SOCIAL ANXIETY DISORDER

Social anxiety disorder can be tough. It’s a type of anxiety where you worry a lot about being judged or embarrassed in social settings. This fear can be so strong that it makes it hard to talk to people, meet new people, or even go to school or work.

Have you ever felt those jitters in social situations? Like when meeting someone new or facing a big audience? It’s a common experience, but it goes beyond nerves for some. If these situations feel overwhelmingly stressful, you might be dealing with social anxiety disorder, also known as social phobia.

Imagine avoiding social interactions altogether because even simple things like small talk or making eye contact make you extremely uncomfortable. It’s not just about feeling shy; it can disrupt every aspect of your life.

In the United States, around 5.3 million people grapple with social anxiety disorder. It often begins during the teenage years, between ages 11 and 19. It’s a prevalent mental health issue, but there’s light at the end of the tunnel. The challenge lies in recognizing when it’s time to seek help.

Causes of social anxiety disorder

Genetic Predisposition: Family history of social anxiety disorder increases the likelihood of developing it.
Brain Function: Overactivity in the amygdala, responsible for fear responses, may play a role.
Onset in Adolescence: Social anxiety disorder commonly emerges around age 13.
Traumatic Experiences: History of abuse, bullying, or teasing can contribute to its development.
Personality Traits: Shyness, coupled with environmental factors like overbearing parenting, can heighten the risk.
Health Conditions: Conditions that draw attention to physical appearance or voice changes can trigger social anxiety.

Types of social anxiety disorder

Mild Social Anxiety:
- Individuals with mild social anxiety may experience both physical and psychological symptoms in social situations but can still engage in or endure these situations.
- Symptoms may be limited to specific types of social interactions, such as speaking in public or eating in front of others.
Moderate Social Anxiety:
- Those with moderate social anxiety experience similar physical and psychological symptoms but may vary in their ability to participate in social situations.
- They may engage in some social activities while avoiding others that trigger more intense anxiety.
Extreme Social Anxiety:
- Individuals with extreme social anxiety face more severe symptoms, including panic attacks, in social situations.
- As a result, they often go to great lengths to avoid social interactions altogether.
- Symptoms may manifest across various types of social situations, impacting multiple aspects of daily life.
Anticipatory Anxiety:
- Many individuals with social anxiety experience anticipatory anxiety, where they feel intense worry and fear leading up to anticipated social situations.

Social Anxiety Levels

Social anxiety levels can fluctuate throughout one’s life, influenced by various factors such as stress, life changes, and treatment effectiveness.

Social anxiety disorder triggers

So, how do you know if your social discomfort has crossed the line into a more serious issue? Let’s break down the situations when social anxiety disorder tends to occur:

Specific Triggers: For some, social anxiety is tightly focused on particular scenarios, like giving a speech or starting a conversation. Others feel intense anxiety in nearly any social setting.
Common Stressful Situations: Here are some situations that often trigger social anxiety:
- Talking to strangers
- Public speaking
- Dating
- Making eye contact
- Entering rooms
- Using public restrooms
- Attending parties
- Eating in front of others
- Going to school or work
- Initiating conversations
Individual Variations: It’s common for people with social anxiety disorder to experience varying degrees of discomfort in different situations. For instance, you might excel at giving speeches but feel overwhelmed at social gatherings.
Personal Triggers: Everyone has their own reasons for dreading specific social situations. However, in general, social anxiety revolves around:
- Fear of judgment or scrutiny by others
- Concern about embarrassment or humiliation, often manifested through blushing, sweating, or trembling
- Fear of unintentionally offending someone
- Discomfort with being the center of attention

What Social phobia Feels Like

Heightened Self-Consciousness: Social situations can make you intensely aware of yourself.
Persistent Fear of Judgment: There’s a constant worry about being scrutinized or criticized by others.
Discomfort in Social Settings: Speaking in groups or presenting can feel daunting and uncomfortable.
Hesitation in Communication: Engaging with others might feel daunting, leading to reluctance in initiating conversations.
Avoidance of Eye Contact: Direct eye contact can feel overwhelming, leading to avoidance behaviors.

Physical Symptoms

Racing Heartbeat: Your heart may beat rapidly in anticipation or during social encounters.
Muscle Tension: Physical tension can build up, causing discomfort.
Dizziness and Lightheadedness: Feeling dizzy or lightheaded is common during heightened anxiety.
Blushing and Sweating: Physical manifestations like blushing or sweating can occur.
Stomach Troubles: Anxiety can lead to gastrointestinal issues such as stomach discomfort or diarrhea.
Breathlessness: Difficulty in breathing or catching your breath can happen.
Feeling Detached: An “out-of-body” sensation may occur during extreme anxiety episodes.

