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The American Psychiatric Association defines Social Anxiety Disorder, also known as SAD, as “a marked or persistent fear of social or performance situations” (Craighead, 2017). SAD originally started out as, what we know today as “social phobia”. Social phobia consists of fears pertaining to performance related activities (socially speaking and writing while in the presence of others). According to Craighead, SAD is one of the most prevalent psychiatric disorders in the United States (Craighead, 200). Many individuals develop this disorder between the ages 13 to 20 years old, and is more common in women than men. This is interesting due to the fact that we cannot exactly get the best results due to honesty. Women are more likely to be open about the problems they have and are more willing to share with family/friends, doctors and even on surveys. Whereas for men, they tend to keep feelings and problems they have in life inside and are not very open to communicate about them. SAD is very commonly develops in addition to other anxiety disorders as well as depression, which more times than none, can lead to an abuse in alcohol and drugs.
Alcohol and Drug Abuse
It is common for individuals with Social Anxiety Disorder to be diagnosed with depression, as these two disorders are usually seen hand in hand. This is also known as comorbidity. With that being said, Criaghead explains findings of depression and individuals diagnosed with Social Anxiety Disorder that leads to an increase in suicide attempts and rates of impairments. There has been some contradiction between studies on treatments of these disorders. Many studies claim that when an individual is both socially anxious and depressed, it can result in these particular individuals excelling in treatments and rehab. Whereas other studies suggest that those with anxiety and depression cause higher rates of dropouts and negative outcomes in individuals because they are already overwhelmed with greater social anxiety symptoms. I feel that both of these results can be accurate because not every person is the same. Some people are going to react to treatments differently, just as they can to medications and rehab. Both of these inferences can help with furthering research so psychologists can attempt to find a cause of these responses to treatments.
“Approximately 48% of individuals with a lifetime diagnosis of Social Anxiety Disorder also meet the criteria for a lifetime diagnosis of Alcohol use disorder” (Craighead, 2017). Alcohol is classified as a depressant which can be very intriguing to someone who is constantly feeling down and upset. A journal article explains how when alcohol is combined with different anxiety disorders it worsens the symptoms and makes treatment more difficult (Gimeno, 2017). This article continues to emphasis that the use of alcohol and having a disorder can affect each other and make it harder to detect influences, being that we cannot differentiate between what is causing what (the alcohol is causing SAD/depressive symptoms or the symptoms are causing an individual to abuse alcohol).
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Having a psychiatric disorder is more likely to increase substance abuse and dependence. It has also been drawn to researcher’s attention that SAD prescriptions are being abused and distributed for recreational use. A study conducted by Anthony Ecker reveals the frequency of cannabis use in those with Social Anxiety Disorder (Ecker, 2018). He states that individuals diagnosed with SAD are using cannabis at “double the rate”, as a way to cope with social situations. He focuses his study around the assumption that Postevent Processing (PEP; reviewing past interactions in great detail) can occur in anticipation of social situations. Ecker states,” PEP tends to be more prevalent and more negatively valenced among socially anxious individuals than among nonsocially anxious individuals” (Ecker, 2017). His study revealed that negative Postevent Processing anticipated an increase in cannabis use in individuals with SAD. In other words, this reveals that when a person who is socially anxious makes an attempt to socialize and it does not turn out the way they want it to (goes bad (in their opinion), causing them to become anxious and stressed), can led to more frequent drug use (or in this case cannabis). This goes to play in real life situations with not only cannabis, but alcohol and other drugs as well.
Self-evaluations
As you might have gathered from previous paragraphs, Social Anxiety Disorder has a lot to do with an individual’s perception of self and what others think about them. This is the main issue in SAD. People with this disorder believe that wherever they go and whatever they are doing, all the focus is on them. This can cause immediate stress, social isolation and avoidance in fear of socialization. Craighead explains a study that was done to observe an attentional bias in those with SAD.
According to Wikipedia, the best definition of an attentional bias is, “the tendency for people’s perception to be affected by their recurring thoughts at the time. Attentional biases may explain an individual’s failure to consider alternative possibilities, as specific thoughts guide the train of thought in a certain manner” (Wikipedia, 2018). The overall purpose of this study was to show that individuals with Social Anxiety Disorder are often diverting their attention away from “social threat-relevant information in their environment” (Craighead, 2017), making it easier to infer that they will do the same in social relationships with others. In a journal article written by Gilboa-Schechtman, explicit and implicit self-evaluations in Social Anxiety Disorder were further observed.
