Chapter II
Presentation of Data

A. Definition of social anxiety disorder or social phobia was defined by different sources. 1. In 400 BC, Hippocrates described the overly shy person as someone who loves darkness as life and thinks every man observes hi. During the second edition of Diagnostic and Statistical Manual of Mental Disorders (DSMII), social fears were described as a specific phobia of social situations or an excessive fear of being observed or scrutinized by others and in the third edition, it was described as a fear of performance situations. Lastly, it is described in the fourth edition as a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others. 2. A social phobia is a fear of being observed by others acting in a way that will be humiliating or embarrassing. It is an irrational and intense fear that one’s behavior in a public situation will be mocked or criticized by others.

3. Social phobia is an irrational fear of being judged, watched or evaluated, or of embarrassing or humiliating themselves. Fear of scrutiny by other leading to avoidance of social situations.
B. There are scientific concerns regarding social anxiety disorder. 1. The signs and symptoms of social phobia were subdivided into four, the physical, emotional and behavioral, associated personality traits and the cognitive aspect. a. Blushing, profuse sweating, trembling or shaking, nausea, stomach upset, difficulty in talking, shaky voice, muscle tension, confusion, palpitations, diarrhea, clammy hands, difficulty in making eye contact are the physical signs and symptoms of social phobia. b. The emotional and behavioral signs and symptoms of social anxiety disorder are intense fear in situations with unknown people, fear of being judged, worrying about embarrassment or humiliation, fear that one will notice anxious or awkward behavior, anxiety that disrupts daily routine, work, school, or other activities, fear of being the center of attention. c. Associated personality traits in those with social anxiety disorder may include low self-esteem, trouble of being assertive, negative self-talk, hypersensitivity to criticism, and poor social skills. d. In cognitive models of social anxiety disorder, people with social phobia experience dread over how will they present themselves to others. In this aspect, many times, prior to the social situations where they suffer social phobia, sufferers may carefully review what could go wrong and how to deal with each unexpected cases. After the event, they might have the perception that they performed unsatisfactorily. 2. Doctors and psychologists said that social anxiety disorder is treated through psychotherapies and medications. a. Social anxiety disorder is treated through medications. (1) Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants that became as the first choice medication for generalized social phobia. General side-effects of SSRIs are common during the first weeks while the body adjusts to the drug. Symptoms may include headaches, nausea, insomnia and changes in sexual behavior. (2) Benzodiazepine is an alternative to SSRIs Benzodiazepines possess anti-anxiety properties and can be useful for the short-term treatment of severe anxiety. b. It has shown that psychotherapies are effective in treating social anxiety disorder. (1.) There are two main components of CBT. In the case of social anxiety, the first one is the cognitive component wherein it can help the patient question how he or she can be so sure that others are continually watching and harshly judging him or her. Second one is the behavioral component that seeks to change people’s reactions to anxiety-provoking situations. (2.) Acceptance and commitment therapy (ACT) is also a treatment for social anxiety disorder. ACT emphasizes accepting unpleasant symptoms rather than fighting against social phobia. ACT is a second line treatment for this disorder if CBT is ineffective. 3. A national survey was done to know in what situations do a person experience social fear. And the following situations are the result, public speaking with 30.2%, talking in front of a small group with 15.2%, talking with others with 13.7%, using a toilet away from home with 6.6%, writing while someone watches with 6%, eating or drinking in public with 2.7%, and 38.6% in other situations.
C. Research into causes of social anxiety disorder or social phobia is becoming broader and broader, to cover multiple perspectives from neurosciences to sociology.
1. If an individual has a first-degree relative who have social phobia, the individual has a greater risk of having a social phobia. This is due to genetics. A study of identical twins who was raised by different families has indicated social phobia due to genetics, one twin developed social phobia, then the other was between 30 to 50 percent more likely to develop this disorder. 2. A previous negative social experience can trigger a social phobia. For around half of those people who are diagnosed with social anxiety disorder, a specific trauma or humiliating social event was confirmed to be associated with the onset or worsening of the disorder. This disorder is caused by being bullied, rejected or ignored in the past. 3. Research has indicated the role of unconditional negative beliefs and conditional beliefs nearer to social phobia. Problems in developing social skills or social fluency just like either inability or lack of confidence to interact socially and gain positive reactions and acceptance from others can be a cause of social phobia. Children appear more likely to develop social phobia if their parents emphasizes the importance of other’s opinions and use shame as a disciplinary strategy. 4. Excessive alcohol misuse can cause panic disorder to develop or worsen during alcohol intoxication and especially during alcohol withdrawal syndrome. Alcohol initially relieves social phobia but immoderate misuse can worsen the symptoms of social phobia. 5. Family difficulties such as lack of close relationships with parents and conflict between parent are the identified childhood difficulties and their relationship to the after development of social phobia. Involvement with immature and child welfare systems, physical and sexual abuse in childhood, violent behavior, school difficulties, and running away from home are also identified. D. Effects of social anxiety disorder can severely limit your ability to live daily life. 1. Social anxiety disorder involves extreme anxiety. If it is left untreated, it may result to severe psychological disturbance, emotional detachment, severe low self-esteem, irrational thoughts and perception, excessive self consciousness, severe depression, emotional outbursts and panic attacks may be the psychological effects of social phobia. 2. Social anxiety disorder can also directly affect your ability to relate to others socially. The effects of social phobia on one’s social life include avoidance of social events or functions, difficulty in sustaining and initiating relationships, isolation from others due to extreme shyness, inability to establish intimacy in relationships, decreased performance in work or school and marital or familiar conflicts due to low self-esteem. 3. Racing heart or tightness in chest due to nervousness, difficulties in occupational functional, shortness of breath, nausea or gastrointestinal upset, dizziness or faintness, muscle tension and profuse sweating or shaking are the common physical effects of social phobia that may be experienced. 4. People with social anxiety disorder may avoid eating or drinking in public, for fear they will make noises when they eat, drop food or otherwise embarrass themselves.
E.Social phobia can be prevented in different ways as stated by researchers.

