Your Guide to Social Anxiety Disorder
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Your Guide to Social Anxiety Disorder

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social anxiety

It’s normal to experience some degree of nervousness, fear, or worry in social situations. For instance, going on a first date or presenting in front of others can cause one’s stomach to knot up (butterflies in the stomach).

Unfortunately, however, for some people the anxiety overwhelms them, interfering with their ability to socialize with others.

What is Social Anxiety?

When anxiety prevents a person from attending social events or hanging out with friends and family at public venues, then there is a good chance that they have social anxiety disorder, also known as social phobia. This condition is more common than most people think.

In fact, studies classify social anxiety disorder as the 3rd largest psychological disorder in the US following depression and substance abuse (i.e. drug addiction and alcoholism).

Moreover, researchers have found that approximately 7% of Americans suffer from some form of social anxiety (i.e. specific social anxiety disorder or generalized social anxiety disorder) each year. [2]

The prevalence rate for social anxiety disorder is currently at 14%. Researchers estimate that millions of people suffer from this distressing and debilitating condition. [2]

When a person has social anxiety, even normal daily interactions can cause extreme fear, shame, nervousness, apprehension, and/or self-consciousness, especially if the person feels criticized or judged by others. [1] As a result of the anxiety, the person goes out of their way to avoid social occasions (i.e. holiday celebrations, birthday parties, etc.).

It is important to remember that chronic and severe stress can negatively affect a person’s self-esteem, relationships, school or job performance, and social interactions.

Although social anxiety disorder is considered a long-lasting mental health condition, by developing healthy coping skills and following your prescribed treatment plan (i.e. medications and/or therapy), you can better manage your anxiety so you can socialize and enjoy life to the fullest.

Symptoms

Nervousness, shyness, and mild distress are not the hallmark signs of a social anxiety disorder, especially when it comes to children and teens. In fact, one’s comfort level in social situations largely depends on one’s mannerisms and life experiences.

For instance, one person may be introverted and more timid, while another may be extroverted and more outgoing. The introverted person would not be diagnosed with social anxiety disorder simply because he/she is shy and more reserved.

Therefore, a normal amount of nervousness, fear, worry, etc. is not classified as a symptom of social anxiety disorder. It only becomes a problem when the anxiety disrupts a person’s life.

More specifically, when the fear and anxiety prevents a person from going to school or work, attending social events he/she wants to attend, is afraid to leave the house, avoids attending family celebrations, etc. on a regular basis.

This condition typically arises during the teen or early adult years, although it can sometimes present in young childhood or middle-age and in older adults.

Psychological & Behavioral Symptoms 

Psychological and behavioral symptoms that sometimes accompany social anxiety disorder include:

  • An extreme, persistent fear of being judged or criticized by peers in social situations
  • Unrelenting worry of embarrassing or humiliating yourself or others
  • Severe fear of communicating with others
  • Worry that others will detect your nervousness or fear
  • An intense fear that others will pick up on your fear, embarrassment, or nervousness from your excessive perspiration, facial blushing, tremors, and/or trembling voice
  • An avoidance of social events out of fear of interacting with others
  • An avoidance of situations in which you are the center of attention
  • Developing anxiety or fear, in anticipation of an overwhelming or challenging event or activity
  • Over-analyzing social events (i.e. your reactions, behavior, and/or ill-perceived flaws), way after the event has ended
  • Expecting the worst case scenario, even before you have attended the social event
  • Excessively consuming alcohol before social situations to ease your nerves
  • Feeling the need to take a friend with you when you go places
  • Hiding in the background or remaining quiet so others won’t notice you

Note: Children with anxiety may exhibit anxiousness by having crying fits, temper tantrums, being extra clingy to parents/caregivers, or experiencing selective mutism in social situations.

Moreover, some children may experience a type of social anxiety disorder in which they develop severe fear, nervousness, and anxiety when speaking or performing in front of crowds, but not when experiencing other types of social situations.

