Anxiety
Disorders >> Social Anxiety And Social Phobia
SOCIAL ANXIETY AND SOCIAL PHOBIA
Social anxiety disorder (or social phobia) is an irrational,
disabling fear of humiliation in everyday social situations.
People with social phobia fear that their behavior
will lead to negative judgment by others, even though
they recognize this fear is illogical.
UNDERSTANDING SOCIAL ANXIETY DISORDER
What is a social anxiety disorder
(social phobia)? Social anxiety disorder,
also called social phobia, is defined as an overwhelming
and disabling fear of scrutiny, embarrassment, or
humiliation in everyday social situations which leads
to avoidance of potentially pleasurable and meaningful
activities. Most people experience some shyness or
nervousness in certain social or work situations,
but for someone with social anxiety disorder, the
anxiety is so extreme that it can become debilitating.
Social anxiety disorder is common, affecting from
7 to 13 percent of American adults in any given year,
making it the third most common psychiatric disorder
in the United States after depression and alcohol
abuse. Unlike other anxiety disorders, which affect
women more than men, social anxiety disorder is an
equal problem for both men and women. Adolescents
and young adults, who often are unsure of themselves
around others and concerned with image and conformity,
are especially susceptible to social anxiety. However,
social anxiety disorder is sometimes seen in children
under twelve.
You may have social anxiety disorder if your feelings
keep you from your work or isolate you from activities
with others.
Warning signs of social phobia include:
- Intense worry for days or even weeks
before an upcoming social situation.
- Extreme fear of being judged by others,
especially people you don’t know.
- Excessive self-consciousness and anxiety
in everyday social situations.
- Fear that you’ll act in ways that
that will embarrass or humiliate yourself.
- Avoidance of social situations to a degree
that limits your activities and causes disruptions
to your daily life.
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SOCIAL PHOBIA VS. SHYNESS
Is social anxiety disorder the same as shyness?
The short answer is “No, it’s much worse.”
Social anxiety disorder is a kind of extreme shyness:
extreme to the point of avoiding social situations
and causing disruption to social and professional
relationships.
For example, if you get the jitters before making
a speech or presentation, that’s considered
pretty normal. If you call in sick to avoid making
the presentation, that’s a clue that your anxiety
exceeds normal levels. The shy guy might be too nervous
to ask someone to dance at a party, but the person
with social anxiety disorder, sure that everyone will
decide his clothes are uncool and that he’ll
spill a drink on himself, will skip the party altogether.
A person with social phobia might fail to attend the
first meeting of a class or conference because she
knows she’ll be asked to introduce herself.
Another might worry all week about a weekly team meeting
at work, deathly afraid that he’ll be required
to describe what he’s working on or even answer
a question. Some people with social anxiety disorder
find it difficult to pick up a phone and call the
cable company (what if the person on the other end
thinks her request is stupid?), stand in line at the
supermarket (he knows people aren’t really staring
at him, but he feels as if they are), or simply walk
down the street (what if she has to talk to someone?).
Social Phobia Triggers
According to the Social Phobia/Social Anxiety Association
(SP/SAA), people with social phobia usually find their
anxiety triggered by situations such as:
- Being introduced to other
people
- Being teased or criticized
- Being the center of attention
- Being watched or observed while doing
something
- Having to speak in public
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- Meeting people in authority
- Attending parties or other social gatherings
- Becoming embarrassed
- Meeting other people’s eyes
- Eating, talking, or making phone calls
in public
|
People with social anxiety disorder usually recognize
that their fears are irrational, but they can’t
help feeling fearful and allowing their fears to affect
the way they conduct their lives. Social anxiety sufferers
often experience negative thought patterns that contribute
to and prolong their anxiety. If you have social phobia,
you may find yourself overwhelmed by thoughts like:
- “I'll act uncomfortable or awkward.”
- “I'll look stupid or incompetent.”
- “I'll seem weird or strange.”
- “I'll feel embarrassed.”
- “I'll be boring.”
SOCIAL PHOBIA IN CHILDREN
How are children affected by social phobia?
In children, the extreme shyness, timidity, and fear
of embarrassing themselves that are hallmarks of social
anxiety disorder are especially distressing because
children are less able to understand that their fears
aren’t based on reality. Again, there’s
nothing abnormal about a child being shy, but children
with social phobia often avoid everyday activities
and situations such as playing with other kids, reading
in class, speaking to adults, or ordering food in
restaurants.