Timing of Symptoms

Immediate or Prolonged: Symptoms can arise immediately before a social event or persist for weeks leading up to it.
Post-Event Reflection: Afterward, you might spend considerable time analyzing and worrying about your behavior.

Impact on Daily Life

Avoidance of Normal Situations: Social anxiety disorder can lead you to avoid everyday situations that others find routine, hindering your ability to participate fully in life.
Interpersonal Relationships: Avoidance of social situations can strain personal relationships, as it may be challenging to connect with others or maintain friendships.
Difficulty Understanding Others: It might be hard to comprehend how others handle social interactions with ease, exacerbating feelings of isolation and inadequacy.

Psychological Effects:

Low Self-Esteem: Constant avoidance and negative thoughts about social interactions can erode self-esteem over time.
Negative Thought Patterns: Social anxiety disorder often accompanies persistent negative thoughts about oneself and others, contributing to a cycle of self-doubt and fear.
Potential for Depression: Long-term social isolation and negative self-perception can increase the risk of developing depression.
Criticism Sensitivity: Individuals with social anxiety disorder may be highly sensitive to criticism, further impacting their self-image and confidence.
Stagnant Social Skills: Avoidance of social situations can hinder the development of social skills, perpetuating the cycle of anxiety and isolation.

Worried about Social Anxiety Disorder?

Seek Professional Help: Discuss your fears and worries with a doctor or therapist experienced in treating social anxiety disorder. They can assess your symptoms and recommend appropriate treatment options.

When to see a doctor

Recognizing when to reach out for help with social anxiety disorder is crucial for managing its impact on your life. Here are some signs indicating it’s time to talk to your doctor:

Persistent Anxiety: If you experience intense and prolonged anxiety in social situations, to the extent that it significantly affects your daily life and functioning.
Avoidance Behavior: If you consistently avoid social situations or go to great lengths to evade them due to overwhelming fear and discomfort.
Negative Impact on Life: When social anxiety starts interfering with your relationships, work, school, or overall quality of life, it’s essential to seek support.
Co-occurring Issues: If social anxiety disorder coexists with other mental health conditions such as depression, substance abuse, or significant stress, seeking professional guidance is essential.
Persistent Symptoms: If you’ve tried self-help strategies or coping mechanisms but continue to struggle with social anxiety symptoms.
Concern from Others: If friends, family, or colleagues express concern about your behavior in social situations or notice significant changes in your mood or functioning.

Diagnosis of social anxiety

Diagnosing social anxiety disorder involves a comprehensive evaluation by a healthcare professional. Here’s an overview of the diagnostic process:

Criteria for Diagnosis:

The diagnostic criteria for social anxiety disorder are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association.
These criteria include experiencing intense fear or anxiety about social situations, avoiding or enduring them with significant distress, and experiencing symptoms that interfere with daily life.
Symptoms must not be better explained by another medical condition, medication, or substance abuse.

Evaluation Process:

A healthcare provider, such as a clinician, psychologist, psychiatrist, or therapist, conducts an assessment to determine if the DSM-5 criteria match the individual’s experience.
This assessment involves asking questions about symptoms, medical history, medications, and substance use, as well as conducting a physical examination if necessary.
The provider may also inquire about the duration and severity of symptoms, their impact on daily functioning, and any previous treatment attempts.

Duration of Symptoms:

To receive a diagnosis of social anxiety disorder, an individual typically needs to have experienced symptoms for at least six months.

Diagnostic Tools:

Healthcare professionals may use standardized tools or questionnaires to gather more information about the individual’s symptoms and experiences.
These tools help assess the severity of social anxiety symptoms and provide additional insights into the individual’s condition.

No Single Test:

There is no single test that definitively diagnoses social anxiety disorder. Instead, diagnosis relies on a comprehensive evaluation of symptoms, history, and functional impairment.

Individualized Assessment:

The diagnostic process is tailored to each individual, taking into account their unique circumstances, symptoms, and needs.

Treatment of social phobia

Medications:

Prescription Drugs: Medications can effectively alleviate symptoms of social anxiety disorder by reducing discomfort and embarrassment.
FDA-Approved Medications: Paxil, Zoloft, Luvox, and Effexor are FDA-approved for social anxiety disorder treatment, but other medications may also be effective.
Effectiveness and Side Effects: Medications may vary in effectiveness for individuals, and it might take several attempts to find the right one. Side effects such as headache, stomachache, nausea, and sleep difficulties may occur.
Warning for Young People: The FDA warns that medications used for social anxiety disorder and depression may increase suicidal thoughts or behaviors in individuals under 24. Close monitoring is necessary for teens taking these medications.

