What disorder do we instill in our daughters since childhood?

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Girls in Arab communities are raised to be quiet. Shy girls are praised for their shyness in the Arab world, unlike the boys who are raised to be brave and outgoing since infancy, and encouraged to blend in with the society. Educators claim that this develops what they call the boy’s “values of manhood”.
On the other side, females are raised by their families to be dependent and isolated from the society, believing that they’re protecting them, and what they call “honor”. They plant the seeds of what they consider female values in them, such as quietness and not making eye contact, practices that prove the lack of awareness in the society of the risks of what they’re dictating on their children since childhood. Therefore, our Arab communities are still suffering from patriarchy.

Social anxiety disorder is a form of anxiety disorders. It occurs when there’s a number of fears toward different situations of social interaction. Having some social anxiety is typical and normal in situations with new requirements, but what we mean by social anxiety here is the unacceptable fear in situations where the individual is expected to interact or behave with others naturally.

The primary disorder in social anxiety is hypersensitivity to criticism, which in turn creates fears of appearing stupid, embarrassing, naïve, or giving any other negative impression. Those with social anxiety are often worried that some of their actions, such as writing, talking, eating, or blushing, might draw the attention and criticism of other people. This fear in itself might be enough to make the person unable to do these things in other people’s presence.

Social anxiety is a state of fear from seeing people because of fear of criticism or discomfort. In this case, the individual avoids these situations and social interaction with other people. He’s fearful of eating in public spaces, going to the cinema, shopping, or sitting in a cafeteria. This fear could be so extreme that the person completely withdraws from social life. Roth, Antony and Swinson mention that social anxiety is characterized by significant and continuous fear of one or several social or behavioral situations, in which the individual is afraid of behaving awkwardly or humiliatingly, in addition to fear of committing some mistake or looking unattractive or incompetent.

Those who suffer from social anxiety are often afraid of showing symptoms that could be interpreted as signs of anxiety, such as sweating, shaking, or blushing. This isn’t solely because they assume others will only notice these symptoms, but also that they’ll use them to reach conclusions about their characters.
For instance, those with social anxiety might believe that if people see them blushing they’ll get a bad impression about them and consider them anxious, weak, or stupid. Chavira and Stein point out that social anxiety can be classified into two types; generalized social phobia, which refers to those who fear almost all social situations; and circumscribed social phobia, which refers to those suffering from fear of specific situations.

Shyness was first addressed about 400 years B.C, from the time of Hippocrates, who described a case where someone suffered from extreme shyness, refusing to leave his home due to his fear of meeting someone, believing he’ll be humiliated and insulted by him, and thus he always wore a hat and covered his eyes. Charles Darwin also wrote about the physiological functions of organs and their relations to blushing and shyness. Social anxiety disorders where also referred to as social situations phobia at the beginning of the twentieth century by Janet in 1903, while Shidler used the term “social neurosis” to describe extremely shy people.

In the 50s, the efforts of Joseph Wolpe to develop the “systematic desensitization” technique reaped fruit. This technique provided science with information on phobia, its causes and treatment. English psychiatrist Isaac Marks, meanwhile, was the one who called to separate social anxiety (social phobia) from other kinds of phobias, and considering it a separate entity from other phobias, in the 1960s. The American Psychiatric Association welcomed this idea, and it was first officially introduced in the third edition of its Diagnostic and Statistical Manual. It was redefined in 1989 to separate those with Avoidant Personality Disorder from those with social anxiety.

Psychiatrist Michael Liebowitz and Richard Heimberg drew attention to research on this disorder, whose name changed from “social phobia” to “social anxiety” in the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, in 1994.

There are two kinds of social anxiety, namely:
1. The Generalized Social Phobia, which is characterized by fear of almost all social situations;
2. The Social Phobia Circumscribed to one or some situations, such as public speaking or eating in public.

The symptoms of this disorder are reflected in three dimensions:
A. The cognitive dimension, where the dominant thoughts of the individual are clear, such as expecting embarrassment or humiliation, or expecting being watched, and believing people want to make him uncomfortable and worried, or that they consider him stupid or weak.
B. The social dimension, where “avoidance” is clear, as the person withdraws from social situations that he’s afraid of, whether the anxiety is generalized or circumscribed.
C. The physical dimension, which reflects the anxiety in social situations, and is reflected in several ways, such as blushing, sweating, having cold hands, difficulty speaking, and diarrhea.

Symptoms of anxiety

Cognitive aspects
The cognitive model of social anxiety disorder explains how those with social anxiety experience dread over being presented to others. They may feel overly self-conscious, pay high self-attention and be negatively critical of themselves after every activity, conversation or anything they do, or have very high and strict performance standards for themselves. According to the social psychology theory of self-presentation, a sufferer attempts to create a well-mannered impression towards others but believes he or she is unable to do so. Therefore, they describe themselves with self-demeaning adjectives, such saying they’re naïve or thinking that their embarrassing actions will be self-devaluing and self-threatening. After the event, they may think negatively about their actions and words, and have the perception that they performed unsatisfactorily. Consequently, they will go over everything that they’ve done. These thoughts may not end with the event, but might often extend for weeks or longer. Those with social anxiety tend to interpret their actions with a negative outlook. Socially anxious individuals also remember more negative memories than those who don’t have social anxiety.

