Social anxiety disorder (SAD), or social phobia can be a serious mental health issue. Contrary to popular opinion, social anxiety disorder is much more than just ‘shyness’
According to the Anxiety and Depression Association of America (AADA) around 15 million adults, in the US alone, suffer from Social Anxiety Disorder. SAD is the third most common mental health issue.
Not surprisingly, the average age of onset is around 13 years old when the classic teenage ‘awkwardness’ and self-consciousness kicks in.
Ultimately, this post will be taking a modern look, based on all the latest research, at Social Anxiety Disorder.
A little bit about Shyness
Our personalities are all different; whilst some people are extrovert and love nothing more than being the centre of attention, others are a little more reserved and quite happy to sit in the background.
For some of us, the thought of a large social event, such as a big, family wedding, fills us with excitement, but for the more reserved, ‘shy’ types amongst us, the same event may fill us with fear and worry.
In many ways, shyness is a normal human trait. Indeed, young children between the ages of 3 and 7 are often shy when they meet new people or experience a new situation, and it is much the same for many adults.
Shyness is an apprehension, mild anxiety, or awkwardness when meeting new people. Shy people often feel very self-conscious in social situations. Furthermore, they tend to view themselves negatively and are overly concerned about what others think of them.
The ‘Medicalization’ of Shyness?
As mentioned, true social anxiety disorder, is not to be confused with simple shyness according to most medical experts.
Although one scientific study shows that social anxiety disorder is 18 % higher amongst shy people, the majority of shy people, a whopping 82 % to be exact, do NOT suffer from social anxiety disorder.
However, a very interesting research paper from the field of sociology argues that shyness has become ‘medicalized’.
Furthermore, the ‘symptoms‘ of shyness, such as quietness, humility and social withdrawal, have become an issue simply because they challenge the values of Western society like assertiveness, confidence and self expression.
Possibly, the positive qualities of shyness need to be celebrated in our society?
What is Social Anxiety Disorder?
Right, enough of the debate regarding shyness and society, let’s take a closer look at Social Anxiety Disorder.
Shyness certainly causes feelings of discomfort but Social Anxiety Disorder has a much larger impact on a person’s quality of life.
An overwhelming and ongoing fear of social situations and interactions with other people is at the heart of SAD.
Social anxiety is a psychiatric condition that used to be classified as a phobia, but unlike a specific phobia, the fears are based on a whole host of social interactions.
Even the most ordinary of activities, which most of us perform without a second thought, can trigger the fight-flight response. It is this natural response to threat that is activated and produces all the uncomfortable symptoms associated with anxiety.
Situations that can cause Anxiety and Fear
Judge me not!
At the heart of social anxiety disorder is the intense fear of being judged negatively by others. Thus, those with social anxiety disorder sad will be preoccupied with every little move they do and everything they say. Sufferers experience an excessive self-consciousness.
Because social anxiety disorder is based on an intense fear of looking bad or being humiliated in front of others, a lot of social situations, obviously cause stress.
The intense anxiety and worry caused by social interaction or situations often starts days, or even weeks, before an event, this is known as ‘anticipatory anxiety’.
The fear and anxiety does not always stop after the event or social encounter. Often a sufferer will re-play to themselves embarrassing (real or imagined) things that they said or did.
This excessive ruminating only leads to a downward spiral effect and serves to reinforce the distorted thinking of the sufferer.
Physical Symptoms of Social Anxiety
The physical symptoms of anxiety attacks are the same as those of other anxiety disorders.
Indeed, social anxiety disorder often goes hand-in-hand with other mental health issues such as low self-esteem, depression, bipolar disorder, generalize anxiety disorder and post-traumatic stress disorder ptsd
Social anxiety symptoms:-
Treatment of Social Anxiety Disorder
Due to the often devastating effects of social anxiety disorder, treatment is aimed at both relieving the unpleasant symptoms and improving relationships and social experiences.
Social Anxiety Disorder often leaves sufferers isolated from others, depressed, alone, and in extreme cases, sometimes even housebound.
There can also be issues with alcohol or substance abuse in an attempt to mask or calm the anxiety symptom.
Lastly, social anxiety will directly affect your ability to relate to others socially and form and maintain healthy relationships.
Talking Treatments for Social Anxiety Disorder
Whilst cognitive behavioral therapy alone has been shown in studies to help with the symptoms of social phobia, a combination of cognitive-behavioral therapy cbt and medications has been proven to be the most effective treatment.
Cognitive-behavioral therapy has been shown in numerous medical studies to be very effective in treating social anxiety disorder.
The aim of cognitive behavioural therapy is to change the way we think about situations and events, which in turn change the emotions and the behaviours surrounding them.
This type of treatment, is particularly effective when carried out in group therapy sessions that involve only SAD sufferers.
In addition to cognitive behavioural therapy cbt, social skills training can also be very helpful for those who are socially anxious. This type of therapy is useful for improving confidence and reducing anxiety.
Medications for Social Anxiety Disorder
Self-Help Tips for Social Anxiety
2) Find the RIGHT therapist. Although there are many therapist that practice cognitive-behavioural therapy, you will need one that specializes in, and understands the right type of therapy for social anxiety disorder.
3) Breathe! Spending some time learning breathing techniques will help enormously to calm you when you are feeling anxious. Do some research and practice daily.
