Social Anxiety Disorder

Social Anxiety Disorder

People all around the world have many fears about different things. Many years ago, a Greek philosopher called Hippocrates (c. 460 – c. 370 BC) described some of the fears that people had in ancient times: such as diseases, natural disasters, and bugs. According to Schneider (2017), the fears or phobias that people have nowadays are caused by stressors such as work, homework, traffic, store times or even parking. But Schneider realized that all the stressors that provoked fear, were things that can be changed or that people can solve in certain times. Death, natural disasters or giving a speech in front of a crowd are some of the phobias that people have nowadays.

Diagnostic criteria

According to the Diagnostic and Statistical Manual of Mental Disorders (IV ed.; DSM-IV-TR; American Psychiatric Association, 2000) the diagnostic criteria for social phobia is that the person should feel anxious or have a deep fear to perform in front of a crowd that is not from the family and that will be evaluated or criticized by other people. The person that is performing is afraid to act and do something embarrassing or humiliating, the person will avoid presentations or talking in front of an audience, the person will admit that the fear is excessive or irrational. Another criterion is that the feelings of avoiding crowds are not produced by any drug or substance that the person took or that is not produced by an illness that the doctors diagnosed and cannot explain the presence of another mental disorder.

According to the DSM-IV-TR (2000), in people under 18 years old, the symptoms should last a minimum time of six months. The exposure to social situations provokes an immediate anxiety response that can be transformed into situational distress. In children situations, anxiety can be shown as crying, tantrums or feeling desperate.

Diagnostic criteria

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) the diagnostic criteria changed in some aspects, one criteria is that almost all social situations can cause anxiety, if the person decides to participate in a social event there will be symptoms of fear or anxiety. Comparing the DSM-IV-TR and the DSM-5 in kids, according to the DSM-5 kids may also freeze, shrink, cling or prefer not to speak in front of people, the symptoms of avoidance, fear and anxiety should not be because of any drug, medicine or substance. Also according to the DSM-5, fear, avoidance, and anxiety interfere most of the times with the daily routine of the individual; also, the individual that is performing in society may show anxiety symptoms or will have fear to act because the individual will be scared to be criticized. Symptoms such as fear of crowds, avoid people and feeling anxious are persistent and last for at least for more than six months or six months.

According to the DSM-5, functioning areas such as social or occupational will be affected by avoidance, anxiety or fear. Other mental disorders such as body dysmorphic disorder, autism spectrum disorder or panic disorder are not a better explanation for social anxiety disorder or social phobia. People with social anxiety disorder feel that people around are examining the individual in a very close way to find any mistake where people can evaluate the individual in a negative way, so the individual is concerned to be criticized, be rejected from social groups or judged with any type of insult or negative adjectives. The simple act of feeling nervous, blushing, sweating or people staring at the individual makes the individual uncomfortable and the individual may go over a panic attack.

According to the DSM-5, the majority of social events are the ones where the individuals are most likely to provoke anxiety or fear, nevertheless, the individual will try to avoid the situations where fear is the main feeling. In advanced cases, the level of avoidance can be excessive, because the individual is afraid of being in contact with people; if a student has an advanced level of social anxiety, the student is more likely to miss classes because the student will feel fear or anxious around the other students inside or outside the classroom.

Prevalence

According to the DSM-5, in the United States, there is a seven percent of 12-month prevalence of social anxiety disorder, in Europe, there is a 0.5 to 2.0% of under 12-month prevalence. At the moment that the individual keeps growing and achieving years, the prevalence rates go down, so for older adults, the prevalence is about two percent to five percent. However, the population that has a higher rate of social anxiety are the females which go from 1.5 to 2.2 and in adolescents level is even higher.

Risk, Prognostic Factors and Gender-Related Diagnostic Issues

According to the DSM-5, there are risks and prognostic factors like temperamental, environmental and genetic and physiological. Also, females that are diagnosed with social anxiety disorder tend to have more social fears, bipolar, anxiety disorders and comorbid depressive, while males have some conduct disorders and in some cases, the individuals try to get rid of the symptoms with alcohol and drugs.

Differential diagnosis

According to the DSM-5, there are several differential diagnoses for the social anxiety disorder like normative shyness where only 12% of people in the United States that are shy, met the diagnostic criteria that fit with social phobia. Then, people with agoraphobia are the cases where the individuals may have fear and want to avoid concurred places because the individuals are afraid of not getting out. Another diagnosis is panic disorder that is the individuals are more afraid of the negative feedback and evaluation.

According to the DSM-5, the generalized anxiety disorder are the individuals that are worried most of the times of the comments of the other people. Then, the separation anxiety disorder are the individuals that have problems at the moment of separating from the parents or family. Also, there are specific phobias that are the individuals that do not pay attention to the negative comments but is possible that the individual fear embarrassment or humiliation. There is also selective mutism where the individuals refuse to speak due to the negative comments and feedback in social groups where speaking is not required.

