Social anxiety disorder, also known as 'social phobia', is a growing mental health problem. The chances of developing social anxiety disorder at any time during your life stands around 13%[i] and it affects 7% of the population at any one time.
What Exactly Is Social Anxiety Disorder?
If you suffer from Social anxiety disorder it means that you have extreme fear of social situations where you will be interacting with other people.
Social anxiety disorder is one of 5 anxiety disorders as listed in The Diagnostic and Statistical Manual of Mental Disorders (referred to as the DSM) which is the diagnostic bible for mental health professionals.
Why Is Social Anxiety Disorder Not The Same As Panic Disorder?
Sometimes social anxiety is confused with panic disorder but they are not the same. People with social anxiety disorder do you not get panic attacks. They may experience anxiety attacks and say they panicked when they were highly anxious. Panic attacks are different and relate more to people who have a fear of having a medical problem.
People with social anxiety disorder know they are experiencing fear and anxiety. They don’t feel the need to go to hospital after an anxiety attack. Instead they may turn to alcohol or recreational drugs to self medicate the anxiety.
What Are The Challenges For Someone Who Suffers From Social Anxiety?
People who suffer from social anxiety often have difficulty with intimate relationships and struggle with maintaining good relationships at work. It is a distressing condition for those people who suffer from it.
Steve, a 20-year-old man living with social anxiety, told me,
“I know I miss out on many opportunities in life and there are many social situations but I would love to be a part of but because of my anxiety I just don’t go there. Generally I avoid social groups, parties, meeting new people and especially starting relationships. I just stay at home because that is the best place for me with this level of anxiety that I suffer a day in day out.”
What Exactly Are We Afraid Of When We Are With Other People?
Specifically it could be explained by being very afraid of being criticised for negatively judged by other people. This disorder may have started in social situations but will create fear and anxiety that pervade in or areas of your life.
It seems that it gets a chokehold and people who suffer from social anxiety find it extremely difficult to recover on their own.
What Is The Viewpoint Of Someone Who Suffers From Social Anxiety Disorder?
It’s not that people with social anxiety don’t want to be friends but the disorder holds those people back from being sociable, friendly and open when mixing with other people.
Consequently, people with social anxiety can be seen as being aloof, uninterested, inhibited, unfriendly, withdrawn or nervous. It becomes a self-fulfilling prophecy as they want friends but they can’t reach out and yet they need other people to help them get over their social anxiety.
What makes things worse is someone with social anxiety disorder knows that it is irrational and doesn’t make any sense. However, even with this intellectual understanding, it doesn’t help the sufferer. In fact it may increase the anxiety because of the self-criticism that intervenes when the sufferer can see that this thinking doesn’t help diminish the fear.
People with social anxiety have a disconnect between “intellectually understanding” that they have a disorder which can be treated and believing that it will really work for them.
This can make it difficult for therapists to help people with social anxiety because all though the sufferer understands it will take time, if they don’t feel the difference immediately they don’t believe it’s going to work for them. This is the nature of the disorder because the fear pervades every part of life and overrides the intellectual process of thinking “I can get over this”.
What Are Social Anxiety Disorder Triggers?
Common, everyday experiences can create distress and trigger symptoms of social anxiety. These triggers are usually related to social interactions. Examples of social anxiety triggers are:
Being observed
Interrelating with strangers
Going to social gatherings
Being at work
Starting a conversation
Being the centre of attention
Dating
Going into a room where people are sitting down
Making phone calls in public
Using a public bathroom
Being introduced to new people
Being criticised
When someone is watching
Making eye contact
Eating in public
Attending a party
What Are Social Anxiety Disorder Symptoms?
When a social anxiety flare up has been triggered, there are some symptoms which may happen. These symptoms may change over time and they can intensify if you're suffering a lot of stress. These symptoms could include:
Racing heart
Shaking
Sweating
Upset stomach
Being cautious
Unable to catch the breath
Trembling
Dry mouth
Intense fear or terror
Dizziness
A blank mind
Tense muscles
In severe situations obsessing that they are severely, physically flawed; this is usually the face.
What Are Social Anxiety Disorder Signs?
How do you know if you are having a social anxiety attack? Well everybody is unique and social anxiety disorder operates differently in every person. However there may be a few signs that most people would relate to. These include:
Avoiding situations where you fear you may be challenged
Worried that other people will notice how anxious you are
Experiencing intense fear of talking to strangers
Worrying about humiliating yourself
You fear that your physical symptoms may show like trembling, Sweating or shaking in your voice
Avoid situations where you might be the centre of attention
Avoid doing things out of fear of embarrassment
Becoming highly anxious about an up and coming event
Being at an event with 10 out of 10 intense fear
Judging yourself harshly after the event
Going over and over things you could’ve done differently
Never expecting things to get any better
Getting Help For Social Anxiety Disorder
Medication
Medication for social anxiety can help people but not all of them. Studies suggest that around 15% of people gain any benefit.
Antidepressants seems to be the most commonly prescribed drug. However, it appears that in order to really benefit from the antidepressants, it needs to be in conjunction with cognitive behavioural therapy.
Taking antidepressants without cognitive behavioural therapy (CBT) does not offer a long-term solution. CBT helps change the neural pathways in the human brain which appears to offer a long-term solution, more of which is explained below, whereas the effects of antidepressants will wear off once the sufferer stops taking them.
Some studies on social anxiety medication have been put under the microscope[ii] as they have been found to skew in favour of the types of medication the drug company sells. These drug companies have often paid for these studies to be done in the first place. The question is: is there a conflict of interest?
Cognitive Behavioural Therapy
Cognitive-behavioural therapy for social anxiety has been highly successful.
The way it works is to permanently change the neural pathway associations in the brain.
What Are Neural Pathway Associations?
Have you ever driven to work, arrived and realised that you were on remote control and you hadn’t paid attention to getting there? But you just arrived. This is a neural pathway association at work. It’s a type of hard-wired programming due to us doing the same thing over and over again until it becomes automatic.
People who have social anxiety disorder have been hardwired to suffer anxiety when they are in old but familiar situations that have previously triggered an anxiety attack. This is because they may have had a bad experience in a social situation when someone had verbally attacked them or made them feel bad about themselves.
As they go over and over that same situation in their mind, they are building neural pathways.
How Can CBT Help With Social Anxiety Disorder Symptoms?
CBT helps to think logically about old triggers and helps to reframe that same situation with a different perspective.
In my case, I used to think that everybody I met was a threat. I imagined they were thinking horrible things about me and I tiptoed around them until I got away. This plunged me into years of social anxiety misery. When I got help it was made clear to me that the people I thought hated me actually didn’t and it was my imagination.
However it did take a lot of therapy, hard work and persistence on my part because I had to work hard on changing those neural pathways. All the work eventually paid off and I don’t suffer from social anxiety any more.
It’s very important to find a therapist who understands social anxiety disorder. Social anxiety is completely treatable and can be overcome with the right expert, diligence and patience.
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[i] https://socialanxietyinstitute.org/what-is-social-anxiety
[ii] Keller, M. B. (2006). Social Anxiety Disorder Clinical Course and Outcome: Review of Harvard/Brown Anxiety Research Project (HARP) Findings. The Journal of Clinical Psychiatry, 67(12), 14-19.