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Dr. Mike Gropper is an American psychotherapist and marital therapist living in Ra'anana. For further details, see end of article.
A young woman in her 20s stays home most of the time absorbed in her books. While she may be a great reader of novels, she avoids all social contacts and rarely sees the few friends she has made. She suffers from loneliness, but the very thought of going to a social gathering fills her with the fear of scrutiny, humiliation and embarrassment.
Her parents encourage her to go a birthday party, where she is conscious of the fact that people might be staring at her. Now she has to talk to the person approaching her. She tries to smile, but her voice comes out weakly. She's sure that she is making a fool out of herself. Her self-consciousness and anxiety rise to the roof. During the past year, this is the first social gathering she has attended.
A man hates to go to work because of a meeting scheduled the next day with his co-workers to discuss their current projects makes him anxious. Finally, the meeting is over. At the next meeting, his boss will be there and he knows that in front of his boss he will stammer, hesitate, his face will turn red, he won't remember what to say, and everyone will witness his embarrassment and humiliation. He often can't sleep for days before these meetings, worrying how he will be perceived as incompetent.
If you - or anyone you know - sound like these two, you may be suffering from an emotional disorder called "social phobia." In the US it is the third most common psychiatric disorder, following depression and alcohol dependence. About 7% of the population is believed to have the problem at any given time. It is equally prevalent in many other countries around the world, including Israel.
So what exactly is social phobia?
It is a fear of scrutiny, humiliation, and embarrassment in social situations that require speaking, eating, or writing in public. These fears may occur in discreet situations, or in most or all social situations. Consequently, people with social phobia often avoid the situations where such scrutiny may occur, or they endure them with intense distress.
The fear is recognized by the person as excessive for the situation. The feared social or performance situations are avoided or else endured with intense anxiety and distress. Many young single people who have sought psychotherapy to help them overcome their social phobia, particularly with members of the opposite sex. Some of these individuals have completely given up on dating, whereas others continue to pursue relationships, but suffer quietly and feel that no one can understand or help them overcome their pain.
The symptoms of social phobia are severe enough to interfere with everyday activities. They include intense fear, nervousness, automatic negative thinking cycles such as "no one will like me or they will think I am a phony," racing heat, blushing, dry throat and mouth, trembling, and muscle twitches. Constant, intense anxiety is the most common feature.
People with social anxiety know that their anxiety is irrational and doesn't make logical sense (which is not the case in panic disorder or anxiety attacks where the sufferer thinks that he is having a heart attack or going crazy), nevertheless, they just can't control the problem. This can result in impaired functioning and reduced quality of life.
People with social phobia are at risk for depression, including contemplating or attempting suicide, alcohol and substance abuse, and other psychiatric disorders. They also may have few friendships, experience trouble dating as noted earlier, drop out of school, and even reject promotions, because of the intense anxiety they experience in social situations. Many social phobics can't even cope with many of life's demands to deal with people in solving the daily problems that confront people such as speaking to someone at the phone company about poor service, or complaining to a store manager about a defective product that was purchased.
What socially phobic people fear most
Being introduced to other people
Being teased or criticized
Being the center of attention
Social situations where the person exhibits excessive self-consciousness
Being watched or observed while doing something
Having to say something in a formal, public situation such as giving a lecture or a speech
Meeting people in authority
Feeling insecure and out of place in social situations
Embarrassing easily (e.g. blushing)
Meeting other peoples' eyes
So what causes social phobia?
Humans are sensitive to anger, criticism, and other means of social disapproval. Some individuals may be more biologically predisposed to automatic nervous system arousal, and show more attentional vigilance to danger cues. Specifically, embarrassment, shame, and pre-performance anxiety due to family and/or social experiences may activate that arousal.
At adolescence, when the adolescent is trying to establish his/her independence, they are inclined to be extremely sensitive about what others feel and think about what they say and how they look. Fitting into the peer group is the challenging task at this age and avoiding embarrassment, real or imagined, is a sought out goal. For this reason, adolescence is considered a time when social anxiety leading to social phobia can take place, especially if the adolescent has certain family and/or biological risk factors described above. Other people may have certain risk factors that make them stand out and identified as deviant. For example people with problems in verbal fluency such as stuttering are more reticent to speak in public and those with problems physical dexterity often avoid eating or writing in public. With social phobia, there is a high correlation with depression. In depression, there is a lack of self-esteem, impairment in motivation and self-assertiveness, and a reluctance to socialize, all of which aggravate the symptoms of social phobia. And the functional impairments in social phobia aggravate the depression.
Help for social phobia
Unfortunately, those suffering from social phobia very often go untreated because the socially anxious person or the health care professionals who know the person do often not recognize the disorder. Many socially phobic people suffer quietly while friends and family members often state "You are just shy, don't worry, you will outgrow it." But, as noted in this article, social phobia is more than just being shy, and unless this individual is treated, social phobia wreaks havoc in this person's life.
Thankfully, the National Institute of Mental Health-funded studies in the United States report a 90% success rate when cognitive-behavioral therapy where socially phobic persons can work through their fear hierarchies in therapy and later in real life are combined with anti-anxiety agents and/or anti-depressants.
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Dr. Mike Gropper is an American trained psychotherapist and marital therapist. Contact him at Golan Center, Ahuza 198, Ra'anana, (09) 774 1913, or Shalom Mayer Center, Diskin Street 9A, Kiryat Wolfson, Jerusalem, (02) 563 6265, email@example.com
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