1. Social anxiety disorder cannot be prevented but seeking help as soon as symptoms arise, it can help make treatment more effective. 2. Completion of prevention on programs just like the use of cognitive behavioral therapy and related techniques may decrease the number of children with social phobia. 3. You can take steps to reduce the impact of symptoms of one’s anxiousness. a. Get help early You must seek a person who is responsible in treating social anxiety disorder when you experience symptoms. b. Keep a journal. Keeping track on your personal life can help you and your mental health provides and identify what’s causing you stress and what seems to help you feel better. c. Prioritize issues in your life. You should carefully manage your time and energy to reduce anxiety. d. Avoid unhealthy substance use. If you’re addicted to these kind of substances, quitting can help you fight anxiousness. If you can’t quit on your own, see your doctor or find a treatment program or ask for a group to help you. F. Many people who are shy do not have the negative emotions and feelings that accompany social phobia. They live a normal life, and do not view shyness as a negative trait. While many people with social phobia are shy, shyness is not a pre-requisite for social phobia. If we treat everyone who is simply “shy” as having a disorder, it leads to stereotyping and waste of resources. If we under-diagnose social anxiety disorder, then people with the symptoms will not receive needed treatment. Whereas social anxiety disorder and shyness have similarities, there are distinct differences between the two. Consider the definitions of both terms: Shyness: anxiety, inhibition, reticence, or a combination of these in social and interpersonal situations, and nervousness or anxiety about evaluation by others. Shyness is considered a normal facet of personality that combines the experience of social anxiety and inhibited behavior, but is also described as “stable temperament.”Shyness is classified as a personality characteristic. Social Anxiety Disorder is classified as a significant amount of fear, embarrassment or humiliation in social performance-based situations, to a point at which the affected person often avoids these situations entirely, or endures them with a high level of distress.

A key difference between the two definitions is that social anxiety disorder is not considered a “normal” facet of personality, or a personality characteristic, whereas shyness is. In fact, people who are shy may view this condition as a positive quality, whereas a person with social anxiety disorder would not describe their condition positively. ` They are different in both qualitative and quantitative ways. If there was only a quantitative difference, it would require all people with social anxiety disorder to be shy, and this is not the case. Only about one half of those diagnosed with social anxiety disorder report having been shy. Looked at another way, less than 25% of shy persons meet the criteria for social anxiety disorder3, meaning that many people are shy without having fear, anxiety, and distress about it. Qualitatively, a diagnosis of “social anxiety disorder” is associated with: greater presence of co-existing or additional disorders with reference to an initial diagnosis (i.e., comorbidity with other anxiety disorders, depression, dysthymia, etc.), greater severity of avoidance, and impairment in life, poorer quality of life.