Behavioral Therapy:

Cognitive-Behavioral Therapy (CBT): Behavioral therapy, particularly exposure therapy, helps individuals identify and modify anxious thought patterns.
Exposure Therapy: Gradual exposure to feared social situations helps desensitize individuals to their anxiety triggers, teaching the brain that these situations are not as threatening as perceived.
Advantages of Behavioral Therapy: Unlike medication, behavioral therapy addresses the underlying causes of social anxiety disorder, reducing the likelihood of symptoms returning after treatment cessation.

Other Therapies:

Relaxation Therapy: Techniques such as breathing exercises and meditation can help manage specific social phobias but are not considered effective for general social anxiety disorder.
Beta-Blockers: These medications, primarily used for heart conditions, can alleviate symptoms of performance social anxiety (e.g., public speaking) but are not effective for general social anxiety disorder.

Each individual may respond differently to treatment, so it’s essential to work closely with a healthcare professional to determine the most effective approach for managing social anxiety disorder. Additionally, never discontinue medication abruptly without consulting a doctor, as it may lead to serious side effects.

Side Effects of medicines used to treat social anxiety

Medications used to treat social anxiety disorder can have side effects, which vary depending on the type of medication and individual response. Here’s an overview:

Antidepressants (SSRIs and SNRIs):
- Common side effects may include nausea, headache, dizziness, drowsiness, insomnia, and sexual dysfunction.
- Some individuals may experience weight gain or loss, dry mouth, blurred vision, or gastrointestinal issues.
- SSRIs and SNRIs can also increase the risk of suicidal thoughts, particularly in young adults, so close monitoring is essential, especially when starting or adjusting the medication.
Anti-Anxiety Medications:
- These medications, such as benzodiazepines, may cause drowsiness, dizziness, confusion, blurred vision, and reduced coordination.
- Long-term use of benzodiazepines can lead to tolerance, dependence, and withdrawal symptoms upon discontinuation.
- They are usually prescribed for short-term relief due to the risk of tolerance and dependence.
Beta-Blockers:
- Beta-blockers can cause fatigue, dizziness, weakness, and cold hands or feet.
- Less common side effects may include shortness of breath, slow heart rate, and gastrointestinal issues.

Onset of Action for the drugs used in treating anxiety

Antidepressants (SSRIs and SNRIs):
- These medications typically take several weeks to reach their full therapeutic effect. It’s essential to continue treatment as prescribed, even if improvement is not immediate.
Anti-Anxiety Medications:
- Anti-anxiety medications, such as benzodiazepines, act quickly to alleviate symptoms but are generally not recommended for long-term use due to the risk of tolerance and dependence.
- They may be prescribed for short-term relief while waiting for the antidepressant to take effect.
Beta-Blockers:
- Beta-blockers work rapidly to alleviate specific symptoms of anxiety, such as tremors or palpitations but do not address underlying psychological symptoms or depressive symptoms.

Consultation with Healthcare Provider:

It’s essential to discuss potential side effects and expected onset of action with your healthcare provider or psychiatrist before starting medication.
Close monitoring and regular follow-up appointments are crucial to assess treatment response, manage side effects, and make any necessary adjustments to the medication regimen.

Effect of Untreated Social Anxiety Disorder

If left untreated, social anxiety disorder can have a significant negative impact on various aspects of life.
It may lead to poor educational outcomes, decreased job performance, difficulties in relationships, and a diminished quality of life.
Untreated social anxiety disorder also increases the risk of developing other mental health conditions such as major depression or alcohol use disorder.

Duration of Social Anxiety Disorder

Without treatment, social anxiety disorder can persist for a person’s lifetime.
However, with appropriate intervention, individuals can learn to manage their symptoms effectively and lead fulfilling lives despite their social anxiety.
Treatment aims to help individuals develop coping strategies and skills to navigate social situations without being overwhelmed by anxiety.

Social Anxiety vs. Shyness:

Anyone can feel shy sometimes. Social anxiety disorder is different because it significantly disrupts daily life. People with social anxiety might struggle to go to the store or talk to others, harming their education, work, and relationships. Shyness typically doesn’t cause such problems.

Here are the key differences between social anxiety and shyness:

Impact on daily life: Social anxiety disrupts daily activities much more than shyness.
Intensity of fear: Social anxiety involves more intense fear and anxiety.
Avoidance behavior: People with social anxiety tend to avoid certain situations more than shy people.

Remember, seeking help for social anxiety disorder is not a sign of weakness but a proactive step toward improving your mental health and overall well-being. Your doctor can guide treatment options and support you in navigating the challenges posed by social anxiety.

