I'm Not Shy, Just Ruined

Recently, I happened to read a conversation between two individuals on a popular social networking site. What I read somewhat disturbed me and revealed the misconceptions a lot of people have about a debilitating disorder. The conversation went something like this:

A. Yeah, well it's been difficult to get out of the house lately; I think I'm developing some sort of social phobia.

B. What do you mean?

A. I'm just feeling like I can only adequately function in work and school settings. I'm getting anxious anywhere else, like I have lost my social skills.

B. Huh?

A. I just think everyone's gonna notice I can't contribute anything worthwhile to the conversation.

B. Oh, everyone get's shy. That's a stupid reason not to leave the house.

Here I had to chime in and help to explain on this individual's behalf and clear up the misconception. It is important to clear this up because a 2005 study by Kessler, et. al. found that as many as 12.1% of the general population suffer from social phobia at some point in their lives. They also found that in any given 1 year period, the number may be as high as 6.1% of the general population. So what is social phobia, really?

First, let's say what social phobia is not. It is not shyness or embarrassment. Social Phobia is not simply nervousness or nerves. It is not inexperience, either. As a matter of fact, someone can develop social phobia in the areas they formerly excelled in. It is known that singer Carly Simon gave up live shows for several years due to intolerable performance anxiety. This is exactly what social phobia is; anxiety. However, it must be seen as a matter of degree. Most anxiety felt by people is mild. Social phobia is debilitating. Social phobia is often relegated to one or more specific areas of social or performance situations. Common situations for social phobia include eating in public restaurants, performance anxiety and urinating in public restrooms. This is termed a phobia since these individuals have no problem performing these activities in public. Furthermore, people experiencing social phobia may experience severe panic attacks when exposed to the situation that is the subject of anxiety.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is the reference of choice for American mental health professionals when diagnosing clients. The DSM-IV requires the following for someone to be diagnosed (edited for length):

A. A marked and persistent fear of one or more social or performance situations...

B. Exposure to the feared social situation... provokes anxiety, which may... (be) a... panic attack.

C. The person recognizes the fear is excessive or unreasonable.

D. The feared social or performance situations are avoided or endured with intense anxiety or distress.

E. (It)... interferes significantly with the person's normal routine, occupational (or academic) functioning, social activities or relationships, or there is marked distress about having the phobia.

F. ... duration is at least 6 months.

G. ...not due to... effects of a substance or a general medical condition.

H. If a general medical condition or mental disorder is present, the fear... is unrelated to it.

Causes are not always obvious, but there is evidence to support both biological and environmental causes for social phobia. In addition, Summerfeldt, et. al. found in 2003 that 92% of adults with social phobia in their sample had experienced teasing and bullying in childhood, compared to only 35-50% among other anxiety disorders. However, one factor must be in place for social anxiety disorder. The person must have learned growing up that social evaluation can be "dangerous", making them vulnerable to develop social anxiety. Treatment considered most effective is cognitive behavioral therapy(CBT); combination of CBT and drug therapy is currently being evaluated. Most recent drugs approved by the FDA for social phobias are the SSRI's such a Paxil, Zoloft and Effexor. However it should be noted that according to Clark, et. al. in 2003, psychological treatment was superior at all times.

Social phobia is a real disorder that can significantly impact a person's functioning in several important areas of life and should be given the same serious consideration as any other mental illness. It is not shyness and statistics indicate it is more prevalent than most people recognize. With more education and research, perhaps more people will begin to recognize this disorder and provide compassionate understanding.

Sources

Clark et. al. (2003) Psychopathology Custom Edition for University of South Carolina, Anxiety Disorders: Social Phobia by Barlow, Durand, Gray and Zide.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005). Lifetime prevalence and ageof-

onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of

General Psychiatry, 62, 593-602

McCabe, R.E., Antony, M.M., Liss, A., Summerfeldt, L.J., & Swinson, R.P. (2003). An examination of the relationship between anxiety disorders and self-reported history of teasing or bullying experiences. Cognitive Behaviour Therapy, 32, 187-193..