The Cincinnati Children’s Hospital Medical Center
reports that social anxiety disorder in children is
triggered by situations such as speaking in front
of the class, talking with unfamiliar children, writing
on the board, performing in front of others, taking
tests, and interacting with strangers. Typical thoughts
among such children are:
- “I hope the teacher doesn’t call
on me.”
- “I’m going to make a mistake.”
- “Everybody’s staring at me.”
- “Nobody likes me.”
Children showing symptoms of social anxiety disorder
may avoid eye contact, speak inaudibly, or fidget
and tremble. They may be sweaty or clammy and complain
of dizziness, headaches, or stomach aches. Often,
children with social phobia don’t want to go
to school.
Children with social anxiety are often lonely, have
fewer friends than other children their age, and report
symptoms of depression. The center also warns that
children who develop social anxiety before the age
of twelve are not likely to outgrow the disorder.
Left untreated, many children with social anxiety
disorder grow up to be socially anxious adults and
continue to have problems in interpersonal situations.
SIGNS AND SYMPTOMS OF SOCIAL
ANXIETY DISORDER
What are the symptoms of social anxiety disorder?
Almost everyone experiences symptoms of social anxiety
from time to time. But if you’re suffering from
social anxiety disorder, these emotional and physical
symptoms are severe and disruptive to your life. If
your lifestyle is consistently limited by your fear
of negative evaluation and your distress over the
anxiety you suffer when socializing, it is likely
that you have social anxiety
| Symptoms of Social Anxiety
Disorder |
| Emotional Symptoms |
- Disabling fear of one
or more social situations.
- Fear of being watched
or judged by others.
|
- Fear that others will notice your
physical symptoms of anxiety.
- Fear
of embarrassing yourself in public.
|
| Physical Symptoms |
- Racing heart or palpitations
- Blushing
- Excessive sweating
- Dry throat and mouth
- Trembling
|
- Muscle tension
- Trouble talking
- Nausea
- Stomach upset
- Diarrhea
|
The Anxiety Disorders Association of America has a
brief
social
phobia self-test that you can complete, print
out, and share with a mental health professional if
you are experiencing symptoms of social anxiety disorder.
EFFECTS OF SOCIAL ANXIETY
DISORDER
What are the effects of social anxiety disorder? Social
anxiety disorder can have a severe and negative impact
on your life, interfering with your school, social,
and professional relationships. The dread of a feared
event can begin weeks in advance and be quite debilitating.
You may experience some or all of the following effects,
leading to further discomfort and an overall dissatisfaction
with the quality of your life:
- Avoidance – You often
go to great lengths to avoid socializing with
people for fear that you will be perceived adversely
or will be humiliated. Left untreated, avoidance
can develop into another anxiety disorder, such
as agoraphobia.
- Low Self-Esteem – Most
people with social anxiety disorder also experience
low self-esteem. The longer you stay in the same
self-defeating cycle of fear and avoidance, the
harder it is on your sense of self-worth.
- Depression
– If you have social anxiety disorder, your
feelings of extreme anxiety and lack of control
over your life may lead to depression, a common
co-existing condition.
- Alcohol
Abuse or Drug
Abuse – About one-fourth of
all people with social anxiety disorder abuse
alcohol. If you experience severe anxiety, you
might turn to alcohol or drugs to alleviate your
pain, although eventually the substance abuse
becomes another problem in your life and makes
treatment and healing increasingly difficult.
- Academic and Occupational Difficulties
– Social phobia can interfere with your
functioning both at school and at work. Social
anxiety disorder may be an obstacle to finishing
school and advancing on the career front.
- Interpersonal Difficulties
– People with social anxiety disorder are
less likely to marry than others and may have
fewer friends and social support.
- Other
Anxiety Disorders – Over half
of people with social anxiety disorder have or
will develop another anxiety disorder at some
point in their life.
TYPES OF SOCIAL ANXIETY DISORDERS
What are different types of social anxiety
disorder? Social anxiety disorder is often
classified into three different types or levels:
- Generalized social phobia
– This is the most common type of social
anxiety disorder. Generalized social phobia affects
a person in most social and performance situations.
A person with this type of social anxiety disorder
experiences anxiety in the majority of interactions
with others.
- Specific social phobia - In
some cases, social anxiety is connected with specific
social situations, such as meeting new people,
using public restrooms, or eating in front of
others. Fear of public speaking is the most common
specific social phobia. Fear of public speaking
is a type of performance anxiety. Performance
anxiety, or stagefright, involves intense fear
over performing in front of an audience, whether
it be playing a piece of music at a recital or
giving a presentation to your boss. For tips on
coping with performance anxiety, visit Overcoming
Stagefright.
