An Annotated Bibliography for Social Anxiety Disorder

Running head: WEEK OUTLINE 1

Social Anxiety Disorder

I. Introduction

Social anxiety disorder is termed as Social Phobia in DSM-5 (2013). The conversation can be inadequately assertive or overly submissive or, less generally, highly dominated by individuals with a social anxiety disorder. They can show an excessively stiff posture of the body or insufficient contact with the eyes, or speak in an overly polite manner. Individuals with Social Anxiety Disorder may seem reluctant to open to anybody while having a conversation. They tend to be reserved with people around them (APA, 2013).

A. Social anxiety disorder is a neuropsychological disorder resulting from modifications in the neurological system, which results in psychological issues related to mental health.

B. Diagnostic Criteria

According to the DSM-5, Diagnostic Criteria for a social anxiety disorder is such that there is noticeable fear or anxiety and it is linked to social situations in which an individual is expected to be observed by other people. An individual has a fear that if he or she acts in a certain way that demonstrates anxiety symptoms, then he/she will be assessed negatively. Social situations almost always trigger fear or anxiety. The individual avoids social situations or tolerates them with excessive fear or anxiety. The fear or anxiety is not even equal to the real threat assumed by the social situation. The duration of the anxiety, fear, or avoidance is somewhat around six months or more. Impairment in important functioning areas such as social and occupational results because of fear, anxiety, or avoidance is evident. Clinically significant distress is also seen in individuals. It cannot be said that fear, anxiety, or avoidance is the physiological effect of the use of any medication or drug or any medical condition. Other disorders such as panic disorder, body dysmorphic disorder, or autism spectrum disorder cannot explain fear, anxiety, or avoidance. The fear, anxiety, or avoidance is separate and or excessive is any medical condition is present (APA, 2013).

Physical and psychological signs and symptoms of Social Anxiety Disorder: Many effects on the mind and body arise from a social anxiety disorder. This leads to symptoms that are physical, emotional, and behavioral. Trembling, sweating, elevated heart rate, and nausea are physical signs. When speaking, a rigid body posture and a trembling voice. Fear of feeling anxiety in front of the media, low self-esteem, and negative self-talk are psychological symptoms. The person often responds sensitively to criticism (Litner, 2020).

B. Reasons for Choosing Topic

I have chosen this topic since I have seen many people experiencing social anxiety around me. People with social anxiety seem to be quiet, withdrawn, aloof, inhibited, and quiet. They do not mix with other people so easily. They have a common fear that resists them from mixing with other people. They feel intense distress in new situations. I have specifically chosen this topic because one of my close relatives experiences social anxiety. I have seen her signs and symptoms, and I have seen how she has missed many opportunities because of her social anxiety. I chose to read about this topic to understand this disorder in a more detailed and comprehensive manner.

II. Discussion

A. Detailed Description of Disorder

1. Signs and symptoms: Social anxiety disorder results in many effects on the mind and body. This leads to physical, emotional, and behavioral symptoms. Physical symptoms include trembling, sweating, increased heart rate, nausea, a firm body posture and trembling voice while speaking. Psychological symptoms include fear of experiencing anxiety in front of the public, low self-esteem, and self-talk, which is negative. The individual also reacts sensitively towards criticism (Litner, 2020). Much research has also been conducted on understanding epidemiology of SAD.

2. Epidemiology: Research has found out that people who experience bullying, are more likely to develop SAD. These people tend to leave school early, have poorer educational skills and have a less number of friends. There are more chances that such individuals do not go for a marriage. If they do, there are more chances of a divorce (Acquah et al., 2016).

3. Studies reveal that younger people are affected by social anxiety excessively. At adolescent age, prevalence rates have been found to be 10%. By 23 years of age, occurrence of 90% of cases has been found. Women are found to be prone to higher social anxiety rates. Links have been found with unemployment and lower educational status (Jefferies & Ungar, 2020).

4. Researchers are also interested in understanding the subtypes of SAD along with its signs, symptoms and epidemiology. There has been substantial research on SAD's diagnostic subtypes, including the performance-only subtype in DSM-5 (APA, 2013). Subtypes reported in youth populations include one (i.e., general factor) of two (i.e., interaction and performance); three (i.e., interaction, performance, and social anxiety-related physical and cognitive symptoms; and five subtypes (i.e., assertiveness, public performance, physical/cognitive symptoms, social anxiety-related symptoms) (Kodal et al., 2017).

B. Description of Natural History of Disorder

1. Development of disorder over time with treatment: When SAD is diagnosed in an individual, then proper treatment is required. So, when a patient exhibits marked discomfort or suffer from complications arising from the condition, medication is suggested. Psychological therapy, pharmacotherapy, or a combination of the two, can treat anxiety disorders (Bandelow, Michaelis & Wedekind, 2017).

2. Development of disorder over time with treatment: Behavioral inhibition that predisposes infants to nervous responses may be important for developing social anxiety characteristics, but it is not enough. If the child's hereditary predisposition is to end up presenting itself as a fully developed adult personality trait, certain environmental factors must be present (Shpancer, 2020).

