How is social phobia different from shyness?
Shyness is a feature of temperament: a person is uncomfortable in a new company, but he still does what is needed and gradually gets used to it. With social anxiety, fear is so expressed that it triggers avoidance: a person refuses performances, does not make phone calls, chooses work without communication, and skips holidays. Often a “pre-alarm” is added in the days and weeks before the event and a long analysis of one’s own behavior after it. It is avoidance and mental analysis that maintain the disorder: they prevent one from becoming convinced that the danger is exaggerated.
- Fear is disproportionate to the actual situation
- Symptoms last for months, not in isolated cases
- Situations are avoided or tolerated with great stress
- Study, work, relationships suffer
- The person considers his fear to be excessive
Causes and risk factors
There is no single reason: the disorder is made up of innate characteristics of the nervous system and life experience. In anxious people, the brain reacts faster to signs of disapproval - a glance, a pause, a change in intonation. This is compounded by the experience of bullying, public humiliation, and a strict critical environment in the family or school. Sometimes the first impetus is a single unsuccessful episode, after which a person begins to avoid similar situations, and the fear becomes entrenched.
- Hereditary tendency to anxiety
- Inhibited, cautious temperament from early childhood
- Bullying and ridicule from peers
- Critical or overprotective parenting style
- A single traumatic episode of public failure
How it manifests itself
Complaints are divided into physical, mental and behavioral. Physical ones arise quickly and are noticeable to the person himself, which is why there is a fear that others will see the excitement. Thoughts usually revolve around assessment: “I’ll say something stupid,” “everyone will notice how I’m blushing.” Behavior comes down to avoidance or “protective actions” - speak quietly, do not make eye contact, keep your hands in your pockets, drink alcohol in advance. Such techniques provide short-term relief, but perpetuate the problem.
- Redness of the face, trembling in the voice and hands
- Rapid heartbeat, sweating, dry mouth
- Feeling empty in the head, difficult to find words
- Nausea or urge to go to the toilet before an event
- Long mental analysis of a conversation that has already passed
- Refusal to speak, make calls, meet new people
Diagnostics: what the doctor checks
The diagnosis is made through a conversation: the doctor clarifies in what situations fear appears, how long it lasts, and how it affects life. Questionnaires and anxiety scales are used to help assess the severity and track the dynamics of treatment. Laboratory tests are needed not to confirm the diagnosis, but to exclude conditions with similar physical manifestations: thyrotoxicosis, anemia, heart rhythm disturbances. The doctor will also check for depression and alcohol addiction, which often accompany social anxiety.
- Detailed clinical conversation
- Social Anxiety and General Anxiety Scales
- Assessing mood and risk of depression
- Questions about alcohol and sedatives
- For bodily complaints - thyroid hormones, blood test, ECG
Treatment and self-help
The first choice method is cognitive behavioral therapy. It combines work with thoughts of assessment and a gradual, step-by-step return to frightening situations without protective techniques. It usually takes several months of regular practice; the effect persists even after completing the course. For severe anxiety, depression, or when therapy is not available, a psychiatrist may prescribe medications, often antidepressants; The drug and duration are selected only by the doctor. Alcohol “for courage” and sedatives without prescription worsen the course and form dependence.
- Cognitive Behavioral Therapy and Exposure
- Communication and public speaking skills training
- Withdrawal of protective behavior
- Medication support as prescribed by a psychiatrist
- Regular sleep, physical activity, limiting caffeine
- Support groups and group therapy