What is Social Anxiety Disorder?
It is not unusual to be nervous or a bit self-conscious from time to time. Perhaps you have become anxious giving a speech or meeting your partner’s parents for the first time. This kind of anxiety is normal and natural. It will not affect the quality of your life and actually has a useful purpose. People with social anxiety disorder (SAD), however, suffer intense fear of social interaction when they think they may be scrutinized or negatively evaluated by others. Fears can include believing they will be judged as crazy, weak, boring, stupid, unlikable, or dirty. People with social anxiety disorder also fear appearing anxious, specifically if others observe them blushing, shaking, trembling, sweating, or stumbling to find words.
The sufferer fears that this will result in being negatively evaluated and or rejected. Some sufferers experience a fear response believing they are offending others with a gaze or by merely experiencing anxiety symptoms in the presence of someone. In cultures where the principle of giving a group priority over each individual in it is present, the fear response may increase. Individuals with SAD often avoid situations where a negative evaluation might occur. Social anxiety disorder can and does significantly affect the quality of a sufferers life. There is, however, effective treatment.
What makes a person susceptible to SAD?
The exact cause of social anxiety is unknown. According to research, a combination of environmental factors and genetics influences social anxiety. Adverse experiences may also contribute to this disorder. Temperament – if an individual exhibits behavioral wariness and fear of a negative evaluation early in life, they are more susceptible to developing social anxiety disorder. Environmental risk factors, childhood maltreatment, and adversity are risk factors for having social anxiety. Traits predisposing individuals to social anxiety include genetic loading for behavioral inhibition. Children who exhibit behavioral inhibition are more susceptible to learning socially anxious behaviors from an anxious parent. First-degree relatives have a 2-6 times greater chance of having social anxiety disorder.
What triggers SAD?
Situations that can be embarrassing or humiliating include being teased or criticized, meeting new people, being called on in class, public speaking, making small talk, eating in public, being the center of attention, being observed while doing something, using public bathrooms, meeting new people, parties, performing on stage, dating, speaking up in a group of people, phone calls, being in small or large groups. Additional situations that can cause anxiety are talking to someone in authority, starting a conversation, maintaining a conversation, silence during a conversation, making eye contact, social media, sending a text or email, having a job interview, expressing a personal opinion, being assertive, leaving a recorded message on someone’s email, reading out loud in front of others, making a mistake in public, having someone review your online profile.
Social anxiety triggers generally occur in either interpersonal or performance situations. This list is, of course, not all-inclusive. Each individual will have a unique set of triggers and accompanying neutralizing thoughts and/or behaviors.
Signs and symptoms
While we all experience fear and anxiety from time to time, it is usually justified. In fact, without anxiety and fear, we would not move out of the way of a speeding bus, and you would not be here reading this page. Fear and anxiety are normal and natural. Fear creates an urge that motivates us to take action to survive. By design, anxiety/fear are uncomfortable. They activate our entire system making a profound and powerful statement. Therefore if you are socially anxious, it is powerfully uncomfortable, and you are likely to avoid people, situations, or events that make you anxious.
Here are some physical symptoms a person with social anxiety experiences, racing heart, tightness in the chest, feeling dizzy, faint, shortness of breath, sweating, nausea, hollowness in the stomach or butterflies, blushing, shaking or trembling, shaky voice. Thinking also changes when we become anxious. Our brains begin to selectively abstract. When anxious, we react as if it is safer to use resources to look for danger than relax vigilance and be caught unprepared. A person with SAD may become hyper self-conscious. The individual may worry for days, weeks, or longer over some imagined concern from a previous conversation. They may spend excessive amounts of time preparing for a minor presentation to a group. The list goes on and is unique to each sufferer.
Finally, our nervous system is wonderful, tremendously complex, and very effective in maximizing our chance for survival. Most often, our sympathetic nervous system responds to our perception of danger. It does not make a distinction between the perception of danger and experiential evidence of danger. If we are conditioned to or think there is a danger, it will engage in protecting us. When our nervous system is engaged to perceive a social situation as “dangerous,” it will often conclude that behavioral avoidance is the safest option. This avoidance of social situations can limit activities, loving, and intimate connections and careers. Avoidance significantly disrupts daily life and a person’s ability to build a life that is preferred and is worth living.