According to the DSM-5, the individuals with major depressive disorder are the individuals that feel that are bad at a situation and fear of the negative evaluation. Then there are the individuals with body dysmorphic disorder that are the individuals that fear the comments of other people because of the individual’s appearance. Another diagnosis are the individuals with delusional disorder that are the individuals hallucinate rejection from a social group. There is also the autism spectrum disorder that are individuals that have same-aged friends, appropriate communication but may have some problems with the beginning of a friend relationship.
 According to the DSM-5, the individuals with personality disorders tend to persist into the adulthood stage and also is common that personality disorder overlaps with the avoidant personality disorder. Finally, there are other mental disorders that can overlap in a minimum percentage with social anxiety disorder like some fears that individuals have when schizophrenia is diagnosed, obsessive-compulsive disorder and psychotic symptoms are present. There is also an important factor that some individuals should consider in order to diagnose a person with social anxiety disorder and is the embarrassment feelings of a disease like Parkinson.

Social Anxiety Disorder Articles
 Bruijnen, Young, Marx, and Seedat (2019) conducted a cross-sectional study about the relation between social anxiety disorder and childhood trauma. Participants were 102 adults, 76 participants met the social anxiety disorder criteria where 51 were exposed to childhood trauma and 25 were not exposed to childhood trauma, the other 26 participants were in a healthy condition. Participants were exposed to a social anxiety scale, a childhood trauma questionnaire, a carver and white’s behavioral inhibition system, and the behavioral activation system scale and a quality of life enjoyment and a satisfaction questionnaire. The results of the study showed that there was a positive correlation between social anxiety and childhood trauma (Bruijnen et al., 2019). Hong (2018) conducted a quasi-experimental study that analyzed a self-confidence group and patients with social anxiety disorder. There was an intervention in the study where the self-confidence group worked with patients with social anxiety disorder and the results of the study showed that after the intervention there was a positive change and a better attitude in the patients with social anxiety disorder (Hong, 2018).
 Schumacher and Seiler (2010) conducted a cross-sectional study about the relationship between sports participation and social anxiety disorder. Participants were 201 primary school children, there were different genders and ages. In the study, the female population showed a higher level of social anxiety but also an even higher level when girls were practicing a sport. The results of the study showed that children that participate in team sports present less social anxiety symptoms than children that participate in individual sports (Schumacher & Seiler, 2010).

Medications

There are some medications that psychiatrists use to control the social anxiety disorder. According to Goodman et al., (2018), olanzapine works as an atypical antipsychotic that inhibits receptors of dopamine, serotonin and histamine all at one time; helps the patient with an antidepressant effect and as a tranquilizer. The quetiapine is an atypical antipsychotic that inhibits receptors of dopamine and serotonin.

The ziprasidone is an atypical antipsychotic and is mostly used for schizophrenia disorder but also is used for anxiety disorders, because the main purpose of the ziprasidone is to work as an antidepressant. Also, the olanzapine is an atypical antipsychotic that inhibits the receptors of serotonin, histamine and dopamine all at one time; the olanzapine helps the patient as an antidepressant. There is also the lorazepam that acts in the nerves of the brain in order to produce a calm effect, the problem with this medicine is that lorazepam can cause addiction as well as the alprazolam.

Conclusion

The majority of people nowadays tend to criticize people that are not normal to society because of weird acting or because people prefer not to speak in front of a crowd or just because of shyness. But society needs to understand that things happen for a reason and if people act in a certain, might be because of a mental disorder or a disability so instead of criticizing without knowing the person, society should try to understand the situation and help the people that requires help. Society also needs to teach the children to respect every person that the kids meet because especially at a younger age, making fun of someone that do not practice a sport or do not do the things that other kids do, is a reason to make fun of that kid, so children need to grow up with a different mentality of how the people is and how different the world can be.

Phobias, fears or a type of attack can be controlled with therapies or medicaments, but the most important help are the people that surrounds the person with the problem because that person needs all the support from someone else in order to fight against the mental disorder. Asking for help on time can save so many lives.

• Bruijnen, C. J. W. H., Young, S. Y., Marx, M., & Seedat, S. (2019). Social anxiety
  disorder and childhood trauma in the context of anxiety (behavioural inhibition), impulsivity (behavioural activation) and quality of life. South African Journal of Psychiatry, 25, 1–7.
• Xia Hong. (2018). Self-confidence group psychological intervention of college students based on EEG test technology – take patients with social anxiety disorder as an example. NeuroQuantology, 16(6), 33–38.
• Dimech, A. S., & Seiler, R. (2010). The association between extra-curricular sport participation and social anxiety symptoms in children. Journal of Clinical Sport Psychology, 4(3), 191–203.
• Goodman, L. S., Gilman, A., Brunton, L., Chabner, B., Knollman, B., & Rosa, H. M. (2018). Goodman & Gilman: Las bases farmacológicas de la terapéutica. México, D.F.: McGraw-Hill.
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Washington, D.C.
• American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC.