Most of us have experienced shyness in a situation at some point in our lives.
Maybe we were at a party and only knew one person, and found it hard to talk to the strangers surrounding us. Or, maybe the thought of calling a new friend on the phone made us a little nervous.
It is normal to feel a bit anxious during new and unfamiliar situations.
But for some, that anxiety goes beyond a temporary feeling of discomfort in certain situations. For some, that anxiety is downright excruciating and debilitating.
A shy person will feel uncomfortable at times, but they won’t feel as though they have to avoid the socially stressful situation on account of their discomfort. A person with social anxiety disorder, however, feels overwhelming effects which make them unable to handle certain situations.
What is Social Anxiety Disorder?
Social Anxiety Disorder, or Social Phobia, is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People who have Social Anxiety Disorder (SAD) experience a constant and severe fear of being embarrassed by their own actions, and they often feel that they are being watched or judged by others. For some the fear is limited to certain situations, such as a fear of speaking in front of groups or new acquaintances or a fear of performing tasks in front of others. For others the fear is so intense that the sufferer experiences overwhelming anxiety any time they are in a social situation. At its most severe, social anxiety disorder can seriously interfere with professional and academic functioning as well as personal relationships.
An estimated 15 million American adults have social anxiety disorder. The typical age of onset is 13 years old. According to the Anxiety and Depression Association of America (ADAA), 36 percent of people with social anxiety disorder report having symptoms for 10 or more years before seeking help.
Common Symptoms of Social Anxiety Disorder
- An overwhelming and persistent fear of social or performance situations that might require the person to interact with unfamiliar people or place themselves open to scrutiny by others.
- The sufferer is afraid that he or she will either act in an embarrassing way or be humiliated by showing signs of their anxiety.
- Engaging in social situations almost always causes feelings of anxiety or even panic attacks.
- The sufferer will try to avoid social or performance situations at all costs, and, if these situations cannot be avoided, they will endure them with an intense feeling of anxiety or fear.
- The person recognizes that these fears are excessive or unreasonable but feels powerless to control their anxiety in social situations.
- When around others, the sufferer may blush, sweat, tremble, have a racing heartbeat, or feel nauseated.
Causes and Risk Factors
Social phobia sometimes runs in families, but no one knows for sure why some people have it while others don’t. Experts say the causes are thought to be either biological or environmental.
Researchers have found that several parts of the brain are involved in fear and anxiety. There may be a dysregulation of neurotransmitters, notably serotonin, related to social anxiety disorder, but serotonin levels are involved in several anxiety disorders, so they are not specific to SAD.
Children who witness a parent of other significant adult who is uncomfortable in social situations may believe that is typical behavior, as Dr. Cheryl Carmin, a psychiatrist and director of the clinical psychology training program at the Ohio State University Wexner Medical Center, explained to Live Science:
A parent or a significant adult figure may model that it’s appropriate to be anxious in situations where your performance will be evaluated. For example, a parent who is commenting on being nervous about a performance review or who tells their child to not be anxious before their first “show and tell” may be priming the child to, in fact, be anxious in that situation. It’s also quite possible that any number of these factors interact.
How is Social Anxiety Disorder Diagnosed?
If you have symptoms of social anxiety disorder, your doctor will ask you questions about your medical history and will perform a physical exam. Although there are no lab tests to specifically diagnose social anxiety disorder, your doctor may use various tests to make sure that a physical illness isn’t causing your symptoms.
If no physical illness is found, you may be referred to a psychiatrist, psychologist, or other mental health professional who is specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specific interview and assessment tools to evaluate people for anxiety disorders. Diagnosis of social anxiety disorder is based the intensity and duration of symptoms, including any problems with functioning caused by the symptoms.
Social Anxiety Disorder Treatment Options
Social phobia is usually treated with psychotherapy, medication, or both.
Psychotherapy, or “talk” therapy, means talking with a trained mental health professional to learn coping skills for dealing with SAD. There are different types of mental health professionals including psychiatrists, psychologists, social workers, and licensed counselors, and there are different types of psychotherapy as well.
Based on the idea that social anxiety disorder is caused by our own internal thoughts, emotions, and behavioral response, these therapies use logical, adaptive coping techniques that are designed to control the thoughts that go through our heads, as well as how we respond to them.
