social anxiety disorder written outEveryone feels nervous before a big crowd or when put into a group where they don’t know anyone. But when those feelings of anxiety are so strong or severe that a person is unable to complete basic tasks due to their fear, they may be dealing with a disorder known as social anxiety or social phobia. The Anxiety and Depression Association of America reports that social anxiety disorder is the second most commonly diagnosed anxiety disorder. For many people, these feelings of anxiety, fear, self-consciousness, and embarrassment are connected to a fear of being judged by others, and it can lead people to avoid all social contact. Unlike shyness, which can go away over time, social anxiety is persistent and debilitating. While social anxiety disorder is a chronic mental health condition, it can be successfully managed through the use of behavioral therapy and, when necessary, medication.


Symptoms of Social Anxiety Disorder

According to the National Institute of Mental Health (NIMH), about 7% of Americans (or 15 million adults) live with social anxiety. Many may start out as extremely shy during childhood, but as the condition progresses into adulthood, social anxiety may begin to impact their ability to handle basic social interactions.

Too many people living with social anxiety try to manage without any mental health support. In fact, the ADAA found that more than a third of people will have symptoms for a decade before they seek treatment.

This type of disorder causes both mental and physical symptoms. Some of the signs of social anxiety include:

  • Blushing, sweating, or trembling
  • Rapid heart rate
  • Having their mind go blank
  • Feeling nauseous or sick to their stomach
  • Showing a rigid body posture, making little eye contact, or speaking with an overly soft voice
  • Finding it scary and difficult to be with other people, especially those they don’t already know and having a hard time talking to them even though they wish they could
  • Being very self-conscious in front of other people and feeling embarrassed and awkward
  • Being very afraid that other people will judge them
  • Worrying about embarrassing or humiliating themselves
  • Staying away from places where there are other people
  • Avoiding situations where they might be the center of attention
  • Spending time after a social situation analyzing their performance and identifying flaws in their interactions
  • Expecting the worst possible consequences from a negative experience during a social situation

Social Anxiety is Not Shyness

depressed man with social anxietyIt is not uncommon for others to misunderstand the behavior of someone with social anxiety. For example, other people in their lives might tell them that they are just “feeling shy” and that they need to “get over it.” The reality is that while social anxiety and shyness have some things in common, they are very different.

The main difference between shyness and social anxiety disorder is the level of impairment an individual experiences in their life. For example, individuals with social anxiety typically experience more intense levels of fear and avoidance during social situations than shy individuals.

While most people might feel nervous before giving a speech, someone with social anxiety will worry about giving the speech for weeks or even months in advance. They may also lose sleep because of their anxiety or experience physical symptoms such as sweating, shortness of breath, or a racing heart when they think about giving the speech.

Someone living with social anxiety can experience it in certain situations and not others. For those with extreme cases, symptoms may occur in any social setting. Places and situations that can cause anxiety, fear, and nervousness include:

  • asking a question in public
  • job interviews
  • shopping
  • using public restrooms
  • talking on the phone
  • eating in public

Causes of Social Anxiety

There is no single cause for social anxiety, but researchers believe a combination of factors such as genes, brain structure, and the environment make a person more susceptible to this type of mental health disorder.

It is common for multiple members of a family to have anxiety issues. If a person has family members with social anxiety, their chances of dealing with the disorder are probably increased. Another factor that contributes to the development of social anxiety is the part of the brain known as the amygdala, which helps control a person’s fear response. An individual with an overactive amygdala may have a heightened fear response and, as a result, more anxiety in social settings.

Finally, some aspects of social anxiety may be a learned behavior that results from certain experiences, particularly in childhood. For instance, someone who has experienced bullying, family conflict, or sexual abuse may be more prone to social anxiety. Some people may develop anxiety after a particularly embarrassing or unpleasant social situation. Others may have social anxiety in response to anxious behavior that was modeled by their parents or as a result of being overly protected or controlled by their parents when they were young.

How Does Social Anxiety Impact a Person’s Life?

Sadly, people living with social anxiety often withdraw from both social activities and people. They may find it difficult to even understand how others are able to handle themselves so easily in most day-to-day interactions. This disorder not only interferes with an individual’s social life but can also impact their performance at work and school. Social anxiety can stop individuals from truly living and enjoying their life.

If left untreated, social anxiety disorder can lead to additional behavioral issues. For example, individuals with untreated social anxiety may find themselves having trouble being assertive or being very sensitive to any criticism. They may also suffer from low self-esteem or regularly engage in negative self-talk. They could also have issues with substance abuse.

How to Diagnose Social Anxiety

Determining if someone has social anxiety is typically done by talking to a mental health professional about the symptoms and experiences individuals have had around social scenarios. Dr. Jonathan Davidson of the Duke University Medical Center’s Department of Psychiatry has developed a tool that can also help. Known as the “Mini-SPIN” (Mini-Social Phobia Inventory), it consists of three questions.

