Social Anxiety Disorder (social phobia) is the fear and anxiety of being negatively judged and evaluated by other people. It is said to be the third largest mental health care problem in the world today.
People with social anxiety are many times seen by others as being shy, quiet, backward, withdrawn, inhibited, unfriendly, nervous, aloof, and disinterested. Feelings of shyness or discomfort in certain situations aren’t necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on personality traits and life experiences. Some people are naturally reserved and others are more outgoing. People with social anxiety typically know that their anxiety is irrational, is not based on fact, and does not make rational sense. Nevertheless, thoughts and feelings of anxiety persist and are chronic (i.e., show no signs of going away).
Paradoxically, people with social anxiety want to make friends, be included in groups, and be involved and engaged in social interactions. But having social anxiety prevents people from being able to do the things they want to do. Although people with social anxiety want to be friendly, open, and sociable, it is fear (anxiety) that holds them back.
The feelings that accompany social anxiety include anxiety, high levels of fear, nervousness, automatic negative emotional cycles, racing heart, blushing, excessive sweating, dry throat and mouth, trembling, and muscle twitches. In severe situations, people can develop a dysmorphia concerning part of their body (usually the face) in which they perceive themselves irrationally and negatively. Constant, intense anxiety (fear) is the most common symptom.
For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, fear of going to school or taking part in any social activity in school, clinging to parents or refusing to speak in social situations.
People with social anxiety usually experience significant distress in the following situations:
- Being introduced to other people
- Being teased or criticized
- Being the center of attention
- Being watched or observed while doing something (like eating)
- Having to say something in a formal, public situation
- Meeting people in authority (“important people/authority figures”)
- Starting conversations
- Making eye contact
- Entering a room in which people are already seated
- Meeting other peoples’ eyes
- Swallowing, writing, talking, making phone calls if in public
- Attending parties or social gatherings
Social anxiety is many times confused with panic disorder. People with social anxiety do not go to hospital emergency rooms after an anxiety situation. People with panic disorder many times go to hospital emergency rooms, or doctor’s offices, at first because they feel there is something physically wrong with them.
Social anxiety, as well as the other anxiety disorders, can be successfully treated. In seeking help, a specialist is recommended. It is believed that effective therapy comes only from people who have experienced this disorder themselves and overcome it. They make the best group leaders. Appropriate active, structured, Cognitive-Behavioral Therapy (CBT) is the only solution to this problem.
Social anxiety medication is useful for many, but not all, people with social anxiety disorder. For social anxiety, research indicates use of the anti-anxiety agents, and (perhaps) certain antidepressants in conjunction with CBT have proven most beneficial. Medication without the use of active, structured cognitive-behavioral therapy has no long-term benefits. Research indicates many antidepressant medications for social anxiety disorder to be useless, even in the short-term. Antidepressants do not work anywhere near as well, in general. A typical superstition promoted by the drug companies, is that antidepressants have anti-anxiety properties. Antidepressants actually make someone more anxious. However, not all people want or need medication. And if need be for a medication, it should be administered in a very low dose followed by CBT.
High rates of alcoholism and other substance abuse, family difficulties and problems, lack of personal relationships, and difficulty in obtaining and continuing with employment are among the everyday problems experienced by many people with social anxiety disorder. Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of biological and environmental factors. Possible causes include:
- Inherited traits.Anxiety disorders tend to run in families. You’re more likely to develop social anxiety disorder if your biological parents or siblings have the condition.
- Brain structure.A structure in the brain called the amygdala may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.
- Having an appearance or condition that draws attention.For example, facial disfigurement, stuttering or tremors due to Parkinson’s disease can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.
- Environment. Social anxiety disorder may be a learned behavior — some people may develop the condition after an unpleasant or embarrassing social situation. Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder. In addition, other negative events in life such as family conflict, trauma or abuse, may be associated with social anxiety disorder. Also, there may be an association between social anxiety disorder and parents who either model anxious behavior in social situations or are more controlling or overprotective of their children.
Social anxiety disorder symptoms can change over time. They may flare up if you’re facing a lot of stress or demands. Although avoiding situations that produce anxiety may make you feel better in the short term, your anxiety is likely to continue over the long term if you don’t get treatment. Left untreated, social anxiety disorder can run your life. Anxieties can interfere with work, school, relationships or enjoyment of life. Social anxiety disorder can cause:
- Low self-esteem
- Trouble being assertive
- Negative self-talk
- Hypersensitivity to criticism
- Poor social skills
- Isolation and difficult social relationships
- Low academic and employment achievement
- Substance abuse, such as drinking too much alcohol
- Suicide or suicide attempts
Other anxiety disorders and certain other mental health disorders, particularly major depressive disorder and substance abuse problems, often occur with social anxiety disorder. Many people with social anxiety also have other mental health issues, such as depression, generalized anxiety disorder or body dysmorphic disorder.
Self-help probably won’t cure your social anxiety, but it may reduce it and you might find it a useful first step before trying other treatments. The following tips may help:
- Try to understand more about your anxiety – think about what goes through your mind and how you behave in certain social situations to help you get a clearer idea of the problems you want to tackle
- Replace your unrealistic beliefs with more rational ones – for example, if you feel a social situation went badly, think if there are any facts to support this or if you’re just assuming the worst
- Don’t think too much about how others see you – pay attention to other people instead and remember that your anxiety symptoms aren’t as obvious as you might think
- Start to do activities that you would normally avoid – this can be tough at first, so start with small targets and work towards more feared activities gradually.