The most effective form of psychotherapy for SAD is cognitive behavioral therapy (CBT). CBT helps guide thoughts in a more rational direction, which helps the patient stop avoiding situations that once caused anxiety. It teaches people to react differently to the situations that trigger their anxiety symptoms. Therapy may include systematic desensitization or real life exposure to the feared situation. With systematic desensitization, the patient imagines the frightening situation and works through his or her fears in a safe and relaxed environment (usually the therapist’s office). Real life exposure gradually exposes the person to the situation but with the support of the therapist. CBT can also help people learn and practice social skills.
About 20 percent of people with social anxiety disorder develop substance abuse problems because they turn to drugs or alcohol to help alleviate their nervousness in social situations. Treatment for SAD may need to include addressing substance abuse issues, if the patient is using drugs or alcohol to cope.
Some people with SAD also experience depression because of the affects that their disorder is having on their ability to function or have close personal relationships. Therapists need to take that into consideration when devising a treatment plan.
Generally, a person seeking medication will be simultaneously involved in some form of psychotherapy. Medications are not a cure, but sometimes they can help control some of the symptoms associated with social anxiety and make it easier to deal with.
There are several different types of drugs used to treat social anxiety disorder, including antidepressants, beta blockers, and anti-anxiety medications (benzodiazepines).
Antidepressants: The primary class of drugs used to treat social anxiety are antidepressants called selective serotonin reuptake inhibitors (SSRIs). This class of drugs was first developed to treat depression, but have been found to be effective in the treatment of anxiety as well. Antidepressants can be helpful when social anxiety disorder is severe and debilitating. Two SSRIs – Paxil and Zoloft, and one SNRI, Effexor – have been approved by the U.S. Food and Drug Administration for the treatment of social phobia.
Beta blockers: Beta blockers are used for relieving performance anxiety. They work by blocking the flow of epinephrine (more commonly known as adrenaline) that occurs when you’re anxious. While beta blockers don’t affect the emotional symptoms of anxiety, they can temporarily control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat. They are rarely prescribed and are generally not recommended for SAD.
Benzodiazepines: Benzodiazepines (including Xanax, Ativan, and Valium) are fast-acting anti-anxiety medications. However, they are sedating and extremely habit-forming, so they are typically prescribed only when other medications for social phobia have not worked, or to help a person with social anxiety get through a specific event.
Prescription medications, though effective in treating many symptoms, also have many drawbacks, like severe side effects and withdrawal symptoms. In addition, they are often no more effective than placebo or natural alternatives when tested head-to-head in clinical studies.
Unlike cognitive behavior therapy, prescriptions do not address the underlying causes of chemical imbalance. The thoughts and feelings you experience are coming from somewhere. Past experiences, daily stresses, and negative thought patterns cause anxiety. Simply taking a drug to treat these causes will not change how you think about certain experiences and situations.
Prescription Drugs can not change our thought patterns or the past associations that have been made in our brains.
Though these chemical balancers can most definitely provide relief for symptoms of social anxiety, treatment can not be achieved until we are able to create new, positive associative patterns within our own thoughts.
Complementary and Alternative Medicine
Complementary and Alternative Medicine is defined as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Many CAM therapies are supported by scientific research, but, in all cases, there are key questions yet to be answered.
CAM modalities are based on aiding the individual to find balance so that an emotional or physical disorder doesn’t become a chronic issue and, when they do, they can find healing through a more natural, holistic approach.
The following complementary and alternative practices are possible options that can be added to a treatment program for social anxiety (click on each to learn more):
- Art Therapy
- Breathing and relaxation exercises
- Chiropractic care
- Herbal medicine
Lifestyle Changes and Support
Although social anxiety disorder generally requires help from a medical expert or qualified psychotherapist, you can try some self-help techniques to handle situations that are likely to trigger your symptoms:
- Reach out to people you can talk to, or join a support group, either local or Internet-based
- Exercise or be physically active on a regular basis
- Get enough sleep
- Eat a healthy, well-balanced diet
- Avoid alcohol
- Limit or avoid caffeine
- Join a group that offers opportunities to improve communication and public speaking skills, such as Toastmasters International
- Do pleasurable activities, like drawing, painting, or listening to music, when you feel anxious
Remember, you are human and it is normal to experience some shyness or social anxiety on occasion. But, if you find that you are experiencing it on a regular basis, or you think it is possible you have social anxiety disorder, seeking the help of a professional is a good idea.
Screening for Social Anxiety Disorder
If you suspect that you might suffer from social anxiety disorder, answer the questions in this assessment from ADAA, print out the results, and share them with your health care professional.