Behavioral aspects
Social anxiety disorder is a persistent fear of one or more situations, in which the person is exposed to interaction with others and fears that he or she may do something or act in a way that will be humiliating or embarrassing. It exceeds normal “shyness” as it leads to excessive social avoidance and substantial relations, and hinders the ability to perform normal activities. Feared activities may include almost any type of social interaction, especially small groups, dating, parties, talking to strangers, restaurants, etc. Physical symptoms associated with these events often include distraction, palpitations, blushing, stomach ache, nausea, rapid, shallow breathing, sweating, shaking of the hands, legs, or whole body, throat dryness, dizziness, lack of concentration, and forgetting. According to psychologist B.F. Skinner, phobias are controlled by escape and avoidance behaviors. For instance, a student may leave the room when talking in front of the class (escape) and refrain from doing verbal presentations because of the previously encountered anxiety attack. Avoidance behaviors could include lying in order to avoid troubling situations (avoidance). Some avoidance behaviors are exposed when a person avoids eye contact and crosses his/her arms to avoid recognizable shaking. Stopping these reactions is undoubtedly the basis for treating social anxiety.

Physiological aspects
Physiological effects, similar to those in other anxiety disorders, are present in those suffering from social anxiety. Children with social anxiety might protect themselves with unnatural behaviors, such as tantrums, crying, and hanging to their parents. In adults, it may be tears as well as sweating, nausea, shaking, palpitations, loss of balance, and blushing. A study found that the area of the brain called the amygdala, part of the limbic system, is hyperactive when patients are shown threatening faces or confronted with frightening situations.

Causes and factors contributing to social anxiety disorder

Research into the causes of social anxiety has shown multiple perspectives explaining social anxiety. The key reasons are:

1. Genetic and familial factors
There is evidence that there is a two to threefold greater risk of having social phobia if a first-degree relative also has the disorder. This could be due to genetics and/or due to children acquiring social fears and avoidance through processes of observational learning or parental education. Studies of identical twins brought up in different families have indicated that, if one twin developed social anxiety disorder, then the other was between 30 percent and 50 percent more likely than average to also develop the disorder. Studies have found that if a parent has any kind of anxiety disorder or depression, then a child is somewhat more likely to develop a social anxiety disorder. Studies also suggest that parents of those with social anxiety disorder tend to be more socially isolated themselves. Adolescents who were rated as having an insecure attachment with their mother as infants were twice as likely to develop anxiety disorders by late adolescence. A related line of research has found that ‘behavioral inhibition’ in infants is an early sign of a sensitive or fearful nature. Around 10–15 percent of individuals show these early signs, which leads us into attributing it to genetics.

2. Social and cultural influences
A previous negative social experience can be a major trigger to social anxiety disorder. For around half of those diagnosed with social anxiety disorder, exposure to a specific traumatic or humiliating situation appears to be associated with the worsening of the disorder. This kind of event appears to be particularly related to specific social anxiety (fear of specific situations), such as public speaking. Further, direct experiences, like observing or hearing about the socially negative experiences of others or verbal warnings of some situations, may also make the development of a social anxiety disorder more likely. Undoubtedly, negative treatment of children and adolescents could result in lower self-esteem and a sense of inferiority. Excessive orders and strict behavioral expectations could result in anxiety and a difficulty in understanding and compliance to them, leading to longer-term effects of not fitting in, or being bullied, rejected or ignored. It is noted that shy or avoidant adults have had unpleasant experiences with peers.

3. Neurochemical factors
Some scientists assume that social anxiety is related to an imbalance in a neurochemical called serotonin. The neurotransmitter dopamine in the D2 receptors is also closely tied to social anxiety disorder. Meanwhile, the efficacy of medications, which enhance or suppress serotonin or dopamine levels, indicates the role these neurotransmitters play in the development of social anxiety disorder. Other neurotransmitters, such as norepinephrine and GABA transmitters, also play a key role in the development of social anxiety disorder. Individuals with social anxiety disorder have also been found to have a hypersensitive amygdala; another area of the brain. The anterior cingulate cortex, which was already known to be involved in the experience of physical pain, also appears to be involved in the experience of ‘social pain’.
Social anxiety disorder occurs more often in females than males, which could possibly be due to the social pressure on women in the Arab world, rather than to biological differences. That is due to fundamental changes in the Arab communities, to which globalism and its mechanism have contributed greatly by instilling some values in people that they didn’t have before. It is now important to teach parents the importance and necessity of including their children in familial discussions and to give them the chance to express themselves openly. It is also important to spread awareness in the community on the wrong education of young girls; to redirect the orientation of media, especially TV shows, which have a great impact on the thoughts and behavior of those who watch them, and which can reflect a direct or indirect positive image of shy girls. It also aims to orient educational institutions not to deal with their students oppressively; and to increase the awareness of educators on the importance of providing help for students suffering from social anxiety disorder, encouraging their students, especially females, to socialize more.


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