It’s common enough for people to feel some anxiety in social situations such as on a first date, going for a job interview, giving a class or work presentation, and so on. Usually, such anxieties pass or are easily overcome, and they aren’t a permanent feature of life. For others, however, they may feel worried and panicked in social situations or by the mere thought of being in them, or they find themselves feeling extremely afraid of being judged by others, or they are very self-conscious in everyday social situations and do their utmost to avoid meeting new people. If you are someone who has been feeling this way for six months or more, and these feelings make it hard for you to enjoy and do everyday things such as talking to people at school, the grocery store, or at work, you may have a Social Anxiety Disorder.
What is Social Anxiety Disorder?
While it is more common in women than in men, the National Institute of Mental Health has noted that around 12.1% of adults in the United States experience Social Anxiety Disorder at some point in their lifetime. Social Anxiety Disorder, which is also called social phobia, is a mental health disorder where a person has an intense and persistent fear of being watched and/or being judged by others.
This fear can end up affecting work, school, socializing with others, and other day-to-day activities. Different individuals have different triggers of social anxiety, and these include meeting unfamiliar people, using a public restroom, eating in public, standing in front of or performing before people, being called upon to speak in class or a meeting, and so on.
Social Anxiety Disorder can make it hard to make and keep friends, as well as perform certain tasks at work or in school. People with this condition might not seek treatment, assuming and believing that it is just a part of their personality. However, once accurately diagnosed by a mental health professional, Social Anxiety Disorder is treatable, and you can see tangible differences in your life with a proper treatment plan.
Causes and risk factors
It’s hard to pinpoint the exact cause of Social Anxiety Disorder. However, as with many other mental health conditions, Social Anxiety Disorder likely arises from the complex interaction of factors such as biology and the environment in which an individual grows up. Some potential causes and risk factors for Social Anxiety Disorder include:
Genetics. Anxiety disorders tend to run in families. However, it’s important to note that this reality may in part be due to genetics but learned anxious behavior may also play a role in this.
Biology. One of the structures in the brain called the amygdala has a role to play in regulating how the body responds to fear. Individuals with an overactive amygdala may have increased anxiety in social situations.
Negative life experiences. People who have negative experiences as children, such as being bullied, teased, and humiliated may be more prone to Social Anxiety Disorder. Additionally, negative events in life like abuse, trauma, or family conflict may be associated with Social Anxiety Disorder.
Some researchers think that misreading others’ behavior may play a role in causing or worsening social anxiety. For example, if you think that people are staring, laughing, or frowning at you when they aren’t, that may leave a negative impression. Also, people with underdeveloped social skills may feel discouraged after talking with people the first time and may worry about doing it in the future, leading to the development of social anxiety.
Unwittingly drawing attention. Having a prominent birthmark, facial disfigurement, or speaking with a stutter may draw attention and make a person feel self-conscious and may trigger Social Anxiety Disorder in some people.
Novel work or social demands. Social Anxiety Disorder symptoms typically start in the teenage years, around the age of thirteen, but new work or social demands such as meeting new people, going to a party, speaking in public, or giving a work presentation may trigger symptoms for the first time.
The signs of Social Anxiety Disorder
Symptoms of Social Anxiety Disorder may appear around the age of thirteen, in the early to mid-teenage years, but it can also show up in younger children or adults. Because of different temperaments, having feelings of shyness or discomfort in certain situations isn’t necessarily a sign of Social Anxiety Disorder.
Some people are naturally reserved, while others are more outgoing and mix easily with strangers in social situations. People feel comfortable in social situations to different degrees depending on their personalities, preferences, and life experiences.
The signs of Social Anxiety Disorder (which goes beyond mere shyness) include persistent physical symptoms in social situations such as blushing, rapid heartbeat, trembling, sweating, having an upset stomach or nausea, shortness of breath, feeling dizzy or lightheaded, going mentally blank or feeling that your mind has gone blank, and experiencing muscle tension.
Other symptoms that may signal Social Anxiety Disorder include:
- intense fear of talking or interacting with strangers
- avoidance of social situations
- anxiety in anticipation of an activity or event
- concern and worry about embarrassing or humiliating yourself
- fear that other people will become aware that you look anxious
- avoidance of the spotlight or situations where you might be the center of attention
- expectations of the worst possible consequences from a negative experience during a social situation
- fear of situations in which you feel you may be judged by others
- fear of being embarrassed by blushing, sweating, trembling, or having a shaky voice in public
- intense fear or anxiety during a social situation
- avoidance of doing things or speaking to people out of fear of embarrassment
- performing post-mortems, in which you spend time after a social situation analyzing your performance and finding any mistakes in your interactions with people
Outlook and treatment
Social Anxiety Disorder symptoms can change over time. They may flare up under stress or increased pressure and work/school/life demands. While avoiding social situations that produce anxiety may seem like a practical choice in the short term, it is likely to continue and possibly worsen over the long term without treatment.
Once diagnosed, your doctor or mental health professional will create a treatment plan tailored to your needs. For instance, a person with social anxiety centered around performance, like giving a presentation or speech but not in other situations will likely require a different treatment plan from someone who feels social anxiety in every social situation. A treatment plan will likely have two main components – therapy and medication.
Talk therapy is one of the more useful tools in dealing with Social Anxiety Disorder. A type of psychotherapy called Cognitive Behavioral Therapy (CBT) is especially useful for treating Social Anxiety Disorder.
CBT addresses patterns of behavior and thinking, teaching you to think, behave, and react to situations in ways that help you feel less anxious and fearful. It can also help you learn and practice social skills. CBT can also be delivered in a group therapy format, which can be especially helpful for some people.
In terms of medications, there are three types of medications that are typically used to help treat Social Anxiety Disorder. These include anti-anxiety medications, antidepressants, and beta-blockers.
Anti-anxiety medications are highly effective, and they begin working right away to reduce anxious feelings. Because they can create dependence and a person can build up a tolerance to these medications making them likely to need higher doses to get the same effect, these medications are usually not taken for extended periods. To avoid these potential pitfalls, doctors typically prescribe anti-anxiety medications for short periods.
Beta-blockers are medications that can help by blocking some of the physical symptoms of anxiety on the body, such as an increased heart rate, sweating, or tremors. Beta-blockers are commonly used for the “performance anxiety” type of Social Anxiety Disorder.
Antidepressants are used to treat depression, but they are also helpful for addressing the symptoms of Social Anxiety Disorder. Unlike anti-anxiety medications, antidepressants may take several weeks to begin working, and they may have side effects such as nausea, headaches, or difficulty sleeping, though these side effects are usually not severe for most people, especially if they start at a low dose that’s increased slowly over time.
Talking to your doctor about any side effects that you may have will help you to get the medication that works most effectively for you in the right dosage and with the least side effects. Whatever the medication your doctor prescribes for you, in combination with talk therapy, Social Anxiety Disorder can be brought under control so that you can enjoy your life without fear.
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