups: it is a type of psychotherapy aimed at making the patient learn a series of techniques and strategies to manage stress and overcome fear associated with situations of public exposure and social interaction that create difficulties.

Specific times and methods of cognitive-behavioral therapy are defined on a case-by-case basis, based on the needs of the individual person and intermediate “tests” may be provided, in which the subject is asked to voluntarily expose himself to gradually more “challenging” situations, in which he will have to apply the techniques gradually learned.

Since fear and anxiety are primary reactions that are difficult to control even by people who do not suffer from them in a pathological way, at least in a first phase and especially in adults, to support the path of psychotherapy antidepressant drugs can be prescribed, useful not only against depression, but also for the treatment of anxiety disorders in their many variants, including social anxiety.