A. Methods to Diagnose, Evaluate, and Manage Disorder

1. Initial diagnosis: As per the signs and symptoms of SAD, there is no medical test to confirm the diagnosis of this disorder. Diagnosis is mainly done on behavioral symptoms which are observed by the healthcare provider and confirmed by the patient. After that, a diagnosis is made (Higuera, 2018). However, Neuroimaging as a more analytical method, has great potential to identify anomalies that are essential to SAD pathophysiological models (Zhang et al., 2015).

2. Methods of ongoing management: In most cases with social anxiety disorder, psychotherapy improves symptoms. In counseling, people learn how to recognize and modify negative feelings about themselves and improve their abilities to gain confidence in social circumstances. The most effective form of anxiety psychotherapy is cognitive behavioral therapy, and it can be equally effective, whether performed independently or in groups. (Mayo Foundation, 2017).

B. Risk Factors

1. Genetic risk factors: Scientists are researching whether there is a correlation between the disease's symptoms and the genes using statistical methods. The assessment of the data previously collected suggested that the SNP in the SLC6A4 serotonin transporter gene is involved in the production of social phobia. This gene encodes a brain pathway that is involved in the transport of serotonin, an essential messenger. This drug suppresses feelings of fear and depressed moods, among other things (University of Bonn, 2017).

2. Lifestyle factors: Lifestyles factors can also lead to the development of social anxiety disorder. One is susceptible to developing this disorder if they do not include exercise in daily routine, have an unhealthy diet, unsupportive family and friends, and do not include any recreational activities in everyday life (Andrew Kukes Foundation for Social Anxiety, 2020).

3. Environmental factors: Research indicates that the likelihood of developing SAD is enhanced by over-control, critical and cold parenting, an unstable style of attachment, aversive social / peer interactions, emotional violence, and other types of childhood abuse and hardship to a lesser degree. These variables can lead to post-traumatic responses, skewed negative self-imagery, and internalized shame-based schemes that subsequently perpetuate SAD symptomatology (Norton & Abbott, 2017).

C. Other Causes

The skills deficit model suggests that social anxiety exists because of inappropriate social skills that often lead to unpleasant social interactions and lead subjects to avoid circumstances causing this anxiety. The cognitive self-evaluation model notes that negative self-perception contributes to social anxiety, and subjects affected by this excessively underestimate themselves and feel that they do not succeed. The classical conditioning approach suggests that when negative situations accompany neutral stimuli, social anxiety grows. The personality traits approach notes that social anxiety arises because of personality variations in emotional, cognitive and behavioral components of personality. Shyness might be inherited (Inam, Mahjabeen & Abiodullah, 2017).

D. Nervous System Structures and Pathways Involved

To date, the known causes of SAD are the consistent hyperactivity of the amygdala and insula (deep-brain structures). Functional magnetic resonance imaging (fMRI) research on humans and other animals has shown that SAD has increased responses to stimuli that may be social or nonsocial. (Khetrapal, 2019).

E. Neurotransmitter(s) and Receptor System(s)

The main mediators of anxiety disorders symptoms tend to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA) within the central nervous system (CNS). There may be other neurotransmitters and peptides involved, such as the corticotropin-releasing factor. Many of the symptoms are mediated peripherally by the autonomic nervous system, especially the sympathetic nervous system (Bhatt, 2019).

F. Current Treatment Options

1. Pharmacological treatments: Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs) are recommended as first-line medications a consequence of their positive benefit/risk balance. (Bandelow, Michaelis & Wedekind, 2017).

2. Non-pharmacological therapies: A significant number of randomized trials have demonstrated CBT's effectiveness for all anxiety disorders. If the reduction of dreaded situations is a relevant factor in phobic disorders, exposure strategies should be included in the care schedule in which patients face their dreaded situations. (Bandelow et al., 2017).

3. Types of care providers: The first step is to get diagnosed. A mental health specialist does this. Later, a therapist can be made available for providing therapy for a combination of medication and psychotherapy.

4. Types of healthcare setting: Social anxiety disorder can be treated in an outpatient setting.

G. Future Areas of Research

Much research has been conducted on epidemiology, etiology and development of social anxiety disorder. It has contributed a lot in understanding the disorder in a detailed manner. however, many areas are still to be discovered. Future studies are needed to evaluate the stability over time of these candidate endophenotypes (endophenotype criterion 2) and identify genetic variants underlying the candidate endophenotypes. These promising results provide a starting point for follow-up studies on the genetic susceptibility to SAD. Moreover, neuroimaging and neurostimulation tools can be combined for future research. This can be helpful in understanding brain alterations in psychopathology and their functional implications (Bas-Hoogendam, 2020).

III. Conclusion

When a similar disorder demands attention (e.g., depression or alcohol), SAD is also reported. It has also been stated that many people do not consider social anxiety as a disease and think it is just part of their character and cannot be altered. Living with an undiagnosed or untreated illness may have major economic implications for individuals and society, including a diminished capacity to work and a loss of productivity, which can have a greater effect on people and society. Also, the spectrum of avoidant behaviors typically associated with social anxiety suggests that affected individuals can fail or be less able to cope socially, and the effects can be severe and enduring for young people at a period in their lives when relationships with others are particularly important (Jefferies & Ungar, 2020). It is therefore, necessary to provide help to people around us who are suffering from disorder.