4) List it! Make a list of social situations that you find difficult and order them beginning with the scariest first. Then start at the bottom of the list and move on up.
5) Set goals: Set some realistic goals to focus on. Rather than concentrating on whether you are blushing or sweating set objective goals for you to achieve. For example, if you are at a party introduce yourself to a stranger and have a conversation for 5 minutes.
New Treatment Alert: Probiotics and Fermented Foods
Well, here is a brand new concept emerging in recent medical research. A healthy gut actually leads to a healthy mind.
That is, medical studies have discovered that the microorganisms in the gut can affect our emotions and anxiety. Likewise, our emotions can affect our gut health too.
Indeed, one 2015 study concludes that:-
“…higher frequency of fermented food consumption is associated with fewer symptoms of social anxiety. Taken together with previous studies, the results suggest that fermented foods that contain probiotics may have a protective effect against social anxiety symptoms…”
For a full discussion on the effects of probiotics and fermented food on anxiety symptoms and depression please click HERE.
Social Anxiety Disorder (SAD), A Personal Tale.
Although naturally, I have always been introverted and quiet, up until grade two I thought I was a ‘fairly’ normal boy.
Since I was a slow learner I always felt behind and inferior to most of my classmates. The diagnosis of social anxiety disorder was not given until I was twenty seven, and I had NO idea that I had suffered with an anxiety disorder.
Whilst social anxiety disorder is a common condition, it is very debilitating. Here are some of the experiences I had while living with the condition; the isolation, loneliness, fear and distresses that filled my life every day.
As a child, I was always very quiet and as far back as I can remember I was self-conscious .
Unlike home, school scared me a lot especially when I had to stand in front of my classmates and present something. The anxiety and fear was ever present, whether I was asked something in class or trying to chat in the playground.
In any group situation, I always made sure that I was not the center of attention. I feared making any decision in front of people and always ending up doing what everyone else wanted me to do.
As a young boy, I believed that I could not make any decisions and I was not worth anything.
This also translated into feelings of not being good enough unless everything that I did turned out perfect.
The Difficult Teen Years
As a teenager, these strange beliefs had become so much a part of me that I believed that everyone I met had to like me for me to feel good.
The expectations that I had were so unrealistic that they ensured that I set myself up for failure even though I didn’t realize it.
Since my expectations were never met, they started eating away at my sense of self-worth. Due to my mental disorder, my self-esteem was very low and I mistrusted and feared most people I came into contact with. I had an entrenched belief that they may hurt or humiliate me.
All this time, my mind was continuously preoccupied with thoughts about how I appear to others, how I spoke, how l looked and what other people were thinking about me.
These thoughts were not only extreme but were always negative and accompanied by high levels of fear and anxiety.
I did not respect my body and started treating myself carelessly and I also allowed others to do the same.
I did anything as long as it would please those around me and this made me engage in some risky and rebellious behaviors to mask my anxiety.
Alcohol and Me
I learnt that after drinking alcohol I felt very good and I did not care as much about what people think about me anymore.
Drinking became a major problem for me. When I felt that I was in situations in which I would be evaluated, I became very reliant on alcohol.
Throughout my teenage years and early adulthood, I drank heavily and I started socializing with people who also drank large amounts of alcohol.
As well as alcohol, I also started experimenting with cannabis in an attempt to control my negative, anxious feeling.
Around this time, I experienced mood swings that affected my life a great deal. As I became more rebellious, the relationship with my parents also deteriorated badly.
In fact, as a fifteen-year-old boy, I was taken to a psychiatrist to try and diagnose the problem. I was informed that my behavior was a result of the way I was treated at home.
Interestingly, no one mentioned anxiety, depression or explored my belief system.
As a twenty-year-old young man, I started experiencing panic attacks almost every day. After having isolated myself, I was living alone. During this time, I had given up on life and on several occasions I even contemplated committing suicide.
I was fearful, withdrawn, and preoccupied with my own fear and anxiety. On arriving home I would drink alcohol and smoke cannabis while dreaming of another day and another life, but not mine. I was in the extreme depths of despair.
The turning point came for me when I was 27 years old. I was hospitalized for 4 weeks to detox from drug and alcohol abuse and for the first time I had a diagnosis – social anxiety disorder.
My treatment included short-term psychotherapy with cognitive-behavioral therapy, self-esteem therapy, anxiety education, reality testing, interpersonal skills training, relaxation techniques, focusing skills, and public speaking courses,and how to deal with my anxiety symptoms.
I am now thirty and it is 3 years since I was diagnosed with social anxiety disorder.
Five months after I left the hospital, I was able to overcome some of my major fears and anxiety and now have a healthy sense of self-worth – and a social life.
Above all, the most important thing to remember is that social anxiety disorder is treatable. Furthermore, with the right guidance and information you can replace your fear with a healthy anticipation and your dreams can become a reality.
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- Stein MB, Stein DJ. (2008) Social anxiety disorder. Lancet. 2008 Mar 29;371(9618):1115-25.(Retrieved November 4th 2016) https://www.ncbi.nlm.nih.gov/pubmed/18374843
- Rodebaugh TL, Holaway RM, Heimberg RG. (2004) The treatment of social anxiety disorder. Clin Psychol Rev. 2004 Nov;24(7):883-908. (Retrieved November 4th 2016) https://www.ncbi.nlm.nih.gov/pubmed/15501560