- Avoidant personality disorder
– Avoidant personality disorder is considered
by many mental health professionals to be the
most severe form of social anxiety. The disorder
is characterized by a lifelong pattern of extreme
shyness to the point of self-isolation. If you
have avoidant personality disorder, loss and rejection
may be so painful for you that you choose a solitary
life and avoid connecting with others.
CAUSES OF SOCIAL ANXIETY DISORDER
What causes social phobia? Many social,
psychological, and biological factors are believed
to contribute to the development of social anxiety
disorder or social phobia. These factors are interrelated
and interact with each other, so it is impossible
to pinpoint exact causes. For example, although social
phobia tends to run in families, it is unknown whether
this is because of genetics or social learning from
family members.
| Social Phobia Causes |
| Social & Environmental
Causes |
| Learning from your environment
|
Some researchers and professionals assert
that social anxiety disorder is a learned behavior;
that is, it can be developed from observing
and interacting with others who experience similar
anxiety. There may be association between parents
who are controlling and overprotective and the
development of social phobia. Parents often
are not able to acknowledge the disorder in
their children because they experience the anxiety
themselves and think of it as normal. |
| Previous negative social experiences
|
Some individuals may develop social phobia
after a particularly negative social experience.
For children, such experiences can include teasing,
bullying, or a particularly embarrassing incident
in public. Problems in speech or language, disfigurement,
sexual or physical abuse, family conflict, and
neglect can also contribute to social phobia. |
| Psychological Causes |
| Emotional or psychological trauma
|
Researchers have turned an increased focus
to the relationship between early-life emotional
trauma and the development of social anxiety
disorder. Your current social anxiety symptoms
may be a result of unresolved trauma that you
experienced earlier in life, regardless of whether
you recall any traumatic circumstances. For
more information, see Emotional
and Psychological Trauma: Causes, Symptoms,
Effects, and Treatments. |
| Poor attachment with primary caretaker
during stages of early-life development |
If you were unable to develop an adequate
bond with your primary caretaker as a child,
you may lack self-regulatory skills to calm,
focus, and soothe yourself in situations you
perceive as stressful or chaotic. Attachment
specialists point to this as a possible cause
of social anxiety disorder and other anxiety,
depression, and stress-related disorders. For
more information, see Helpguide's Parenting:
Attachment, Bonding and Reactive Attachment
Disorder. |
| Biological Causes |
| Genetics/Heredity |
Many research studies suggest a modest genetic
component to social phobia. Behavioral inhibition
is believed to be the biggest inherited risk
factor. Behaviorally inhibited infants are upset
easily by things that are unfamiliar and are
likely to develop into fearful children. By
adolescence, they show an increased risk for
social anxiety disorder. |
| Brain Structure |
The amygdala is the part of the brain that
controls your fear response. Recent brain-imaging
research has indicated that people who frequently
experience social anxiety have an overactive
amygdala and an underactive prefrontal cortex. |
| Biochemistry |
Other research studies have focused on the
notion of a biochemical basis for social anxiety
disorder. An imbalance in the brain chemical
serotonin may be a factor. Other neurotransmitters
that may be involved include dopamine and GABA. |
TREATMENT AND HELP FOR SOCIAL
ANXIETY DISORDER
How is social anxiety disorder treated?
Cognitive behavioral therapy (CBT) and exposure therapy
are both very effective in the treatment of social
anxiety disorder. Certain medications can also be
helpful for social anxiety disorder. Sometimes, CBT
or other behavior therapies are combined with medication.
But regardless of the treatment approach, you will
need a qualified therapist to oversee the process.
Cognitive Behavioral Therapy
The most frequently used form of psychotherapy for
the treatment of social anxiety disorder, or social
phobia, is cognitive behavioral therapy (CBT). This
type of therapy is based on the premise that your
own thoughts — not other people or situations
— determine how you behave or react. Even if
an unwanted situation doesn’t change —
you still have to make that presentation at work;
your sister still expects you at her wedding —
you can change the way you think and behave in a positive
way. CBT teaches you how to quell the anxiety you
feel in social situations so you can face such situations,
rather than avoiding them.
In CBT for social phobia, a therapist will first help
you identify the automatic negative thoughts that
underlie your fear of social situations. These negative
assumptions might include thoughts such as “I
don’t have anything interesting to say”
or “I’m going to look stupid.” Once
you’ve identified these negative thoughts, you
and your therapist will analyze and challenge them.
