What is Social Anxiety Disorder?
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We all become numb from time to time, longing for alone time, and fearful of large groups of people. And most of us get nervous before that big presentation at work or on a first date with a stranger.
But if you are someone who is intensely stressed out from presentations or speeches, is anxious in social situations, has a phobia of interacting with new people, or feels judged by others – to the point where it affects your daily life – You may have a social anxiety disorder.
But it’s not as scary as it sounds, and it doesn’t have to interfere with your life. There are great resources and ways to get help so it doesn’t continue to negatively affect your life or cause you to avoid social attitudes. Read on to learn all about social anxiety disorder, if you have it, and how to treat it.
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What is Social Anxiety Disorder?
“Social anxiety is basically a phobia of social situations or a significant fear or increased concern about a situation in which someone might be checked by someone else,” explains psychiatrist Jessi Gold MD, MS., Assistant Professor in the Department of Psychiatry in Washington University in St. Louis.
Patients can say something like, “Every time I walk into a room, I feel like people are watching, judging, and thinking of me,” says Dr. Gold. Often times they add that they logically know that this is not true, but they feel “paranoid,” she says.
James Shamlin, LCSW, a Pittsburgh psychotherapist, agrees, adding that social anxiety disorder can most simply be defined as the “consistent and persistent fear of being criticized by others” – be it a peer, a romantic interest, or an authority figure.
The disorder can also cause “anticipatory anxiety” when someone thinks of an event that will happen in the future, Shamlin says. For those with social anxiety disorder, “you endure it with intense fear or anxiety, or ideally you are really actively trying to avoid it at all,” adds Dr. Gold added.
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Avoidance can then develop into a cycle that only makes your anxiety worse, says Pittsburgh-based psychotherapist Terrie L.. Means LCSW. “It’s like that creepy, hairy monster under your bed that you’re scared to look at, but I often ask what happens when you look?”
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What does a social anxiety disorder look like?
Most of us have some degree of fear or social anxiety. Most of us get nervous during a presentation or speaking, and we can all feel a little uncomfortable around a large group of new people, for example. But that doesn’t necessarily mean you have social anxiety.
So how do you distinguish between a normal level of anxiety and a disorder? “As with all mental illnesses [the social anxiety] Stress that affects your daily life or your functioning in a certain aspect of your life – socially, at work or in your relationships, ”explains Dr. All of gold must take six or months to qualify as a true disorder.
Dr. Gold adds that the level of fear you feel is usually “out of proportion to the situation” and usually occurs every time someone gets into that situation. For example, symptoms can interfere with activities like ordering groceries, returning items at a store, or making calls, Means says.
She adds that it can even affect your “ability to eat or drink in front of others, write on a blackboard as a student, use a public restroom, or speak in public”. (Speaking publicly is actually number one in social anxiety, Means says.)
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Another sign of the disorder, according to Shamlin, is having a lot of inner focus on yourself, thinking about situations often, and finding out if you did or said something “stupid”. Other tell-tale symptoms are physical and include “sweating, flushing, tremors, racing heart, nausea, difficulty concentrating, tense muscles, speaking quickly or speaking softly and quietly, and reduced eye contact,” Means said.
If you get these symptoms normally, you could be suffering from a social anxiety disorder. But it is also important not to self-diagnose – in this case seek professional treatment and advice.
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What causes social anxiety?
Like many mental illnesses, this disorder is usually the result of several factors, but it can be mainly attributed to the chemistry of your brain or genetics.
“There’s actually evidence of its existence from brain scans, and it runs in families, so there’s a genetic basis too,” says Dr. Gold. But “nurture” can also work with “Nature”. For example, traumatic social situations that are embarrassing or where someone felt judged could also trigger the emergence of a social anxiety disorder, especially if they were younger, she explains.
According to ADAA (Anxiety Disorders and Depression Association of America), social anxiety disorder starts at 13 years old on average, although it can start even younger, Means explains.
With the lockdown of Covid-19, Means said patients with the disorder were initially relieved to be able to avoid large gatherings and social facilities. But re-entering a social environment proves to be a trigger for many people who already have a social anxiety disorder. “People with social anxiety also find that their self-esteem or self-confidence has been negatively affected,” says Means.
What treatments can help with social anxiety disorder?
If you think you may have a social anxiety disorder, it is important to seek help so that you can find ways to manage the disorder and prevent it from affecting your life.
Shamlin says the most common way to treat the disorder is cognitive behavioral therapy (CBT), which “helps people look at their thoughts about their dreaded social situations and helps change thought patterns”.
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While it can be intimidating, exposure therapy is also an effective form of treatment that can help patients separate the fears of a negative outcome from the specific action taken, says James. An example of this that Means gives her patients is making eye contact with a stranger to see their eye color. “The purpose of exposure therapy is to help people gradually learn that the negative outcome they fear isn’t causing the negative outcome they often expect,” says James.
Another very effective treatment method is group therapy. Dr. Gold says because it allows patients to be exposed to a group setting in a safe space. Often times, patients are given a seemingly ridiculous task, such as buying things for every penny – and tolerating the fear of it. “Then when you do something simple, like saying hello to someone you don’t know, it feels so easy and boring,” she says.
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In certain circumstances, it can be beneficial to manage your social anxiety with both therapy and medication, says Dr. Gold. “Medicines can be absolutely helpful in helping you better tolerate the physical sensations and interact in everyday life,” she adds. “It shouldn’t be used instead of therapy, but in addition.”
If you are struggling with social anxiety or any other mental illness, contact the SAMHSA National Helpline at 1-800-662-HELP (4357).