The researchers found that individuals with SAD with both implicit and explicit self-evaluations displayed lower social-rank and affiliation. Meaning that regardless of their evaluations, both groups (explicit and implicit) with SAD lack the aspiration to rise in social status. Having a disorder like Social Anxiety can really affect the social life of a person. Craighead explains that when given the chance to socialize, one might not pick up on social cues, like smiling, eye contact, and head nodding, that could let that individual know that this is a good/positive interaction, and could enhance future conversations.
Another issue with Social Anxiety Disorder is you overthink situations and constantly assume everyone is judging you, or as Craighead says, “their own worst critics” (Craighead, 2017). This can result in different reactions (depending on the person), such as shaking, sweating, redness of face, heat flashes, and in some cases, panic attacks. Expecting a negative outcome in social situations is very popular for this disorder. This ties into overthinking and judgement because people with SAD make up how a situation will play out and continuously put themselves in a “no win” situation which affects their social life and overall well-being.
After doing some research, I came across a journal article that showed how having SAD can affect other mental disorder, more specifically, Body Dysmorphic Disorder (BDD). As defined by our class textbook, BDD is, “an overwhelming concern that some part of the body is ugly or misshapen” (Beidel, 2017). Similar to SAD, individuals with BDD struggle with how they are perceived by others and themselves. The study conducted in the journal article consisted in, “’safety behaviors’ (SBs) aimed at checking, hiding, fixing, and reducing threat associated with their perceived flaw in appearance” (Summers, 2018) and how they contributed to an individual’s perceived appearance. A similarity in these two disorders is that both have negative outlooks on themselves and situations.
A person with BDD believes there is something wrong with them and their body, and that everyone sees/thinks the same thing they do. A person with SAD believes they are going to say/do something wrong and everyone will judge them. Both of these consist of a something psychologists refer to as The Spotlight Effect. This occurs when individuals believe all eyes are on them, when in reality, everyone is focused on themselves. This happens a lot with SAD and is a very difficult concept for these individuals to grasp. They don’t understand that people are more worried about themselves than they are you, and if they did SAD would not be as common as it is today.
Cortisol Response
A common thing that is very unknown is WHY something happens, especially in regard to metal disorders. I thought I could take some time to explain the basic neuroscience behind Social Anxiety and what happens to the body when an increase in stress arises. The root of anxiety is found in family members. If a parent, aunts/uncles, or grandparents had it, you are at greater risk of developing it as well. The textbook does a good job of explaining how CT, MRI, fMRI, and PET imaging data help locate abnormalities in the brain.
For example, these tests reveal that several portions of the midbrain, including the amygdala, as well as the limbic and paralimbic systems are involved in anxious emotions (Beidel, 2017). “Cortisol (along with its partner epinephrine) is best known for its involvement in the “fight-or-flight” response and temporary increase in energy production, at the expense of processes that are not required for immediate survival. The resulting biochemical and hormonal imbalances (ideally) resolve due to a hormonally driven negative feedback loop” (Aronson, 2009).
Social Anxiety Disorder (SAD) can be influenced by many different environmental factors. For instance, one study on the cortisol response to social stress in SAD shows how individuals with this disorder are linked to higher cortisol levels if they have experienced some type of dimensional characteristics in the past (Vaccarino, 2014). Participants had their Cortisol Stress Response (CSR) measured following the Trier Social Stress Test (TSST) to see if there were more CSRs in individuals with SAD or dimensional characteristics (i.e. childhood trauma). The results suggest that the Emotional Abuse (EA) scores in SAD participants is associated with the cortisol stress response (Vaccarino, 2014). These findings show that certain internal factors in an individual with SAD may influence the rising of the participant’s cortisol levels.
Another study was done to demonstrate how the being in the presence of other people can increase cortisol levels in individuals with SAD. An experiment was conducted to study the anxious attachment style and enhanced cortisol response to group psychosocial stress. Researchers found that high scores on insecurity and proximity-seeking scales showed greater cortisol activity (Smyth et al., 2015). There are many factors that can contribute to stress and anxiety, especially those with SAD. By understand research on this subject, psychologists can get a better understanding of internal/external stimuli that affects socially anxious individuals.