For example, you may ask yourself questions about
the negative thoughts: “Do I know for sure that
I won’t think of anything interesting to say?”
or “Even if I’m nervous, will people necessarily
think I look stupid?” Through this logical evaluation
of your negative thoughts, you can gradually change
them into more realistic and positive ways of perceiving
anxiety-triggering situations. Other CBT techniques
for social anxiety disorder might include role-playing
and social skills training. As you act out and prepare
for situations you are afraid of, you will become
more and more comfortable and confident in your social
abilities.
Exposure Therapy
In exposure therapy for social anxiety disorder, you
are exposed in a safe and controlled way to the social
situation you fear. Just as it is used in the treatment
of other types of phobias, exposure therapy for social
phobia involves gradual, repeated encounters with
the situation you fear. If you’re uncomfortable
in large social gatherings, your therapist may first
have you imagine being at a large party. Using relaxation
techniques, you will imagine this anxiety-producing
party until the fear begins to subside. Once you are
able to imagine going to a party without fear, you
may expose yourself to a party in real life. With
each successful exposure experience, you feel an increasing
sense of control over your social phobia and you become
desensitized to your fear.
COPING WITH SOCIAL ANXIETY
DISORDER
What lifestyle changes or self-help tips can
help me cope with social phobia? Just learning
about social anxiety disorder and knowing that it
is highly treatable can relieve some of your pain
and discomfort. There are also a number of coping
techniques that you can use to relieve anxiety when
you find yourself in a social situation.
For example, one doctor suggests that when you think
“Everyone is watching me,” you look around
the room or the street and take an actual count of
the people who truly are watching you (You’ll
find that few will even be looking in your direction.).
He also suggests that rather than leave a social situation,
you wait 15 minutes and see if your anxiety symptoms
lessen. If they get even a little bit better, wait
15 minutes more.
Other coping techniques include:
- Slow, shallow breathing.
- Consciously trying to heighten or exaggerate
your anxiety or symptoms. Paradoxically,
this usually has the effect of decreasing
anxiety or its symptoms.
- Positive self-talk can reduce anxiety.
It includes telling yourself that your symptoms
and anxiety will diminish if you wait them
out, and that other people in the room are
probably anxious too.
- Breaking some of the tension by verbalizing
your feelings in a humorous way (“Boy,
I sure am a nervous wreck.”).
- Carrying supportive statements, such
as “I’ve handled this before,
and I can handle it now,” on index
cards and looking at them when necessary.
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Steps to Overcome your Social Anxiety
In its section on self-care for social anxiety disorder,
the Mayo Clinic suggests the following ideas for you
to try when taking steps to overcome your social anxiety:
- Imagine a stressful situation happening
in a comfortable place.
- Focus on personal qualities you like
about yourself.
- Eat with a close relative, friend or
acquaintance (someone with whom you feel
safe) in a public setting — a picnic
or a restaurant.
- Make eye contact and return greetings
from others, or say hello first.
- Prepare for conversation. For instance,
read the newspaper to identify an interesting
story you can talk about.
- Give someone a compliment.
- Show an interest in others. Ask about
their homes, children and grandchildren,
hobbies or travels.
- Ask a retail clerk to help you find an
item.
- Get directions from a stranger.
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Actively seeking out and joining supportive social
environments is another effective way of tackling
and overcoming social phobia. The following suggestions
are good ways to start interacting with others in
positive ways:
- Take a social skills class or
an assertiveness training class.
These classes are often offered at local
adult education or community colleges.
- Join a support group.
The Anxiety Disorders Association of America
has a directory
of anxiety support groups . You can
also join a virtual support group such as
Social
Anxiety Support , an online forum dedicated
to social phobia sufferers.
- Volunteer doing something you
enjoy, such as walking dogs in
a shelter, or stuffing envelopes for a campaign
– anything that will give you an activity
to focus on while you are also engaging
with a small number of like-minded people.
See Helpguide's
Volunteering and Civic Engagement: Finding
Your Best Opportunities for tips on
becoming involved.
|
Ellen Jaffe-Gill, M.A, Melinda Smith, Heather Larson,
and Jeanne Segal, Ph.D. contributed to this article.
Last modified on 9/30/06.
Reprinted with permission from http://www.helpguide.org/.
C 2008 Helpguide.org. All rights reserved.
You can find the original article at
http://www.helpguide.org/mental/social_anxiety_support_symptom_causes_treatment.htm
SOURCE:
www.helpguide.org
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