Social Anxiety Disorder

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:

Low self-esteem

Trouble being assertive

Negative self-talk

Hypersensitivity to criticism

Poor social skills

Isolation and difficulty in social relationships

Low academic and employment achievement

Causes:

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:

Physical Symptoms

  • Shortness of Breath
  • Excessive Sweating
  • Blushing
  • Blurred Vision
  • Shaking
  • Dry Mouth
  • Trembling Voice
  • Palpitations
  • Muscle Tension
  • Nausea
  • Headaches
  • Numbness or tingling in extremities
  • Dizziness
  • Chest tightness

Behavioral Symptoms

  • 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

Emotional Symptoms

  • 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

Cognitive Symptoms

  • 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

Diagnosis:

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

Treatment:

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 – 

Anti-anxiety medications

Antidepressants

Beta-blockers

Social Anxiety Disorder

SAD (Social Anxiety Disorder)

What is SAD?

Social anxiety disorder (SAD) more commonly referred to as social anxiety or social phobia is an inherent mental health issue characterized by senseless anxiety due to social interactions.

According to a research paper drafted by Phillip Jefferies and Michael Ungar, Social anxiety occurs when individuals fear social situations in which they anticipate negative evaluations by others or perceive that their presence will make others feel uncomfortable. (cited:

.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239133

It is an intense persistent fear of being watched and judged by others. This fear can affect work, school and other day-to-day activities. It can even make it hard to keep friends. (cited:

https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness

According to some rough SAD statistics, this disorder affects about 7.1 percent of the population, 8 percent of women and 6.1 percent of men.

Though SAD can affect people regardless of age or gender, research points towards a general early (teenage) onset of social anxiety due to reasons unknown or some underlying trauma.

Causes of SAD

Social anxiety may have a plethora of underlying causes yet in some cases the disorder might be sudden and unexplained.

Ever since it was officially recognized as a disorder in 1980 by the American Psychiatric Association, scientists all over the world have been trying to identify and understand the causes of social anxiety disorder (SAD).

Like for most psychological conditions, the majority of contemporary professionals agree upon the idea that SAD is caused by a combination of genetics as well as environmental and socioeconomic factors.

What this means is that there is hardly one specific root cause of social anxiety, but rather a variety of factors that can lead to a certain vulnerability that favours its development. (Cited:

https://www.conquersocialanxiety.com/causes/

Social anxiety may also be directly linked to low confidence and constant self blame.

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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. However, it isn’t entirely clear how much of this may be due to genetics and how much is due to learned behaviour.
  • Brain structure. A structure in the brain called the amygdala (uh-MIG-duh-luh) 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.
  • Environment. Social anxiety disorder may be a learned behaviour — some people may develop significant anxiety after an unpleasant or embarrassing social situation. Also, there may be an association between social anxiety disorder and parents who either model anxious behaviour in social situations or are more controlling or overprotective of their children. (cited:

https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561

SYMPTOMS

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Getselfhelp.co.uk

Symptoms of SAD include physical, behavioural or cognitive changes that are often dead giveaways of some underlying issue.

Emotional and Behavioural Signs:

The following emotional and behavioural symptoms may show up in people with social anxiety:

  • Fearing situations where you might be judged
  • Fear of showing physical symptoms such as blushing, trembling, sweating, or an unsteady voice
  • Worrying you will embarrass or humiliate yourself
  • Intense fear of interacting with strangers
  • Avoiding any situation in which you will being the centre of attention
  • Getting anxiety in anticipation of an activity or event
  • Avoiding going places or speaking to people out of fear of embarrassment
  • Fearing people will notice your anxiety
  • Spending significant time analysing and critiquing the way you acted in a social situation
  • Expecting the worst outcomes from a negative social experience

For children, emotional and behavioural signs may include: 

  • Crying
  • Throwing temper tantrums (outbursts of crying and anger)
  • Clinging to parents or guardians
  • Refusing to speak to people 

Physical Signs:

Some of the external signs of social anxiety disorder include:

  • Blushing
  • Rapid heartbeat
  • Sweating
  • Difficulty catching your breath
  • Shaking
  • Nausea or upset stomach 
  • Light-headedness or dizziness
  • Tight muscles 

Social Signs:

One of the main signs of social anxiety is avoiding social situations. Someone with this disorder may avoid or find difficulty being in the following situations: 

Treatment and Self help

As established SAD is a disorder that requires thorough medical attention, which may include therapy, meditation, courses for instilling confidence etc.

  • Psychotherapy. Psychotherapy improves symptoms in most people with social anxiety disorder.
  • First choices in medications. Though several types of medications are available, selective serotonin reuptake inhibitors (SSRIs) are often the first type of drug tried for persistent symptoms of social anxiety.
  • Other medications. Other antidepressants. You may have to try several different antidepressants to find one that’s the most effective for you with the fewest side effects.
  • Stick with it. Don’t give up if treatment doesn’t work quickly. You can continue to make strides in psychotherapy over several weeks or months.
  • Alternative medicine. Several herbal remedies have been studied as treatments for anxiety. Results tend to be mixed, and in several studies people report no benefits from their use. (Reference: www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/diagnosis-treatment/drc-20353567

Thinking Differently


When we’re in a social situation with a group of people, our focus of attention becomes totally caught up in our own thoughts and feelings.  We see everyone around us, but all we can think about is how they might be thinking critically about us!  The adrenaline response of anxiety makes us feel terrible too, so we’re thinking about how horrible that is, and how we just want to escape the situation. 

It is very helpful to learn how to change our focus of attention and take more control over how we react to thoughts.  We can learn to just notice the thoughts, acknowledge them, then let them pass.  Notice the Mind Bully and let it go – turn your focus of attention to something else.  First of all, you might learn to focus on your breathing.

Practise Mindful Breathing

(cited: https://www.getselfhelp.co.uk/socialanxiety.htm

Conclusion

In conclusion, social anxiety is the third most common disorder worldwide that affects millions of unsuspecting individuals every year throughout the world. It is high time that we treat social anxiety patients with respect and consideration and give this disorder its due attention without tiptoeing around it.

It is also absolutely essential for people suffering with SAD to seek medical help(easier said than done) but one has to start somewhere.

Lastly, there should be no embarrassment in seeking professional help and it should be absolutely normalised.

A strong will to overcome anxiety, is the guaranteed first step in the long overdue chain of recovery.

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