Social Anxiety Disorder by Gillian Friedman M.D.
Also called social phobia, social anxiety disorder involves a fear of
being in social situations where one can be judged, criticized or negatively
evaluated by others. It is a common but under-recognized problem, affecting
about 13 percent of the population at some time during their lives.
Social anxiety can be limited to a single social situation, such as
speaking in front of groups (a specific social phobia), or it can be
generalized to multiple social situations or environments where individuals
feel conspicuous. Common situations that can trigger anxiety include
being introduced to others, being watched while doing something (like
eating), meeting important people, being asked to say something in front
of a group, making small talk at parties, returning items at a store
or restaurant, making telephone calls to strangers or having to leave
a message on a voicemail.
Symptoms that occur with social anxiety can include nervousness, racing
heart, sweating, nausea, dry mouth, trembling, intense fear, embarrassment,
humiliation and self-judging, critical thoughts. When social anxiety
occurs, people often become even more embarrassed that others will notice
their anxiety, and further attention will be drawn to them. Socially
anxious individuals can never fully relax in the presence of others.
They are continually self-conscious, haunted by the possibilities of
what others might think of them.
Anxiety attacks or panic attacks can occur within a number of anxiety
disorders besides social anxiety disorder. Social anxiety disorder,
however, can be distinguished from other common anxiety disorders, such
as generalized anxiety disorder (GAD) and panic disorder, by the situations
and thoughts that trigger anxiety symptoms. People with generalized
anxiety disorder worry excessively throughout the day about multiple
events and situations, but the worry is not specific to social evaluation.
Individuals with panic disorder experience anxiety mainly as discrete
attacks with some of the same symptoms that are seen in social anxiety
(sweating, racing heart, nausea, etc.), but their fear is that there
is something medically wrong with them (i.e. they’re having a
heart attack or suffocating). In contrast, people with social anxiety
disorder generally know that anxiety and fear are causing their symptoms.
Social anxiety can cause significant impairment in employment and social
functioning. Socially anxious people may keep jobs far below their skill
level because they are fearful of job interviews, social contact in
the office or having to supervise others. Their social circles can become
limited to only immediate family, or in severe cases to no one at all.
The most effective treatment for social anxiety disorder is a type of
therapy called Cognitive-Behavioral Therapy or CBT. Through a series
of structured exercises, socially anxious individuals learn to identify
the negative thoughts that are accompanying their anxiety. They also
learn common ways that thinking becomes distorted in emotionally charged
situations, and learn to generate more neutral alternatives. The therapy
also teaches skills for distracting from anxiety when it starts to occur
(focusing the mind on something else so the anxiety is less noticeable).
Individuals then practice more neutral thoughts by using behavioral
experiments to gradually attempt some of the activities that were previously
anxiety-producing. The experiments help people with social anxiety watch
for evidence about others’ reactions instead of just making negative
assumptions. Therapy groups specific for social anxiety help them practice
fearful activities (looking people directly in the eye or doing foolish
things in front of other people) in a safe environment.
Medications can sometimes help social anxiety disorder, but are most
effective when used in conjunction with CBT. Antidepressant medications,
particularly those that work on the brain chemical serotonin, may decrease
the intensity of generalized social anxiety. For people with specific
social phobias, like public speaking, medications called beta-blockers
can prevent some the physical manifestations of anxiety such as racing
heartbeat and sweating, although they do not target thoughts or fears.
In some instances, anxiolytic medications (such as Valium or Xanax)
are prescribed. However, rebound anxiety can occur when these medications
wear off, and their addictive potential can make them problematic.
Anxiety Disorders Association of America
Anxiety Network International
Social Anxiety Institute
Assoc. for the Advancement of
Additional Writings About Social Anxiety Disorder?
Triumph Over Fear: A Book of Help and Hope for People with
Anxiety, Panic Attacks, and Phobias, by Jerilyn Ross, Rosalynn Carter
Dying of Embarrassment: Help for Social Anxiety & Phobia,
by Cheryl N. Carmin, et al
Painfully Shy: How to Overcome Social Anxiety and Reclaim Your
Life, by Barbara Markway, et al