Social Anxiety

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Social Anxiety, according the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-V) is

significant fear or anxiety about one or more social scenarios in which the person is exposed to possible evaluation by other people.

It is normal to sometimes feel anxious. However, when you have social phobia, you have a constant fear of being judged by others or humiliated in front of them. You may avoid all social situations, including:

• asking a question
• job interviews
• shopping
• using public restrooms
• talking on the phone
• eating in public
• public speaking
• interacting with authority figures such as, e.g. bosses or teachers
• being observed eating or drinking
• having a conversation
• meeting new people
• participating in meetings
• Interacting with unfamiliar people or strangers
• Attending parties or social gatherings
• Going to work or school
• Starting conversations
• Making eye contact
• Dating
• Entering a room in which people are already seated
• Returning items to a store

People who have social anxiety disorder worry that they will behave in a way that will be embarrassing and humiliating, and that they will be judged by others, particularly people they do not know well. 

Social Anxiety is the overwhelming fear of social activities, such as meeting or interacting with people.

Sometimes social anxiety starts during teenage years, and may get better as they get older

Other people require professional treatment to help deal with the thoughts and feelings.

People with this disorder have trouble talking to people, meeting new people, and attending social gatherings. They fear being judged or scrutinized by others. They may understand that their fears are irrational or unreasonable, but feel powerless to overcome them.

Social anxiety is different from shyness. Shyness is usually short-term and doesn’t disrupt one’s life. Social anxiety is persistent and debilitating. It can affect one’s ability to:

• work
• attend school
• develop close relationships with people outside of their family

Symptoms of Social Anxiety Disorder

Social interaction may cause the following physical symptoms:

• Blushing
• Excessive sweating
• Trembling or shaking
• Difficulty speaking
• Dizziness or lightheadedness
• Rapid heart rate
• Trembling
• Upset stomach or nausea
• Trouble catching your breath
• Feeling that your mind has gone blank
• Muscle tension

Psychological symptoms may include:

• Worrying intensely about social situations
• Worrying for days or weeks before an event
• Avoiding social situations or trying to blend into the background if you must attend
• Worrying about embarrassing yourself in a social situation
• Worrying that other people will notice you are stressed or nervous
• Needing alcohol to face a social situation
• Missing school or work because of anxiety

Symptoms of social anxiety may not occur in all situations. You can have limited or selective anxiety. For example, symptoms may only occur when you’re eating in front of people or talking to strangers. Symptoms can occur in all social settings if you have an extreme case.

What Causes Social Anxiety Disorder?

The exact cause of social phobia is unknown. However, current research supports the idea that it is caused by a combination of environmental factors and genetics. Negative experiences also may contribute to this disorder, including:

• bullying
• family conflict
• sexual abuse
• Growing up in a phobic environment
• Traumatic/humiliating social event
• Adolescents can develop this condition as a result of insecure attachments with their mothers when infants
• Growing up with overprotective or hypercritical parents
• Some cultures are too diming and can cause one develop this condition
• Substance use especially alcohol or benzodiazepines

Physical abnormalities such as a serotonin imbalance may contribute to this condition. Serotonin is a chemical in the brain that helps regulate mood. An overactive amygdala (a structure in the brain that controls fear response and feelings or thoughts of anxiety) may also cause these disorders.

Anxiety disorders can run in families. However, researchers aren’t sure if they’re actually linked to genetic factors. For example, a child might develop an anxiety disorder by learning the behavior of one of their parents who has an anxiety disorder. Children can also develop anxiety disorders as a result of being raised in controlling or overprotective environments.

Complications

Left untreated, social anxiety disorder can run your life. Anxieties can interfere with work, school, relationships or enjoyment of life. Social anxiety disorder can cause:

• Low self-esteem
• Trouble being assertive
• Negative self-talk
• Hypersensitivity to criticism
• Poor social skills
• Isolation and difficult social relationships
• Low academic and employment achievement
• Substance abuse, such as drinking too much alcohol
• Suicide or suicide attempts

Social anxiety sufferers have negative thoughts and beliefs that contribute to their fears and anxiety. These can include thoughts such as:

• “I know I’ll end up looking like a fool.”
• “My voice will start shaking and I’ll humiliate myself.”
• “People will think I’m stupid”
• “I won’t have anything to say. I’ll seem boring.”

Challenging these negative thoughts is an effective way to reduce the symptoms of social anxiety.

Unhelpful thinking styles that fuel social anxiety:

• Mind reading – Assuming you know what other people are thinking, and that they see you in the same negative way that you see yourself.
• Fortune telling – Predicting the future, usually while assuming the worst will happen. You just “know” that things will go horribly, so you’re already anxious before you’re even in the situation.
• Catastrophizing – Blowing things out of proportion. For example, if people notice that you’re nervous, it will be “awful”, “terrible”, or “disastrous.”
• Personalizing – Assuming that people are focusing on you in a negative way or that what’s going on with other people has to do with you.

Therapy 

Of all the professional treatments available, Cognitive-Behavioral Therapy (CBT) has been shown to work best for treating social anxiety disorder. CBT is based on the premise that what you think affects how you feel, and your feelings affect your behavior. So if you change the way you think about social situations that give you anxiety, you’ll feel and function better.

CBT for social phobia may involve:

- Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises.

- Challenging negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views.

- Facing the social situations you fear in a gradual, systematic way, rather than avoiding them.

Contact us on how we can support you overcome your social anxiety.