Reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Presenting in public or having to perform in front of an audience can be nerve-wracking. Even for the best of us, it isn't uncommon to experience anxiety, sweaty palms, a racing heart, or stomach lurches when it's time to face a crowd.
For people with social anxiety disorder (SAD), however, this reaction can apply in everyday social situations — eating in public, interacting at the workplace, or even taking a visit to the local grocers.
Social anxiety disorder or social phobia is a mental health condition that causes an intense or persistent fear of being watched, judged, or negatively evaluated by others.
This condition can become so severe, completing everyday tasks, or going about normal life can become virtually impossible.
We'll be taking a closer look at this condition, its causes, symptoms, and the best ways to manage social anxiety disorder.
We'll begin with what social anxiety disorder is not — a mere feeling of shyness at having to interact with others.
Social anxiety disorder is so much more than that. A person with this condition feels extreme fear or anxiety at certain or all social interactions. This fear is so strong that it becomes difficult or impossible to control.
Routine activities — answering questions at meetings, attending school, or using public restrooms can become activities that a person with this condition can worry about, sometimes for weeks before the slated event is set to occur. This disorder causes an extreme form of self-consciousness.
However, while social anxiety isn't shyness, it is usually birthed from extreme shyness. This condition is fairly common, affecting around seven percent of Americans — the Anxiety and Depression Association estimates that around 15 million American adults live with SAD.
A number of factors may contribute to the causes of social anxiety. They include:
Genetics: Genes may influence the chances of developing social anxiety disorder. Higher incidents of this condition have been found in relatives of people with this condition. This is especially in comparison with families where it is absent.
Likewise, twins — particularly identical twins, are each likely to develop this condition if one of the pair has it.
Underdeveloped social skills: Where a person has poorly developed social skills, there's a chance that they worry about embarrassing themselves when interacting with people.
It may also cause a misreading of facial expressions. For instance, a person with social anxiety disorder may believe their actions are being frowned or sneered at, when this is simply not the case. This can worsen anxiety when dealing with people.
Domineering parents: where parents are overly controlling towards children, this can increase the risk of said children growing up into reserved, bashful, and shy adults. This upbringing can increase the risk of developing social anxiety disorder.
Stressful social events while growing up: bullying, physical abuse, public embarrassment, or experiencing a blank mind during a public performance, have all been linked to developing social anxiety disorder.
When a person with social anxiety disorder is required to perform or present in front of an audience, or to simply be among other people, the following symptoms may be observed:
A rigid posture
Quickened heart rate
A fear of being judged or having to interact
Worry over embarrassment in front of others
Anxiety about having to interact
Awkwardness around others
Embarrassment over the obvious physical symptoms like sweating and trembling
In addition to this, a person with social anxiety disorder may avoid eye contact or interacting with others. In other cases, they may avoid the social situation altogether — whether it is a minor setting such as public transportation, or difficult to avoid environments such as the workplace or school, especially for extended periods of time.
People with this condition usually experience the first symptoms in their early to mid-teens. Before their 20s, most people would have developed social anxiety disorder in its full form.
To determine whether or not a person is living with social anxiety disorder, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) specifies the following indicators:
Pronounced fear or anxiety in social situations where the individual is exposed to others
Fear of negative evaluation in social situations
Experiencing fear at the prospect of social interaction
Enduring social situations with anxiety. Alternately, avoiding the social situation entirely
This fear is excessive in comparison with the reality of the social situation
Because of the nature of this condition, there's a tendency for a person living with social anxiety disorder to simply chalk his anxiety and fear at social conditions to his bashful personality.
This may explain why fewer than five percent of people with this condition seek treatment after a year of exhibiting symptoms. In the same vein, more than a third of the people living with this condition wait around ten or more years before seeking treatment.
Without the proper management, social anxiety disorder can worsen to the point where gainful employment is impossible. It can make relationships are extremely hard to hold on to, while instances of suicidal ideation may become commonplace when living with social anxiety disorder.
Thankfully, this disorder is highly treatable, and its management may be achieved using the following measures:
Otherwise known as talk therapy, psychotherapy is considered by some to be one of the most effective ways to manage social anxiety. In particular, cognitive behavioral therapy (CBT) has stood out for the benefit it poses for improving the symptoms of this condition.
This form of therapy helps with identifying and changing negative thought patterns and behaviors that may have a dangerous influence on outlook and behavior.
For this disorder, CBT is able to help the patient develop a different, less threatening understanding of social situations.
The therapist may achieve this by identifying the fearful thoughts that cause worry, trembling, and other symptoms of anxiety during social situations. They also help the individual identify and correct the beliefs they hold about social situations that may trigger anxiety.
Cognitive behavioral therapy also helps to shift negative beliefs about oneself into more positive standpoints.
Other forms of therapy like interpersonal therapy can help to improve relationships with others, as well as social abilities to help with reducing distress during interactions. Psychodynamic therapy helps to examine the relationship conflicts a person experiences. This helps to understand how they may lead to the symptoms of the anxiety disorder.
Belonging to an online group therapy of people with social anxiety can provide real-time feedback about how people really view those with the condition. This can help with dispelling the idea that others are immediately judging and evaluating those with the condition.
Support groups offer the comfort that there are others facing the same challenges, and may help with sharing the tips they use to manage their condition. By joining a social anxiety forum or health anxiety forum, you may feel less alone when dealing with this type of anxiety.
Drugs are a very effective way to manage and improve the symptoms of social anxiety disorder.
Antidepressants like serotonin reuptake inhibitors (SSRIs) are usually the first resort. This medication helps to increase the levels of serotonin — a neurotransmitter that regulates mood and feelings of wellbeing — in the brain.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are also effective at managing anxiety symptoms. They achieve this by stabilizing the brain's levels of serotonin and norepinephrine (another neurotransmitter that affects the mood).
Beta-blockers also help to manage symptoms of anxiety by regulating the racing heart and high blood pressure faced when in an anxiety-inducing social situation. They are especially useful when anxiety creeps in before a performance or presentation.
Anti-anxiety medication also helps to manage the appearance of extreme fear, worry, or panic that comes with this disorder.
Social anxiety disorder can transform even the most mundane social interactions into scenarios that require excessive planning and advance worry.
The origins of this condition may come from overbearing parents, traumatizing events growing up, or it may be the result of a genetic disposition to anxiety disorders.
Despite its comparisons to shyness, social anxiety is much more severe, and may even lead to suicidal thoughts in very serious cases.
There are however tried and trusted means to manage social anxiety disorder. These include therapy, medications, and the assurance provided by support groups.
Learn more about ways to improve your mental health online.
Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.
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