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Social Anxiety Disorder (SAD)

- mild tw: rape -

Definition of SAD


  • A mental health issue

  • Fear of speaking or performing in front of others

  • Terrified of being humiliated and judged by saying the wrong things


SAD vs shyness


SAD:

  • Extremely concerned + worried about how other people think of them

  • Physical symptoms: nausea, rapid heart rate, shaking etc.


Shyness:

  • Just a type of nervousness when facing a crowd

  • Excessive sweating

  • Timid voice

  • Has no serious physical symptoms


Factors


Genetic

  • One-third of the people suffer from SAD due to pass generations

  • (Not exclusive and not all will pass SAD to their offspring)

  • Researchers and scientists have not found any genetic makeup related to SAD yet.


Societal

Example: Taijin Kyofusho

  • Japanese form of social phobia

  • Emphasizes group formity instead of individuals to reflect on how you “fit in”.

  • Stems from judging people based on appearance and body shape etc.

  • More women get Taijin Kyofusho than men.


Environmental

  • Direct conditioning: a child might develop SAD at school by classmates. Making fun and laughing at the child for tripping over a stone, or forgetting something, or being scolded by teachers etc, making them feel uneasy to do everything

  • Observational learning: when the child saw someone or something in an unpleasant situation, they most likely will not do those kind of activities, making them scared to try out new things

  • Transferring information (indirectly): parents might indirectly tell their children the darker side of society (such as kidnap and rape) during social gatherings etc.

  • Overprotective parents


Symptoms

Physical

  • Chest tension

  • Diarrhea

  • Dizziness

  • Derealization

  • Headaches

  • Muscle tension

  • Shortness of breath


Cognitive

  1. Having negative beliefs: being stubborn, holding strong beliefs on how they deal with certain social situations

  2. Being negatively biased: depreciating your social abilities

  3. Having negative thoughts: thinking you can’t socialize well with others and automatically think about negative outcomes and consequences.


Behavioral

  1. Avoiding social activities to reduce the anxiety of facing the crowd

  2. Being “safe”: excessive actions/preparation to control experiences of social situations

  3. Escaping social situations


Diagnosis

Criteria:

  • The anxiety has continued for 6 months or longer

  • Meeting new people and giving speeches makes them anxious

  • Feeling embarrassed if someone rejects them

  • Being terrified of people who judge their appearance or acts

  • Constantly experiencing fear before and during social situations

  • They cause distress and affect their daily living such as sleeping routines


Treatment

Prescription medication

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • first-line pharmacotherapy treatment

  • potential of having withdrawal effects, including dizziness and nausea

  • E.g paroxetine, fluvoxamine etc.


Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): antidepressants that act on neurotransmitters serotonin and norepinephrine, e.g venlafaxine, duloxetine


Monoamine Oxidase Inhibitors (MAOIs): although effective, they’re not the first medicines given due to severe side effects


Psychological therapy

Cognitive-behavioural therapy

  • Exposure: imagining/experiencing social situations in real life, to make patients feel more comfortable to go to social activities

  • Cognitive restructuring: focusing on patients’ negative beliefs, biases and thoughts, identifying and evaluating them, as well as using alternative thoughts to replace the original thoughts

  • Social skills training: rehearsing and role-playing, to decrease anxiety when facing the public in real life


Acceptance and commitment therapy

  • Learning to accept negative thoughts instead of throwing them away

  • Learning skills for practicing mindfulness


Psychoanalysis

  • Helps you understand some issues in childhood that leads to social anxiety

  • Useful for people who has deep unresolved conflicts



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