Social Anxiety Disorder
What is Social Anxiety?
All types of situations in which you are amongst people are social situations, and involve some level of either social interaction or exposure to the scrutiny of others. This means that social situations are not only those in which you 'socialise' - for example, dating, parties or dinner with friends, but are also situations of any kind where there are other people - such as being at school or work, public speaking, meetings, exams, writing in front of others, using public toilets, and speaking on the telephone.
"Anxiety" refers to a mental or emotional state of apprehension and fearfulness, which may range from a feeling of unease to acute panic or terror. Prolonged or intense anxiety may lead to physical symptoms such as sweating, a racing or pounding heart, blushing, trembling, nausea, or feeling dizzy. Anxiety generally occurs as a response to a feared situation and is exacerbated by negative or fearful thoughts.
Social anxiety is fearfulness related to social situations. Many people experience anxiety, feel self-conscious and shy in certain social situations, for example, when meeting new people, attending a job interview or speaking in public. However, the anxiety is usually temporary and subsides after the event has passed.
What is Social Anxiety Disorder?
For people with social anxiety disorder (or social phobia), social situations bring feelings that go far beyond simple anxiety or nervousness. The anxiety may be so extreme and disabling that it interferes with their daily life, work and/or education, family and social life. People with social anxiety disorder may often avoid feared situations or endure them with intense distress. For people with social anxiety disorder the key element is severe anxiety and worry about social interactions due to a persistent fear that people are thinking about them in a negative way, or fear of behaving in a way that may cause feelings of embarrassment or humiliation. The anxiety is experienced in situations where the person believes that he/she is being scrutinised or observed by others.
For some people the anxiety can lead to panic-like symptoms, which may include heart palpitations, blushing, trembling, nausea, faintness and profuse sweating. The anxiety usually triggers anxious thoughts about the feared social situations and contributes to a person's distress and difficulty performing in such situations. Thoughts and beliefs which are commonly associated with social anxiety disorder include:
"I look out of place"
"I sound stupid"
"I don't fit in"
"I'm making a fool of myself"
"I'm inferior to other more talkative people"
"People will notice that I am blushing and look nervous".
A person with social anxiety disorder recognises that the social anxiety is excessive and unreasonable, however, he/she feels unable to change or control the feelings or behaviour. Living with social anxiety disorder usually has an adverse affect on a person's self-esteem. People often experience feelings of inferiority, a hypersensitivity to criticism, negative evaluation, or rejection, and find it difficult to be assertive. It is also common for people to fear indirect evaluation for example in test or exam situations.
For some people, social anxiety disorder may be selective - they may have an intense fear of public speaking, for example, but be comfortable in other social or performance situations. These specific social phobias are focused on a particular area of anxiety and generally are related to worries about performance. Other people may experience a more generalised social anxiety and have several social phobias about a variety of social or performance situations in which they may be observed.
The Impact of Social Anxiety Disorder
Social anxiety disorder can have a significant impact on a person's life. For some people it can limit performance and choices at school and work or make it difficult to develop and maintain friendships and relationships. People may often find themselves making decisions about their life on the basis of avoiding feared situations. Many people with social anxiety disorder also develop depression and some may misuse alcohol, drugs or medication to help reduce the anxiety and cope with difficult situations.
Who is affected by Social Anxiety Disorder?
Social anxiety disorder affects literally millions of people - up to 13% of the population may experience social anxiety disorder at sometime in their life. Social anxiety disorder affects people from all walks of life and occurs in both males and females. Social anxiety usually starts during adolescence with some people reporting onset in early childhood. Many people with social anxiety disorder describe themselves as having been a shy or socially inhibited child. Social anxiety disorder typically continues throughout a person's life (particularly if the person does not obtain appropriate help) although the degree of impairment it causes may vary depending on the development of resilience and coping styles, life stressors and demands.
Treatment
Cognitive behavioural therapy has been found to be effective in treating Social Anxiety Disorder. The most useful cognitive behavioural techniques include cognitive restructuring - challenging and changing false or distorted thoughts, ideas and beliefs to more realistic and helpful ones, gradual exposure to feared situations, attention training and anxiety management techniques such as controlled breathing exercises. Learning about the nature and impact of social anxiety disorder is also an important component of a therapeutic program. Group programs designed to assist people to learn ways of managing social anxiety have also been shown to be very helpful as they provide an opportunity for exposure to social fears in a supportive environment. Other psychological techniques that appear to be helpful for some people are - social skills training, imaginal desensitisation, relaxation, and supportive psychotherapy. Some medications are also effective in the treatment of social anxiety disorder and may be used in conjunction with cognitive behaviour therapy.
It is important to obtain an accurate diagnosis, and appropriate treatment from a health professional - psychiatrist, psychologist, counsellor and/or general practitioner, who is experienced and knowledgeable about social anxiety disorder.