Fears associated with contexts of social interaction are widespread in the population, although fortunately they do not always significantly interfere with the quality of life. There are cases, however, in which these fears take on the qualities of a real disorder, which is referred to as social phobia.
This type of phobia represents an important risk factor with respect to school performance, professional success and relationship fulfilment. If the person does not intervene in this suffering in any way, it may tend to become chronic and with it attempts to manage it, which do not always prove successful.
The diagnostic criteria outlined by DSM 5 are as follows:
strong anxious response to exposure to interpersonal situations in which one is potentially scrutinised
fear that anxiety symptoms will become evident and negatively evaluated by observers
avoidance responses to anxiogenic situations or strong distress during exposure to them
fears are not realistically proportionate to the feared condition
impairment of quality of life
exclusion of organic causes or other psychopathological problems
the symptoms have persisted for at least 6 months
People suffering from social anxiety fear being in situations that make them feel exposed, evaluated, ridiculed. They fear that their discomfort is visible, e.g. through reddening of the face, trembling of the voice or hands, sweating or difficulty in carrying on a speech. Symptoms of a somatic nature are often present, such as tachycardia, dry mouth, gastric and urinary disorders, nausea, feeling of suffocation - to name but a few.
These fears may be limited to some specific situations (e.g. public speaking) or involve most social activities.
Thus, to give examples, it may happen that some people have difficulty speaking on the telephone or eating in front of other people. The more the situations are feared, the more the suffering and impaired functioning will be amplified.
Most people react to this form of intense discomfort through avoidance of situations that could generate it, triggering a damaging spiral in which anticipatory anxiety triggers the maintenance of avoidance and thus the reinforcement of symptoms: this can lead to progressive social isolation that can sometimes result in secondary depression. Thus, the person suffering from this type of discomfort may involuntarily trigger a vicious circle in which the state of hyperactivity in which he or she finds him or herself when exposed to anxiogenic stimuli is followed by unsatisfactory 'performance', which goes on to confirm the fears and thus reinforce the disorder itself. The person is unable to construct situations in which the dangerousness of certain situations is disconfirmed and remains focused on his own internal states and his own 'performance', considered, sometimes unrealistically, to be poor.
The peculiarity of social phobia lies in the fact that the phobic object is 'the other', who becomes distant and fearsome, as if he had greater power, greater competence. Indeed, the other performs - from the point of view of the person with social phobia - better and can therefore judge, mock, attack.
The person with social phobia, on the other hand, perceives himself as weak, vulnerable, incompetent, feels ashamed and is afraid of being 'discovered' and humiliated.
A psychodynamic reading of social anxiety
Psychodynamic literature frames phobias and the resulting anxiety as symptomatological forms that result from unconscious mechanisms, which are therefore activated beyond the subject's will. That is, it is important to emphasise that the dynamics described are neither voluntarily chosen by the person, nor are they very often present to consciousness. In phobia, there is an unconscious displacement onto the outside (the phobic object/situation) of strongly distressing internal content.
The internal content may be of a different nature: for example, it may be an impulse (sexual desire, aggression, etc.), deemed unacceptable by the subject and therefore removed and then projected onto the external world. Or it may be a conflict, once again removed from consciousness and then shifted outside itself. Often the conflict around which the social phobia arises may have to do with the achievement of autonomy.
It is as if the person, despite being an adult, still unconsciously finds himself having to choose between becoming autonomous (but risking the disapproval or abandonment of the reference figures) or remaining, instead, dependent on them. If this conflict remains unresolved, phobia, and therefore also social phobia, may be the outcome, as the symptoms that will develop will not allow the subject to live his or her existence fully and freely.
It is as if all the individual's potential will always remain obscured, coarted by mental patterns focused on the 'fear of'.
However, in the psychodynamic reading, fear and desire intermingle, and on a shrewd analysis of the specific meanings of a person's fears, it is possible to discern their innermost desires. Psychodynamic theories have developed a multiplicity of further interpretations relating to the development of symptoms of a phobic nature and with respect to social phobia specifically.
A few brief hints have been developed here, also in view of the fact that each person is unique and the nature of the conflict he or she carries, or of the contents that are in some way repressed, are entirely personal and can be traced in one's own pathway, which speaks of one's personality and history. What to us are nothing more than undesirable and disabling symptoms, if listened to, can tell us surprising truths.
If you feel like it, I invite you to listen to a song by Lorenzo Cherubini, 'Mi fido di te', which somehow speaks to us about all this.