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[ 2 ]. Cuncin, Arlin, A Brief History of Social Anxiety Disorder available: socialanxietydisorder.about.com/od/overviewofsad/a/history.com [ 3 ]. Richard P. Halgin, Abnormal Psychology: Clinical Perspectives on Psychological Disorders (New York: McGraw-Hill Companies, 2007) p. 176
[ 4 ]. Ibid., p. 157
[ 5 ]. Cuncin, Arlin, Overview of Social Anxiety Disorder available:socialanxietydisorder.about.com /od/overviewofsad.com
[ 6 ]. ICD-10 Version:2010 available:Apps.who.int/classifications/icd10/browse/2010/en#/F40.1
[ 7 ]. “Social Anxiety Disorder Symptoms and Effects” available:www.timberlineknolls.com/mood-personality/social-anxiety/signs-effects
[ 8 ]. Ibid.
[ 9 ]. Ibid.
[ 10 ]. Shyness and Social Anxiety Treatment available:en.m.wikipedia.org/wikiSocial_anxiety_disorder
[ 11 ]. Stuart A. Montgomery and Hans Den Boer, SSRIs in depression and Anxiety available: en.m.wikipedia.org /wiki/Social_anxiety_disorder
[ 12 ]. Westenberg, HG , “Facing the challenge of social anxiety disorder” available: en.m.wikipedia.org/wiki/Social_anxiety_disorder
[ 13 ]. Kashdan, T.B. and Rottenberg, J., “Psychological flexibility as a fundamental aspect of health” loc.cit.
[ 14 ]. Bluett EJ., et.al., Acceptance and commitment therapy for anxiety and OCD spectrum disorders: an empirical review loc.cit
[ 15 ]. Op.cit., p. 190
[ 16 ]. Kendler, K.,Karkowski, L., and Prescott, C., “Fears and phobias: reliability and heritability” loc.cit. [ 17 ]. Ibid.
[ 18 ]. Causes of Social Anxiety Disorder loc.cit
[ 19 ]. Mineka, S. and Zinbarg, R., Conditioning and ethological models of social phobia loc.cit.
[ 20 ]. Okano, K., “Shame and Social Phobia: a transcultural viewpoint” loc.cit.
[ 21 ]. Tera,M., Figueira, I. and Barros, H., “Impact of alcohol intoxication and withdrawal syndrome on social phobia and panic disorder in alcoholic inpatients” loc.cit.
[ 22 ]. Op.cit., p. 159
[ 23 ]. Jacquelyn Ekern, “Social Anxiety attack Causes, Statistics, Signs, Symptoms And Side effects” available: www.addictionhope.com/mood-disorder/social-anxiety
[ 24 ]. Ibid.
[ 25 ]. Ibid.
[ 26 ]. Hoeksema, Susan, Abnormal Psychology ( New York: McGraw-Hill Companies, 2004) p. 189
[ 27 ]. “Can social anxiety disorder be prevented?” available: www.sociaanxietyforum.org/social-fear-sad-good/89683 [ 28 ]. Drake, Kelly L. and Ginsburg, Golda S., “Family factors in the Development, Treatment, and Prevention of Childhood Anxiety Disorders” loc.cit.
[ 29 ]. Mayo Clinic Staff, “Diseases and Conditions: Social anxiety disorder (social phobia) “ available: www.mayoclinic.org/disease-conditions/social-anxiety-disorder/basics/prevention/com-20032524
[ 30 ]. Ibid.
[ 31 ]. Ibid.
[ 32 ]. Ibid.
[ 33 ]. Richards, Thomas, Ph.D, “Shyness… or Social Anxiety Disorder?” available https://socialanxietyinstitute.org/welcome-dr-thomas-richards [ 34 ]. ibid.
[ 35 ]. Ibid.
[ 36 ]. Ibid.
[ 37 ]. Ibid.