Emotional Symptoms

Emotional symptoms that sometimes accompany social anxiety disorder include:

  • Extreme self-consciousness and anxiety in everyday social situations
  • Extreme worry, fear, and concern for days, weeks, or even months before an upcoming social event (i.e. presentation, date, or party)
  • Intense fear or nervousness at the thought of being watched or judged by others, especially by strangers

Physical Symptoms

Physical symptoms that sometimes accompany social anxiety disorder include:

  • Facial Blushing
  • Accelerated Heartrate
  • Tremors
  • Excessive Perspiration
  • Gastrointestinal Distress (i.e. Nausea, Vomiting, Constipation, Diarrhea, Abdominal Pain, Gas, and/or Upset Stomach)
  • Shortness of Breath
  • Dizziness (i.e. Lightheadedness)
  • Mental Fogginess
  • Muscle Tension (i.e. Aches and Pains)

Avoidance Symptoms

It is important to understand, even “normal,” “everyday” experiences can be hard to deal with when you have social anxiety disorder. Some of the avoidance symptoms commonly associated with this disorder include:

  • Deliberately hiding from strangers, loved ones, co-workers, and/or friends because you’re afraid to interact with them
  • Avoiding parties and social events because you’re afraid of being embarrassed
  • Shirking school or work because you are apprehensive of sitting in a classroom or performing at work where others can see and critique you
  • Rarely starting conversations because you’re afraid you will look silly
  • Avoiding eye contact at all costs
  • Rarely dating because you’re afraid of what your date will think of you afterwards
  • Only entering a room after everyone is seated
  • Rarely returning items to a store, because you are nervous about interacting with the customer service representative
  • Hating eating in front of others, because you are worried of what others will think of you and your eating habits
  • Only using a public restroom when you are in dire straits

Note: Social anxiety disorder symptoms can fluctuate. More specifically, they can reoccur (flare-up), if you’re highly stressed and/or overwhelmed, like when you have to do something with others or in front of others that you don’t want to do.

And, although avoiding these types of situations can temporarily ease your anxiety, if you don’t properly address it, it can become chronic over time.

Causes

Social anxiety disorder resembles many other mental health conditions in that its origin involves a combination of both environmental and biological elements.

Possible causes of social anxiety disorder include:

  • Genetics: Anxiety disorders tend to be inherited from your family. However, it is unclear if this link is primarily due to genetics (nature) or if the majority of these behaviors are learned (nurture).
  • An Overactive Amygdala: Researchers suggest that the amygdala, a part of your brain, is responsible for regulating your body’s reaction to fear. More specifically, it is believed that people with an overactive amygdala are hypersensitive to fear, thus triggering extreme worry, stress, and anxiety in social situations.
  • Environmental Factors: As mentioned above, some researchers suggest that social anxiety disorder may actually be a “learned behavior” that some people develop after a stressful, overwhelming, and/or humiliating social interaction or situation.Moreover, these researchers associate this condition with parents/caregivers who either modeled overly anxious behaviors in specific or generalized social settings or those who tended to be more dominating, controlling, and/or overprotective (i.e. “helicopter parenting”) towards their children.

Risk Factors

Several factors can increase your risk of developing social anxiety disorder. Some of these risk factors include:

  • Family History: You have a higher risk of developing social anxiety disorder if a 1st degree, biological relative (i.e. parent, sibling, grandparent, cousin, etc.) is already grappling with it.
  • Traumatic Experiences: Children and teens that are regularly bullied, teased, criticized, rejected, embarrassed, taunted, and/or ridiculed, have a higher risk of developing social anxiety disorder than those who are not. Moreover, traumatic experiences (i.e. relationship conflict, family dysfunctions, abuse, and/or neglect) are linked to social anxiety disorder.
  • Personality Characteristics: Children and teens that are more introverted, shy, socially withdrawn, and/or reserved in new situations or with new people have a greater risk of developing social anxiety disorder.
  • Social & Work Responsibilities: Social anxiety disorder symptoms usually present during the teen years. However, presenting in front of others at work, giving a speech during a work meeting, going on a first date, going to parties or social events, and just meeting new people and interacting with them can trigger this condition in some people.
  • Appearance-Related Disabilities: People with appearance-related disabilities (i.e. Parkinson disease tremors, stutters, or facial deformities, scars, and/or facial or bodily defects) are at-risk for developing social anxiety disorder due to poor self-esteem and self-consciousness.

Complications

It is important to understand that if this form of anxiety is left unaddressed, it can disrupt your life. More specifically, severe social anxiety can affect your job or school performance, self-esteem, relationships and even your ability to enjoy life.

