Tuesday, 26 July 2011

Dealing with Social Phobia

Published in City Times

Recognizing and Dealing with Social Phobia

Most of us experience nervousness or anxiety, some time or the other as we journey through life when faced with certain situations like having to make a public speech or presentation, attending an interview, performing before a large audience, or even mingling with people in a social gathering, et al. However, for some people, these situations brings on feelings that go beyond simple, normal nervousness and anxiety. These people may be socially phobic, explains Dr.Raad Haider Younis Alkhaiat, Consultant Psychiatrist, Zulekha Hospital, Sharjah.

What exactly is social phobia?
Phobia itself is an unexplained, abnormal, excessive, persistent and uncontrollable fear of something, that an individual experiences or feels. For these people, avoiding the fear-inducing situation is the predominant objective in their lives. And this avoidance is paramount in the treatment of such individuals.

Some people suffer from social phobia which is a real and serious anxiety disorder that could affect their health by affecting their feelings, thoughts and behaviour. These people are fearful of meeting people, mingling with them, particularly strangers, of facing large audiences as when they have to make a speech. In short, they are fearful of being the focus of attention. They are forever being plagued by the thought that they are being judged by others and fear becoming the object of embarrassment or ridicule when in the midst of people.

What is the incidence of social phobia in any general population and who are the people at risk of the disorder?
Statistics indicate that 3% of any general population suffer social phobia. It is one of the most common psychiatric problems we come across in our clinical practice. In fact, it has been found to be the 3rd commonest psychiatric problem after depression and alcoholism in the USA. An interesting observation with respect to this region is that we find in our practice, most of the individuals suffering from social phobia, are males. Of course, according to statistics available from the USA, the problem does not have a gender bias, though some studies indicate that it may be slightly more in females. One reason for this could probably be that the problem affects men worse than it does women and therefore we come across more men seeking psychiatric help.

But this could perhaps be because women may avoid seeking help for fear of being labeled?
Probably yes. They are reluctant to come to a psychiatrist. This again is part of the phobia!

When do symptoms of social phobia start manifesting?
The onset usually starts during late childhood, more appropriately, from about 12 years of life. Unless identified and treated early, the disorder worsens and may assume a chronic nature.

Does social phobia have any physical manifestations by way of symptoms?
Yes. Social phobia has mental as well as somatic or physiological aspects to it. The feeling of fear brings on physiological symptoms as rapid breathing and heart rate, tight chest, blushing, sweaty hands making them clammy and cold and abdominal pains. All these changes happen at the time of fear. These somatic aspects play an important role in further fueling the fear already present because the individual feels something is drastically going wrong with him or her. So they feel as if they are about to faint, or fall down. The whole thing is a vicious circle wherein the mental aspect of the fear is being reinforced by the physiological changes that take place on account of it.

Is social phobia the same as shyness?
No. Shyness is a personality trait, a person’s inherent or innate nature which develops in early childhood. There are a lot of people who are shy, but this is only part of their nature; it is not an illness. But phobia is an illness that starts all of a sudden, without any reason, in puberty. Shyness is feeling inferior, revealing a lack of confidence, but phobia is a feeling of fear.

What can untreated social phobia lead to?
If the phobia becomes chronic, it hampers the life of the person suffering it and those around him. Interpersonal relationships, whether at home, school or work front, marital relations, cam all become disrupted. Students could become school dropouts because they cannot cope with their phobia anymore. Untreated, the disorder can become disabling and disruptive.

Can a socially phobic person resort to socially undesirable activities?
Yes. If this phobic person has this phobia, it will change his/her behaviour and attitude to other people. The attitude is one of escapism, and this in itself might make the individual feel more inferior and insecure, creating some sort of anger within himself/herself. The anger could be turned towards oneself or towards others. The individual might try to compensate for the excessive fear by indulging in socially undesirable or aggressive behaviour, especially if he/she finds somebody who will encourage him/her in this direction. He/she knows he’s/she’s troubled, but doesn’t know how to deal with the situation.

Can socially phobic individuals become depressive or manifest suicidal tendencies?
Of course, having social phobia in a chronic form may make a person develop secondary depression. If the depression becomes severe enough to affect various aspects of his/her life, suicidal tendencies may surface.

How can people with social phobia be helped?
Therapy is behavioural and with drugs. While giving medicines is important, the most important aspect of treatment is the behavioural approach by a technique called systematic desensitization. As I told you in the beginning, avoidance is the dominant factor in social phobia and hence also the frontline in tackling the problem. We try to desensitize these people to the fear by making them approach the fear-inducing situations headlong, though in a systematic and gradual manner, not push them into it. We draw out a systematic schedule for the individual to follow and initially we have someone reliable to accompany the individual when he/she is facing the fearful situation. The person accompanying the phobic person is someone with whom the person is on a comfort level and can feel safe in his/her presence. The therapy may take weeks or even months to show any results but it has to be persisted with till the person is able to rid himself/herself of it.

Of course, for treatment to be effective, parents and family members need to first and foremost identify the problem in their ward and ensure psychiatric help. But again, efficacy of treatment needs compliance from the patient himself/herself, to understand that he/she needs help to come out of it.

Where does medication feature in this scheme of things?
In the beginning of the treatment, the patient might need some sedative to reduce the somatic symptoms of breathing, sweating, et al. These medications are only given to calm the person’s state of mind and ease the physiological symptoms which reinforce the fear. But these drugs should be strictly taken under psychiatric prescription and supervision.

Once treated and the person is rid of the phobia, is there possibility of it recurring under stressful conditions when the individual may face, for instance, public humiliation?
Some people recover completely from the phobia and it does not appear in later life. Even if they are faced with stressful situations, they will be able to deal with them. There are others who get improved, but not completely and some features of the phobia still remains in them. Some of the chronic cases may not really improve significantly. Having said that, once phobic, the risk of recurrence is always there.


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