The person suspected of having social anxiety is asked by the tester to rate on a scale of 0 to 4 how true three statements are for them. The 0 represents “not at all” and the 4 is “extremely present.” The three questions the inventory asks participants to rate are:

  • Being embarrassed or looking stupid are among my worst fears.
  • Fear of embarrassment causes me to avoid doing things or speaking to people.
  • I avoid activities in which I am the center of attention.

Other tests that a health care provider may use to determine if someone has social anxiety include the Fear of Negative Evaluation Scale, the Liebowitz Social Phobia Scale, or the Social Avoidance and Distress Scale.

A mental health professional will most likely explore the individual’s symptoms and common behavioral patterns to decide if they are, in fact, experiencing social anxiety disorder. During this assessment, the provider will usually ask the individual to explain their symptoms and to describe what situations cause those symptoms.

Some of the criteria that indicate social anxiety include:

  • constant fear of social situations due to fear of humiliation or embarrassment
  • feeling anxious or panicky before a social interaction
  • a realization that their fears are unreasonable
  • anxiety that disrupts daily living

Handling Negative Thinking

man in therapy for social anxietyA major component of social anxiety is frequent negative thinking and self-criticism. Individuals with social anxiety may not want to engage socially out of concern they will humiliate themselves or look like a fool. To combat this negativity, the first step is to identify the automatic negative thoughts that fuel the fear of certain social situations. For instance, a person may dread a work presentation. The presentation itself is not the cause of the anxiety but rather a fear of making a mistake in front of coworkers and being viewed as incompetent.

A mental health professional can help the individual to analyze and challenge these negative thoughts. They can ask themselves things like “Even if the presentation doesn’t go well, will my coworkers actually think I can’t do my job?” Trying to logically evaluate the feelings behind the fear can be scary, but this process can provide an opportunity to view anxiety-provoking situations in a more positive way. Understanding the fear behind the anxiety can help lessen its impact.

Finally, a person struggling with anxiety can also try to focus their attention on other people rather than themselves. It is hard for most people to concentrate on more than one thing at a time, so if the individual tries to actively engage and listen with someone else, they are less able to get lost in their own thoughts. What’s more, a person’s own anxiety is rarely as obvious to others as the person may think. Even if it is apparent, those around them may be feeling just as nervous themselves and aren’t likely to judge.

Living with Social Anxiety

Learning to live with and overcome social anxiety typically occurs through the use of psychotherapy, medication, or a combination of the two. A particular kind of psychotherapy, known as cognitive behavioral therapy or CBT, can be especially helpful. CBT teaches someone with social anxiety disorder how to think, behave and react in different ways so that they feel less anxious and fearful. This form of talk therapy also provides an opportunity for individuals to learn and practice coping skills.

Support groups can be a good addition to talk therapy, offering a safe space among people with similar concerns. Group members support each other, providing feedback and making someone with social anxiety feel less alone.

At Lasting Recovery, we utilize both cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) in a group setting to help our clients manage their social anxiety.

In some cases, an individual’s health care provider may choose to prescribe pharmaceuticals like anti-anxiety medications, antidepressants, or beta-blockers to help an individual manage their social anxiety. It’s important to understand that every medication has side effects and that no medication is a substitute for behavioral therapy. Among the most common medications used for social anxiety include:

  • Anti-anxiety medications. While anti-anxiety medications work very quickly, individuals should not take them for long periods of time as they can lead to dependence.
  • Antidepressants. These medications may take several weeks to take effect, but they do not cause dependence in the same way that anti-anxiety medications do. They can, however, cause side effects ranging from headaches to nausea to difficulty sleeping.
  • Beta-blockers. Doctors may prescribe beta-blockers to help with the more physical symptoms of anxiety. They will stop the increased heart rate, sweating, or tremors that come with social anxiety.

While no one can prevent social anxiety disorder from developing, they can potentially reduce the severity of their symptoms by not waiting to seek treatment. The earlier someone gets help, the more manageable their anxiety may be. They can also try to reduce their anxiety by prioritizing how they spend their time, ensuring that they are focusing their time and energy on stress-relieving activities. Finally, they should avoid substances such as alcohol, drugs, and even caffeine or nicotine, all of which can cause or worsen anxiety.

Treating Social Anxiety and Substance Use

Alcohol and drug addiction and social phobia are often co-occurring due to the effect of substances that suppress fears, allowing for less anxiety in social situations. For those prone to chemical dependency, addiction to drugs or alcohol can occur, creating additional challenges for the person who has become isolated as a result of the chemical use combined with social anxiety. Substance abuse treatment offers a safe place to address both disorders and begin healing.

Treatment for addiction and these co-occurring disorders leads to improved physical health, increased enjoyment, and an overall healthier lifestyle.

Is social anxiety keeping you from leading the life you want? If you or someone you know is struggling with this disorder, let Lasting Recovery’s trained professionals help. Contact us today to learn more about how we can help you overcome your fear of social interactions.

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