Listed below are some complications associated with social anxiety disorder:

  • Poor Self-Esteem
  • Passiveness
  • Negative Self-Talk
  • A Hypersensitivity to Criticism
  • Inadequate or Unhealthy Social Skills
  • Social Isolation & Difficultly Developing and Maintaining Healthy Relationships with Others
  • Poor Academic Achievement & Employment Success
  • Substance Abuse (i.e. Drugs Addiction and Alcohol Abuse)
  • Suicidal Ideation (Thoughts) & Suicide Attempts
  • Secondary Anxiety Disorders & Other Mental Health Conditions (i.e. Major Depressive Disorder, Generalized Anxiety Disorder, Phobias, PTSD, etc.)

Prevention

There’s really no way to predict who will ultimately develop social anxiety disorder. However, you can take steps to reduce the likelihood of it so that you can enjoy life to the fullest.

Listed below are some helpful prevention strategies that can save you from a lot of anxiety:

  • Seek Help: Get help as early as possible. The longer you wait, the harder it is to treat social anxiety disorder. So, it is important to schedule an appointment as soon as possible if you suspect that you have it.
  • Write in a Journal: Keep track of stressful events, traumatic experiences, and/or relationship, school, or work woes. Writing in a journal can help your psychologist or psychiatrist better identify what’s triggering your stress and what eases it.
  • Prioritize! If you want to conquer your social anxiety, you’ll need to prioritize your tasks from most to least important. You’ll also need to learn how to better manage your time and capitalize on your energy reserves. The key to reducing your anxiety is to do the things you enjoy, especially if these activities involve other people.
  • Shun Drugs & Alcohol: Drugs and alcohol, and even caffeine and nicotine, can trigger or exacerbate social anxiety. So, if you’re a drug addict or an alcoholic, it is in your best interest to stop doing them, especially if you have high levels of anxiety in social situations. It is important to note that if you’re unable to control the abuse or addiction on your own, a physician, psychologist, clinical social worker, and/or support group can help you regain your vitality and happiness in social situations.

Treatment

Social anxiety disorder can be successfully treated. It is recommend that you consult a psychologist, psychiatrist, or clinical social worker, if you or someone you know is suffering from this condition. Treatment typically consists of cognitive-behavioral therapy, self-help techniques, support groups, and/or anti-anxiety meds.

Therapy [2]

The good news is that cognitive-behavioral therapy has been proven effective in the treatment of social anxiety disorder. In fact, studies have indicated that comprehensive cognitive-behavioral therapy can lead to long-lasting changes in those who suffer from this disorder.

Effort, patience, persistence, and consistency are key elements that can help a person overcome his/her fears, worries, nervousness, and/or concerns. It is important to note that this treatment has been successful in those without cognitive problems (i.e. Alzheimer’s disease, dementia, etc.).

A successful cognitive-behavioral treatment program should address cognitive-based (thoughts and beliefs) concepts and techniques, because the goal of this therapy is to change your brain associations (neural pathways), so that you no longer have extreme social fears and phobias.

Your brain is continuously developing, so it is still possible to alter any irrational and damaging beliefs, thoughts, perceptions, and feelings through cognitive-behavioral therapy.

Listed below are some treatment options for social anxiety disorder:

Self-Help [2]

It is important to understand that your mind and body are intrinsically linked; therefore how you treat your body can have a significant impact on your ability to manage your anxiety symptoms and boost self-esteem and self-confidence.

And, although self-help techniques won’t cure your social anxiety, they can be used in conjunction with your prescribed treatment plan to reduce your symptoms and aid in the treatment process.

The following self-help tips may help ease your social anxiety, so that the treatment process is more effective:

Eliminate or Reduce Your Caffeine Consumption

Caffeinated foods and drinks (i.e. tea, chocolate, soda, coffee, and energy drinks) are considered “stimulants,” which means they can increase your anxiety, especially in social situations.

Move!

In other words, make moving (i.e. exercise and physical activities) a priority in your life. All it takes is 30 minutes a day to make a noticeable difference in your physical and mental health.

If you absolutely abhor exercising, move by doing something you enjoy like dancing to your favorite songs, skiing, playing golf, swimming, and/or strolling around the mall window-shopping.

