Social anxiety disorder or social phobia refers to the intense anxiety experienced due to fear of being judged, embarrassed, rejected, or humiliated when in a social setting or performance situation.
Those who suffer from this disorder know that their fear is unreasonable but yet, are still unable to control it. They are often viewed as shy or socially awkward by the people around them.
According to the Anxiety and Depression Association of America, this disorder is the second most diagnosed anxiety disorder and there are about 15 million American adults who are suffering from it.
Social anxiety disorder usually develops in the teenage years and research shows that 80% those who are diagnosed with this disorder are likely to also experience another psychiatric disorder during their lifetime.
It is a disorder that will disrupt daily life if proper treatment is not given.
Causes of social anxiety disorder
Social anxiety disorder is most likely caused by both biological and environmental causes. Genetics can influence brain structure and give some people a heightened response to fear and anxiety.
There is also evidence that shows that a person is more likely to have anxiety if a family member has it. This can be due to both genetics and/or learned behaviour.
Environmental factors can also cause a person to develop anxiety. Some people may start to fear social interactions after an embarrassing social situation. Children may pick up that their parents feel anxious in social situations and learn this behaviour. Overprotective parents may also cause their children to develop fears that might hinder them from being confident in social situations.
Signs and symptoms of social anxiety disorder
Signs and symptoms can be both psychological and physiological. If you have a mild social anxiety disorder, these signs may be limited and selective. For example, you may feel anxious only when you have to ask a question in class, or when you have to eat in public. If you have an extreme case, the symptoms may occur in all social settings.
- Constant worry about being humiliated or embarrassed in a social situation
- Intense worry about social situations
- Feeling anxious for days or weeks before a social event
- Worrying that you will be noticed or judged because you are anxious, especially in a social situation
- Avoiding social events
- Using alcohol so that you can attend an event or face a social situation.
- Increased or rapid heart rate
- Feeling nauseous
- Feeling dizzy or lightheaded
- Finding it hard to speak
In order to avoid the anxiety that occurs, a person with a social anxiety disorder will most likely avoid asking questions in social situations, avoid eating in public, using public toilets or even avoid going shopping. They may refuse to talk on the phone or go for a job interview because of their fear of being embarrassed if they make a mistake or say the wrong thing.
One study showed that those who have this anxiety disorder have fewer friends and have more difficulty maintaining friendships while another study shows that they are less likely to get married, less likely to have children and more likely to divorce.
Additionally, another research reported that those who have social anxiety disorder were less productive because of their symptoms and took more days off work.
How is social anxiety disorder diagnosed?
Your doctor will diagnose this anxiety disorder from the symptoms that you show and describe. You will most likely be asked to explain your symptoms as well as to describe the situations when you feel anxious.
Your doctor will look out for descriptions of constant fear of situations, and feelings of fear and worry before a social interaction. Additionally, your doctor may also ask if you realize that your fears are irrational and whether or not the anxiety that you experience disrupts day to day activities.
There is no need to feel humiliated or embarrassed if you are experiencing these symptoms. Be honest with your doctor so that the right and most effective treatment can be prescribed for you.
Social anxiety disorder treatment
There are several types of treatment that can help you to manage and overcome social anxiety disorder. Do be aware of your options and discuss the best treatment plan with your doctor. It may take some trial and error before the most effective therapy and/or medication is found for you.
Cognitive behaviour therapy
One of the best ways to treat social anxiety disorder is with cognitive behaviour therapy (CBT). This psychotherapy aims to address negative and distorted thought patterns that result in negative feelings and behaviour. According to CBT, your perception of the situation determines how you feel. Thus, you can change the way you feel by changing the way you think.
Cognitive restructuring or thought challenging in CBT is a process whereby negative and irrational thoughts are replaced with positive and realistic thoughts.
Your therapist will most probably work with you to identify your negative thoughts. You will then be taught to evaluate these thoughts and by doing so, challenge the negative thinking pattern. Once you have done so, your therapist will teach you to replace the negative and irrational thoughts with those that are realistic and positive.
In CBT you will also most likely learn how to recognize when you start to feel anxious, and coping skills and techniques such as deep breathing.
Changing years of faulty thinking can take time so be patient with yourself. Press on in your CBT therapy until you start to see results.
