By: Catherine Joachin
What is social anxiety?
Social anxiety disorder also referred to as social phobia, is a mental health condition which involves an overwhelming fear of judgment. The disorder is marked by chronic self-consciousness and fear of humiliation that can turn everyday interactions into highly anxiogenic situations and lead to the development of avoidance behaviors that can negatively impact relationships, routine, and quality of life.
(Mayo Clinic, 2021; Cleveland Clinic, 2022)
Diagnostic criteria for social anxiety disorder
While day-to-day events (e.g. entertaining conversations with strangers or going to social gatherings) can be challenging, experiencing feelings of shyness or discomfort in the face of a few social scenarios is insufficient to warrant a diagnosis of social anxiety disorder since comfort levels are susceptible to change on account of personal traits and life experiences (Mayo Clinic, 2021). Although there are no standardized instruments used in the context of social anxiety disorder diagnosis, the DSM-5 lists the following requirements in order to meet diagnostic criteria:
– Avoidance of anxiogenic social situations
– Chronic fear or anxiety over social situations out of fear of being judged by others – Experiencing disproportionate anxiety levels
– Anxiety is actively interfering with regular daily activities and functioning
– Condition is not better explained by medical or mental illness, medication, or substance use.
(Mayo Clinic, 2021; Cleveland Clinic, 2022)
Symptoms
Social anxiety disorder can manifest in the form of emotional and behavioral symptoms in the following ways:
- Experiencing extreme self-consciousness
- Having a fear of interacting with strangers
- Avoiding situations that may lead to embarrassment or being the center of attention
- Assessing performance and pointing out flaws in your interactions after the fact
- Anticipating the worst possible outcomes following a negative experience during a social situation
Social anxiety can also provoke physical symptoms, including:
- Blushing, trembling or sweating
- Accelerated heartbeat
- Feeling nauseated
- Trouble catching your breath, dizziness or lightheadedness;
- Feeling that your mind has gone blank,
- Body tensing up or becoming rigid
(Mayo Clinic, 2021)
Symptoms can be subject to change over the course of the prognosis. Left untreated, social anxiety can negatively impact individuals in the following ways:
– Lowering self-esteem
– Increasing loneliness and isolation
– Dampening social skills
– Lowering academic or employment achievement
– Increasing vulnerability to depression, suicidality and substance abuse
(Anxiety and Depression Association of America, 2023)
Causes and risk factors associated with social anxiety disorder
Social anxiety disorder is predominantly diagnosed in adolescence, but symptoms can appear earlier or later in life (Mayo Clinic, 2021). Individuals with a family history of anxiety disorders are at greater risk of developing the condition and so are people who have endured negative social experiences such as teasing or bullying (Cleveland Clinic, 2022).
While there is no consensus on whether social anxiety emerges as a conditioned response to having lived through an unpleasant situation or is an inherited trait, overstimulation of the amygdala, a condition which heightens our response to fear stimuli, may be implicated in the development this condition as well (Mayo Clinic, 2021).
Treatment and Prognosis
Treatment options for social anxiety disorder include psychotherapy in the form of coping strategy-learning such as cognitive behavioral therapy (CBT) and pharmacological interventions (Brandt & Mula, 2016; Mayo Clinic, 2021; Cleveland Clinic). Selective serotonin reuptake inhibitors (SSRIs) are generally the first antidepressants recommended, followed by serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, a form of anti-anxiety medication intended for short-term use, and beta blockers, which are used to prevent stimulating effects of certain neurotransmitters (Mayo Clinic, Cleveland Clinic). The prognosis is generally optimistic considering most patients seem to respond well to available treatment options (Anxiety and Depression Association of America, 2023).
How does social anxiety disorder affect someone with epilepsy?
Anxiety disorders are the most commonly reported mental issue in individuals with epilepsy (McCagh, Fisk & Baker, 2009; Brandt & Mula, 2016). Poor social skills and social anxiety signs can even be observed in children, with youth reporting improved concepts of self-image as their social anxiety levels dropped (Jones et al., 2014). Studies suggest that shared neurobiological networks between the amygdala and the hippocampus could explain this comorbidity, as anxiety can both follow or precede epilepsy onset (Brandt & Mula, 2016).
Moreover, epilepsy-related events can induce anxiety while stress can amplify epileptic symptoms. The unpredictability of epilepsy, not being allowed to perform certain activities, stigmatization, low self-esteem, and rejection from society, for instance, can intensify feelings of anxiety and aggravate epileptic symptoms (e.g. increasing seizure frequency) (Vazquez & Devinsky, 2003; McCagh, Fisk & Baker, 2009). However, sources of anxiety can differ in terms of significance. For men, intractable seizures are the primary sources of social phobia while lacking control over seizures is the driving factor behind social interaction anxiety in women (Lee et al, 2021).
Conclusion
Social anxiety disorder is a psychiatric condition with a high prevalence in the epilepsy community. The condition can severely impact the quality of life of individuals affected by it and while its comorbidity with social phobia is understudied, research suggests that the bidirectional relationship between epilepsy and anxiety might explain the exacerbation of symptoms in stressful social situations.
References:
Anxiety and Depression Association of America (2023). Social Anxiety Disorder. Anxiety and Depression Association of America. Retrieved from https://adaa.org/sites/default/files/ SocialAnxietyDisorder-brochure.pdf
Brandt, C., & Mula, M. (2016). Anxiety disorders in people with epilepsy. Epilepsy & Behavior, 59, 87–91. https://doi.org/10.1016/j.yebeh.2016.03.020
Cleveland Clinic (2022). Social Anxiety Disorder (Social Phobia). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/22709-social-anxiety#management-and treatment
Jones, J. E., Blocher, J. B., Jackson, D. C., Sung, C., & Fujikawa, M. (2014). Social anxiety and self-concept in children with epilepsy: A pilot intervention study. Seizure (London, England), 23(9), 780–785. https://doi.org/10.1016/j.seizure.2014.06.011
Lee, S.-A., Cho, Y.-J., Ryu, H. U., Kim, K. T., Seo, J.-G., Kang, K. W., Kim, J. E., Kim, Y.-S., Kim, J. B., Hwang, K. J., Han, S.-H., Lee, G.-H., Shin, D. J., Kim, J. H., & Lee, S.-Y. (2021). Sex differences in seizure effects on social anxiety in persons with epilepsy. Epilepsy & Behavior, 124, 108318–108318. https://doi.org/10.1016/j.yebeh.2021.108318
Mayo Clinic (2021). Social anxiety disorder (social phobia). Mayo Clinic. Retrieved from https:// www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/ syc-20353561
McCagh, J., Fisk, J. E., & Baker, G. A. (2009). Epilepsy, psychosocial and cognitive functioning. Epilepsy Research, 86(1), 1–14. https://doi.org/10.1016/j.eplepsyres.2009.04.007
Vazquez, B., & Devinsky, O. (2003). Epilepsy and anxiety. Epilepsy & Behavior, 4, 20–25. https://doi.org/10.1016/j.yebeh.2003.10.005
