Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder that involves intense fear of social settings. Everyday interactions can cause a significant amount of anxiety, and self-consciousness, due to the constant fear of being scrutinized and judged negatively by people. According to ICD-10 guidelines, the main diagnostic criteria of social phobia are fear of being the center of attention or behaving in a way that will be embarrassing or humiliating.
People experience anxiety in several social situations, from meaningful encounters to everyday trivial ones. They can experience overwhelming anxiety or fear in social situations, such as meeting new people, being on a job interview, answering a question in class, talking to a cashier in a store, answering the phone and making new friends. Even everyday things like eating or drinking in front of others or using a public restroom may cause anxiety. Social anxiety disorder is referred to an illness of lost opportunities where “individuals make major life choices to accommodate their illness”.
Social anxiety disorder is known to appear at an early age in most cases. 50% of people with this disorder develop it by the age of 11, and 80% develop it by age 20. This early age of onset may lead to people with social anxiety disorder being particularly vulnerable to depressive illnesses, substance use, and other psychological conflicts. Generally, social anxiety begins at a specific point in an individual’s life, which develops over time as the person struggles to recover. Eventually, mild social awkwardness can develop into symptoms of social anxiety or phobia.
Social anxiety isn’t the same as just “shyness”. Shyness is short-term and doesn’t impact daily life majorly or lead to excessive social avoidance. Whereas social anxiety is persistent, interferes with everyday life, and disrupts one’s ability to attend school, work, and develop close relationships. This disorder could lead to the following:
Trouble being assertive
Hypersensitivity to criticism
Poor social skills
Isolation and difficulty in social relationships
Low academic and employment achievement
Research into the causes of social anxiety and social phobia is wide-ranging with encompassing multiple perspectives. Scientists haven’t yet figured out the exact cause. Studies suggest that genetics can play a part in combination with environmental factors.
Genetics: Anxiety disorders tend to run in families. Studies suggest that parents of people with social anxiety disorder tend to be more socially isolated themselves, and shyness in adoptive parents is associated with shyness in adopted children. Growing up with overprotective and hypercritical parents has also been associated with social anxiety disorder. Adolescents who found having an insecure (anxious-ambivalent) attachment with their mother as infants were twice as likely to develop anxiety disorders by late adolescence, including social phobia
Brain structure: A structure in the brain called the amygdala could play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing more anxiety in social settings.
Social Environment and Experiences: A social anxiety disorder may be a learned behaviour. Half of the people diagnosed had the anxiety worsened due to a specific traumatic, unpleasant or embarrassing social situation. Direct experiences, observing or hearing about the socially negative experiences of others, or verbal warnings of social problems and dangers, may also make the development of a social anxiety disorder more likely. Longer-term effects of not fitting in or being bullied, rejected, or ignored are also causes.
Signs and Symptoms:
- Shortness of Breath
- Excessive Sweating
- Blurred Vision
- Dry Mouth
- Trembling Voice
- Muscle Tension
- Numbness or tingling in extremities
- Chest tightness
- Avoiding what makes you anxious
- Fidgeting or other nervous actions
- Isolating yourself and limiting actions related to the social situation
- Leaving or escaping from a feared social or performance situation
- Fear of rejection, humiliation
- Worrying about being left out or being unable to overcome anxiety
- Feeling defeated as if there is something “wrong” with you
- Feeling exposed or vulnerable around others
- Racing thoughts
- Worrying about what people will think
- Believing everyone is looking at you or judging you
- Thinking it is not worth the discomfort of trying to socialize
- Assuming the worst about a situation or interaction
- Analyzing social interactions after it’s over
- Negative evaluations of yourself
Clinicians use a predetermined set of criteria to diagnose SAD, also known as the DSM-5. The following is an overview, which also corresponds to its presentation and help with the understanding of social anxiety disorder.
Fear or anxiety is evident in social situations, where possible scrutiny may be experienced.
Aversion to situations in order to avoid getting embarrassed, humiliated, or rejected.
If the person is able to endure it, it is often done with intense fear or anxiety
Anxiety experienced by an individual that is not proportional to the situation
If the fear or anxiety has lasted for 6 months or longer.
When an individual experiences anxiety or distress that affects their daily living
Anxiety or fear that is not associated with a medical condition, medication or substance abuse
Treatments depend on the severity of your emotional and physical symptoms and how well you function daily. The length of treatment also varies. Some people may respond well to initial treatment and not require anything further, while others may require some form of support throughout their lives.
Cognitive Behavioural Therapy: CBT is the first-line psychotherapeutic treatment for this disorder. It is a type of psychotherapy useful for treating social anxiety disorder. CBT teaches you different ways of thinking, behaving, and reacting to situations that help you feel less anxious and fearful. It can also help you learn and practice social skills. CBT delivered in a group format can be especially helpful.
Psychoanalysis: Psychoanalysis and psychodynamic therapy involve a therapist helping you to understand underlying issues from childhood that may have contributed to your social anxiety. It is most useful for people who have deeper unresolved conflicts contributing to their anxiety. Psychoanalysis may also be useful in some instances to explore potential resistance to change.
Support Groups: Many people with social anxiety also find support groups helpful. In a group of people who all have a social anxiety disorder, you can receive unbiased, honest feedback about how others in the group see you. This way, you can learn that your thoughts about judgment and rejection are distorted. You can also learn how others with social anxiety disorder approach and overcome the fear of social situations.
Medication: There are three types of medications used to help treat social anxiety disorder –