10 tips to overcome social anxiety

Overcoming social anxiety disorder often requires treatment, but there are steps you can take to manage symptoms and improve your quality of life:

1. Seek Treatment:

Cognitive behavioral therapy (CBT) and medications like antidepressants have been shown to be effective in treating social anxiety disorder.
Talk to a healthcare provider about treatment options that may be suitable for you.

2. Maintain Healthy Habits:

Get enough sleep and engage in regular physical exercise, which can help reduce stress and improve overall well-being.

3. Avoid Substance Use:

Avoid alcohol and recreational drugs, as they can worsen symptoms of social anxiety and interfere with treatment effectiveness.

4. Medication Compliance:

If you’re prescribed medication for social anxiety disorder, take it regularly as directed by your healthcare provider. Don’t skip doses or discontinue medication without consulting them first.

5. Attend Therapy Sessions:

If participating in talk therapy, such as CBT, attend sessions regularly and actively engage in the therapeutic process.

6. Seek Support:

Reach out to trusted family and friends for support and understanding. They can provide encouragement and help you feel less alone in managing social anxiety.

7. Consider Support Groups:

Joining a support group for individuals with social anxiety disorder can offer a sense of community, shared experiences, and additional coping strategies.

8. Regular Healthcare Check-Ins:

Schedule regular check-ups with your healthcare provider to monitor your progress and discuss any concerns or changes in symptoms.

9. Open Communication:

Be open and honest with your healthcare provider about your symptoms, treatment progress, and any challenges you may be facing. They can provide guidance and adjustments to your treatment plan as needed.

10. Don’t Hesitate to Reach Out:

If you experience worsening symptoms or feel that your treatment isn’t effective, don’t hesitate to contact your healthcare provider. They can provide additional support and adjustments to your treatment approach.

10 tips to help someone with social anxiety

Supporting someone with social anxiety disorder requires patience, empathy, and understanding. Here’s how you can help:

1. Educate Yourself:

Take the time to learn about social anxiety disorder to gain insight into their experiences and challenges. Avoid making assumptions and seek reliable information from reputable sources.

2. Practice Empathy:

Show compassion and understanding towards their feelings and experiences. Validate their emotions and avoid minimizing or dismissing their struggles. Try to imagine how you would feel in their situation.

3. Encourage Seeking Help:

Encourage them to seek professional help from a healthcare provider, therapist, or psychiatrist. Social anxiety disorder is a medical condition that often requires cognitive behavioral therapy (CBT) and/or medication for effective treatment.

4. Offer Support:

Be a supportive presence in their life by actively listening to their concerns, offering encouragement, and providing reassurance when needed. Let them know that you’re there for them without judgment.

5. Be Patient:

Understand that recovery from social anxiety disorder takes time and may involve setbacks along the way. Be patient and supportive throughout their treatment journey, acknowledging their progress and efforts.

6. Respect Their Boundaries:

Respect their boundaries and avoid pressuring them into social situations that may trigger anxiety. Offer support without pushing them out of their comfort zone too quickly.

7. Practice Acceptance:

Accept them for who they are, including their social anxiety disorder. Avoid criticizing or judging their behavior, and instead focus on fostering a supportive and non-judgmental relationship.

8. Offer Practical Assistance:

Offer practical support, such as accompanying them to therapy appointments or helping them find resources for treatment. Be willing to assist them in accessing the care they need.

9. Be a Positive Influence:

Encourage positive coping strategies, such as mindfulness, relaxation techniques, and self-care practices. Lead by example and promote healthy habits that can help alleviate anxiety symptoms.

10. Maintain Communication:

Keep communication open and honest, allowing them to express their feelings and concerns freely. Check in regularly to see how they’re doing and offer your ongoing support.

Sources

Anxiety Disorders Association of America: “Social Anxiety Disorders.”, “Anxiety Medications and Kids.”
National Institute of Mental Health: “A Real Illness: Social Phobia” and “Facts About Social Phobia.”
Facts for Health: “Social Anxiety, Medications (Pharmacotherapy) and Ineffective Treatments.”
Clevland clinic: “Social Anxiety Disorder.”
Medline: “Anxiety Disorders.”
National Institute of Mental Health: “Social Phobia.”
Schneier, F. Archives of General Psychiatry, 1992.
Barlow, D. “Psychosocial treatments for panic disorders, phobias, and generalized anxiety disorder” in: A Guide to Treatments that Work, Nathan, PE, and Gorman, JM (Eds), Oxford University Press, New York, 1998.
Mayo Clinic: “Social Anxiety Disorder.”
Andrew Kukus Foundation for Social Anxiety: “What is social anxiety?”
Anxiety and Depression Association of America: “Social Anxiety Disorder.”