Patients are afraid of and avoid many social situations. In severe cases, They may even be separated from society for a long time and unable to work and study normally.

Patients are afraid of a specific situation and usually have no symptoms. Only worry in anticipation, worry about encountering fearful situations, Or may show signs of fear and anxiety when entering a feared situation.

First-degree relatives of patients with social phobia, that is, parents, children, and co-parents Brothers and sisters are at a significantly higher risk of contracting the disease, suggesting that the disease may be hereditary.

The biological cause of social phobia is not yet clear. Possible mechanisms include hyperfunction of the norepinephrine system, Increased sensitivity of the 5-HT system, excessive response of the hypothalamic-pituitary-adrenal axis (HPA axis), etc.

Imaging studies suggest that hypersensitivity of the conditioned fear network centered on the amygdala may be related to the occurrence of the disease. Neuroimaging studies have initially shown that patients with social phobia may have basal ganglia and striatum. Regional cerebral blood flow enhancement and dopamine dysfunction.

The disease has significant family factors. patients with social phobia, Their parents often convey a negative social experience to their children, such as parental marital conflicts, Parental overprotection or abandonment, childhood abuse, frequent relocation during childhood, Lack of close relationships with adults during childhood, poor performance in school, etc.

Social phobia in children is mainly manifested when children interact with strangers (including peers). Persistent anxiety, manifested as excessive timidity, nervousness, shyness, fear, or embarrassment, Excessive concern about one's own behavior and social avoidance behavior, often refusing to go to school and avoiding group activities with peers. However, children have good social relations with their parents or familiar people.

70% to 80% of patients will have at least one diagnosis of another mental illness in their lifetime, which is a comorbid phenomenon. Common ones are affective disorders, other anxiety disorders, eating disorders, substance abuse disorders, etc. Comorbid social phobia may increase the risk of suicide.

affective disorder

Other anxiety disorders

Social phobia is often accompanied by physical manifestations, such as blushing, rapid heartbeat, dry mouth or throat, Autonomic symptoms such as difficulty swallowing, body tremors or muscle twitches, sweating, nausea or vomiting, etc. Shy blushing is the most prominent autonomic manifestation of social phobia, and panic attacks may occur when you are extremely nervous.

Most people experience social anxiety or avoidance, but this fear can be understood and controlled. It will not hinder normal life and work. Patients with social phobia will show excessive, Unreasonable fear and fear will lead to active avoidance of these situations and loss of self-control.

There are similarities in avoidance behavior between the two, and the core fear of avoidant personality disorder is also Rejection, ridicule, or humiliation by others, but patients with personality disorders target a wider range of scenarios. People with social phobia are relatively limited and can recognize that this anxiety or worry is excessive, It is unreasonable, and the personality disorder takes a long time to form, and the onset is insidious.

Both panic attacks have similar characteristics, but panic disorder occurs without embarrassment or embarrassment. It is an acute anxiety attack that is unpredictable and can be followed by embarrassing experiences. Rarely are dizziness or respiratory symptoms associated with physical symptoms of social phobia attacks.

Both have fear and avoidance of crowded situations, but agoraphobia is afraid of being in crowded situations. The inability to escape in time when danger arises in certain situations, rather than the reasons for these situations themselves. The main difference between the two is the objects of fear and anxiety.

Patients with depression may experience a decrease in social behavior, often due to low mood, Caused by lack of motivation and accompanied by other core symptoms: loss of pleasure, Loss of interest in things, fatigue, etc., and there is an identifiable onset time.

Is there avoidance of social situations? This avoidance is due to self-formed obsessions. Or they are afraid that others will discover their compulsive actions. Obsessive actions and obsessive thinking are the key points of identification.

With a clear history of traumatic events, social avoidance is used to increase safety and avoid traumatic re-experiencing.

It is a first-line drug for social phobia, with good therapeutic effect, few adverse reactions and good tolerance. Paroxetine, sertraline, fluvoxamine, fluoxetine, etc. are commonly used. The dosage and frequency of medication should be as directed by the doctor. These drugs take up to 6 weeks to take effect, and generally take 9 months to 1 year. Regular treatment is required under the guidance of a doctor. If the medication is reduced or stopped early, it is easy to relapse. This class of drugs is effective for comorbid depression, panic disorder, generalized anxiety disorder, or obsessive-compulsive disorder.

It is effective in controlling anxiety symptoms, has a quick onset of action, and can quickly adjust the dose. It can be used temporarily. Commonly used are clonazepam, alprazolam, etc. Follow the doctor’s advice on dosage and frequency of medication. Long-term use of these drugs may cause drug dependence and withdrawal reactions, and may also lead to excessive sedation, Movement coordination disorders and memory problems. Use with caution in patients with alcohol or drug dependence.

Highly effective for pre-performance anxiety and can be taken as needed approximately 1 hour before the performance event. It can effectively reduce the physical symptoms associated with social phobia, such as rapid heartbeat, trembling, sweating, etc. It rarely impairs attention and coordination, and there is no drug dependence. Propranolol and atenolol are commonly used.

Most people with generalized social anxiety disorder do not benefit from these medications.

Highly effective against social phobia and effective against some comorbid depression.

This type of drug has poor tolerance and obvious adverse reactions, such as insomnia, orthostatic hypotension, decreased sexual function, Weight gain, etc., and interactions with tyramine-containing foods can lead to fatal hypertension, so use is limited. However, it can be tried for some refractory patients.

Venlafaxine and mirtazapine have certain curative effects.

Gabapentin, buspirone, bupropion, topiramate, pregabalin, atypical antipsychotics, etc. have all been reported to be effective.

Cognitive behavioral therapy is currently the most commonly used psychotherapy method. Mainly include: exposure therapy, cognitive restructuring, relaxation training and social skills training.

exposure therapy

cognitive restructuring

relaxation training

social skills training

Be able to identify some subconscious conflicts related to social anxiety and avoidance behaviors, Patients may benefit in the long term through exploration of these conflicts. However, as drug treatment and The development of cognitive behavioral therapy, which no longer receives the attention it once did.