People with anxiety will usually avoid the anxiety trigger. For example, a person with a fear of dogs may avoid all parks because there may be dogs there. A person who has social anxiety disorder may want to avoid events such as birthday parties or social gatherings.
The problem is when the fears are avoided, there is no chance of overcoming them. Instead, avoiding the fears only cause the fears to have more hold on your life.
Exposure therapy deals with the avoidance and exposes you to the anxiety trigger. It is based on the premise that the more you are exposed to the trigger stimuli, the more control you will have and thus, anxiety will lessen.
Exposure therapy is usually carried out in a safe environment and in stages. Therapists often use systematic desensitization to help you challenge your fears and build confidence.
This technique starts with baby steps. If you are afraid of going to birthday parties, your therapist might start off by showing you pictures of birthday parties and then followed by watching a video of birthday parties. The aim is to get you to a place where you can manage and overcome your anxiety by facing your fear.
Group therapy helps those who have social anxiety disorder by allowing one to practice being in a social setting. Social and interaction techniques can be learnt and by learning these skills, one’s confidence in social settings can be built. Group therapy enables role-playing to prepare one for interactions that they might have.
Anti-anxiety medications, antidepressants and beta-blockers are used to help treat social anxiety disorder.
Anti-anxiety medications are quite powerful and usually only used if the case is very severe. These medications are immediately effective but patients can build up a tolerance to it. Thus, higher and higher doses are needed to get the same effect. Anti-anxiety medications are usually prescribed only for a short duration.
As the name suggests, antidepressants are primarily used to treat depression. However, they are also used to help manage social anxiety disorder symptoms. Antidepressants take time to be effective and you may need up to several weeks before you feel its full effect.
People who are on antidepressants may also feel side effects such as problems sleeping, headaches and nausea. Side effects are usually mild but do inform your doctor if you experience it. Additionally, your doctor would have weighed that the benefits of taking antidepressants far outweigh the negative side effects that you might experience.
Beta-blockers refer to medication that decreases physical symptoms of anxiety that occur in the body, such as rapid heart rate, shaking and sweating. This medication is usually used for those who experience social anxiety due to having to ‘perform’. For example, a person who is unable to attend a job interview may be prescribed beta-blockers.
Medication is sometimes used together with psychotherapy for better treatment results. Do be aware that you should not stop your medication without informing your doctor as some medications might cause withdrawal symptoms. Always consult your doctor if you think you need to change your dosage or stop your medication.
Besides therapy and medication, people who suffer from this anxiety disorder may also find help and comfort from support groups. Just knowing that you are not alone in this journey can help a lot. Support groups function to give unbiased and honest feedback as well as help one to learn ways to manage and overcome the anxiety caused by social situations. The group can also act as a mirror and let you discover how your anxious thoughts are irrational or distorted.
What can you do at home?
While these are in no way a substitute for treatment, here are several things you can do at home to help overcome anxiety.
Avoid alcohol, caffeine and nicotine
Alcohol, caffeine and nicotine can cause as well as make anxiety worse. If you have an addiction to alcohol or nicotine, seek professional help. Quitting on your own might be hard, but with the right support, it is not impossible.
Get enough rest
Our bodies need to rest and it is recommended that a person gets a minimum of 8 hours of sleep per 24 hours. Sleep deprivation can cause anxiety to worsen and symptoms to be more intense. Getting enough rest helps our bodies to heal.
Have a balanced diet
A balanced diet is important for both physical and mental health. While this is not a substitute treatment plan, a healthy diet that provides you with the nutrition and energy that you need can help put you in a better mood.
What happens if a social anxiety disorder is left untreated?
If left untreated people who have a social anxiety disorder may turn to high to high-risk behaviours such as relying on drugs and alcohol. They may feel extremely lonely because they are afraid of social interactions. They may also have suicidal thoughts.
This is definitely a cause for concern as the Anxiety and Depression Association of America reported that up to 36% of people who have social phobia do not disclose their condition to health professionals until they have suffered from the symptoms for at least 10 years.
Social anxiety disorder can disrupt your life but with the proper treatment, there is a good outlook. Be aware of the triggers that cause you to dwell in fear and worry and seek help from health professionals if you feel that you may have this disorder. You do not have to let social phobia control your life.