Social Anxiety Disorder: Integrative Approach to Psychopathology

Integrative Approach to Psychotherapy

Social Anxiety Disorder

Case Example

The film Elling presents a story of Elling, the seventh in a family of nine musically-talented children, who is only six when his and his brothers' musical talents are discovered by a visiting tycoon who then offers to sponsor the family troupe on a merry-go-round of public performances. During one of his first performances, Elling runs off-stage, afraid of the flashing lights and the audience applause. In another instance, he is asked to perform an Ella Fitzgerald song, but is unable to, and cries the entire night after his younger brother beats him to the prize. The fear of performing grows strong, and Elling continues to be paralyzed by the same while onstage; at times recalling nothing about his performance, other than the curtains being drawn. This fear perforates into other areas of his life and he soon finds himself shunning social places for fear of what people may be thinking of him. With time, the family's 'good boy' finds himself too frustrated, and is tempted to try alcohol. The sponsor, however, who still believes in Elling's talent and openly favors him over the rest, obtains professional help for him; and only then does Elling get diagnosed with social anxiety disorder (SAD).

The Multidimensional Model to Abnormal Behavior

Whereas one-dimensional models attribute psychopathology to a single, specific cause; multidimensional models posit that various reciprocal influences interact to yield the etiological processes that give rise to abnormal behavior (Wakschlag et al., 2013). These influences can be categorized into four -- biological; behavioral and cognitive; emotional; and social, cultural, and interpersonal influences. The subsequent subsections demonstrate how these four dimensions weave together to create the social anxiety disorder.

Biological Influences: these bring together all causal factors brought about by neuroscience and genetics (Wakschlag et al., 2013). Studies have shown that a child would have higher chances of having SAD if a first-degree relative has the disorder (Wakschlag et al., 2013). This has been attributed to genetics, and the fact that children acquire avoidance and social fears through parental psychosocial education and the process of observational learning (Schneier, 2006). To this end, a child with shy and socially-isolated parents is highly likely to develop social phobia. This heritability may, or may not apply to Elling's situation, given that he was the only one with the disorder; however, we also cannot rule out the possibility of there being other forms of anxiety disorders in the rest of the family. Furthermore, individuals who had insecure (anxious-ambivalent) relationships with their mothers are twice as likely to develop social phobia later on in life (Schneier, 2006).

Social, Cultural, and Interpersonal Influences: negative social experiences have been found to trigger social phobia, especially in individuals with high levels of interpersonal sensitivity (Schneier, 2006). The humiliating social events during public performances were a trigger to social phobia in Elling's case. Being ignored, rejected, or bullied could lead an individual to develop feelings of inferiority and inability to fit in, both of which are triggers to social phobia (Wakschlag et al., 2013). Cultural factors also have a hand in the worsening of social phobia. The style of parenting, for instance, depends on the culture of the people among whom an individual lives. In America, for example, a child is highly likely to develop social phobia if their parents use shame as a disciplinary strategy, and emphasize the importance of others' views (Schneier, 2006). However, this strategy would have no such effect on a Chinese or African child (Schneier, 2006). The risk of developing social phobia also depends on what an individual seeks to gain from interacting with others (Schneier, 2006). To this end, an individual who seeks positive reactions and others' acceptance is more likely to develop feelings of inferiority and insecurity than one who places more emphasis on competitiveness (Schneier, 2006).

Emotional Influences: in addition to determining how a person feels, emotions determine the situation or environment in which an individual will engage, as well as the condition of such engagement (Hedman et al., 2013). To this end, anxious individuals may either avoid situations they consider anxiety-provoking (like Elling avoided social gatherings) or attempt to modify the same so that they are able to handle it (engaging in drug use and abuse to reduce consciousness, fear, and anxiety while onstage). Additionally, anxious individuals are often overwhelmed by their emotions, and find themselves unable to regulate the same.

Behavioral and Cognitive Influences: it is widely-accepted that anxiety reflects an in-built fight or flight system erring on the side of safety. Social threats have evolved, and so have the ways of dealing with them; shyness and blushing are now used to establish an individual's social rank or living status (Hedman et al., 2013). They are no longer just another childhood tendency; rather, they are an early indication of whether or not an individual qualifies for leadership or responsibility. Such influences instill feelings of inferiority, and are a key trigger to social phobia, because an individual is forced to develop behavioral techniques of dealing with the same.