The median age of onset is age 13, and 75% of young people have a period of onset between 8 and 15 years of age. Sometimes the disorder emerges from an individual with a temperament that includes behavioral inhibition and fear of negative evaluation. SAD can follow people throughout their entire life, presenting problems at any age. You may suffer more as you age without appropriate intervention.
The onset of social anxiety disorder can follow a stressful or humiliating event, including being bullied or publicly shamed. It may also develop slowly over time. It is relatively rare for a first onset to come as an adult. If so, it is more likely to occur after a stressful or humiliating event or following life changes that require new, unfamiliar social roles. Furthermore, people who suffer from SAD are at a higher risk of school dropout. This disorder may also cause risks of decreased well-being, employment, workplace productivity, socioeconomic status, and quality of life issues. Only about half of those who suffer from SAD seek treatment, and it generally takes 15-20 years of experiencing symptoms before doing so.
Roughly 7% of the population of the U.S, about 15 million people, suffer from social anxiety disorder. In general, social anxiety disorder is found more frequently in women than in men in the general population. Gender rates are equal or more pronounced for males in adolescents and young adulthood, however. SAD runs in families.
The following criteria are used to identify characteristics of SAD.
- The individual exhibits significant fear or anxiety about being scrutinized by others in one or more social situations. For example, he/she may be anxious about negative evaluations when conversing, meeting new people, eating or drinking, or performing in front of others.
- The individual is afraid of negative evaluation by others due to acting in a certain way or showing anxiety symptoms. The person fears humiliation, embarrassment, and potential rejection.
- Social situations almost always provoke fear and anxiety.
- Sufferers avoid social situations are or endured them with intense fear or anxiety.
- This fear or anxiety is out of proportion to the actual threat posed by the social situation.
- The fear and anxiety cause significant distress that interferes with the person’s quality of life. Areas of impairment may include their job and other activities of daily living.
- The fear is not the result of substance use, medication, or another medical condition.
- Rule out panic disorder, body dysmorphic disorder, autism spectrum disorder as causes of fear.
- If another medical condition (e.g., Parkinson’s, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
- Performance only specifier: Individuals with performance only SAD do not fear or avoid nonperformance social situations.
Treatment for SAD
There are many different kinds of psychotherapies for many kinds of problems. Choose a treatment that is empirically supported, effective at helping the issue from which you are suffering. Cognitive Behavioral Therapy (CBT) and Psychopharmacology have been shown to be effective in treating social anxiety disorder. Four general approaches used to effect change in social anxiety are:
- Exposure based strategies are effective in helping face feared situations in a gradual way, repeatedly until they no longer produce unjustified fear.
- The teaching of fundamental interpersonal skills is essential.
- Cognitive strategies used to identify and change unhelpful and distorted thoughts and beliefs that are maintaining social anxiety.
- Mindfulness strategies designed to help accept what is out of one’s control to reduce the pain of resistance to reality.
Medication for SAD
There are are often differing opinions in the medical community regarding medication strategies for SAD. Antidepressants are the most frequently recommended medications for social anxiety. Other types of medication used to manage symptoms of SAD include anti-anxiety medications, anticonvulsants, antipsychotics, beta-adrenergic blockers. Please consult a medical professional prior to taking any medication for SAD. Find a doctor experienced in the treatment of SAD.
It has been my experience that having social anxiety disorder significantly impedes an individual’s potential and growth. SAD sufferers are individuals who are often very intelligent, talented, and creative. It can be difficult to take your first step toward treatment. Making a call to ask question may be a good place to start. Our treatment center is near you providing empirically based treatment for SAD. Feel free to contact me if you suspect you or someone you care about has Social Anxiety Disorder. MSAM provides services to Philadelphia and areas surrounding Philadelphia including Montgomery County, Delaware County and the Main Line.