Add Omega-3 to Your Diet

Omega-3 fatty acids can help you combat social anxiety because they support brain health. They are also effective at boosting your mood, improving your outlook on life, and helping you better manage your anxiety symptoms.

The foods with the highest levels of omega-3 are: sardines, herring, tuna, salmon, anchovies, mackerel, walnuts, flaxseed, and seaweed.

Drink Moderately

It is common for some social anxiety sufferers to drink alcohol to calm their frazzled nerves in social situations. However, drinking too much alcohol can actually worsen your anxiety symptoms instead of improving them.

Give Up Smoking

One of the most powerful and addictive “stimulants” on the planet is nicotine. And, contrary to popular belief, nicotine can increase (not decrease) your social anxiety. Therefore, you can help ease your anxiety levels by not smoking, especially in social situations.

Get Some ZZZ’s

Sleep deprivation can lead to anxiety, especially at work or at school. Therefore, it is highly important to be well-rested before going into an environment with other people. Adequate sleep can keep you calm when interacting with others.

Join a Support Group [2]

If you are suffering from social anxiety, you may want to consider checking out a social anxiety support group. Keep in mind, however, that a good support group doesn’t pressure, manipulate, push, or coax their members to do anything they don’t want to do.

Therefore, if you encounter a support group that tries to persuade or forces you to do things (under the guise of “breaking” your phobias and fears) that make you uncomfortable – leave.

There are plenty more social anxiety groups that won’t make you feel uneasy. Remember, the goal of this group should be to help you work through your anxiety with those who are experiencing the same thing. Social anxiety groups should always be uplifting, supportive, and positive.

Medications [3]

In some cases, anti-anxiety meds are needed to get the anxiety under control. It is important to note that although these meds may relieve your social anxiety symptoms, it’s not a cure for the condition.

Still, anti-anxiety meds are one of the most common ways to combat social anxiety, along with therapy and self-help techniques.

Listed below are prescription medications commonly used to treat social anxiety:

Beta Blockers

These medications work to ease performance anxiety. And, although they don’t appear to help too much with the emotional effects of social anxiety, they can help you better manage your physical symptoms, such as shakiness, trembling voice, excessive perspiration, and an accelerated heartbeat.

Anti-Depressants

These medications may reduce severe and debilitating social anxiety disorder in some individuals by altering your mood and how you perceive events.

Benzodiazepines

Benzodiazepines are fast-working anti-anxiety meds. Unfortunately, however, these drugs also have a sedative quality to them and are highly addictive, so they are usually only prescribed when nothing else has worked.

How to Help a Child with Social Anxiety [7]

Listed below are ways you can help your child cope with social anxiety:

Don’t Try to “Fix” It

No one wants to see their child distressed, anxious, wracked with fear, or severely worried or nervous. However, you can’t “fix” this for your child, no matter how much you want to.

So, acknowledge with your child that you can’t “fix” what happens to them in social situations, however, you can be there as a support system for them during these times.

The worst thing you can do is remove triggers so your child doesn’t have to face the root of their anxiety. To overcome social anxiety, they are going to have to face their fears head-on.

You can’t do that for them. The best thing you can do for your child is to teach them how to cope with their fears and worries and how to persevere despite them. In other words, teach your child how to better manage their anxiety in social situations, and be there to listen to them. Over time, your child’s social anxiety will lessen.

Be Realistically Positive

In other words, don’t tell your child that their fears and worries will never happen, because you don’t know that. More specifically, don’t invalidate your child’s fear of going to the prom by saying, “Oh honey, you’ll have the best time ever – I did.”

Or, don’t dismiss their fear of starting a new school by saying, “Oh honey, you’ll make tons of friends at your new school.” Stay away from saying things like that because you’ll only ramp up your child’s stress and anxiety (i.e. the need for him/her to live up to your expectations).

However, you can be realistically positive by expressing your hope and desire that they have a good time at the prom or make friends at their new school. Explain to your child that regardless of what happens, they will be okay. And, also explain how proud they will be after they push past their fears.

The more your child musters the courage to face their fears, the more likely their social anxiety will diminish over time. Moreover, your child will gain confidence, because your expectations are more realistic.

Don’t Avoid Things

Don’t deliberately stay away from social situations that make your child anxious. If you do, you’re not doing your child any favors. In fact, you may unintentionally be making the situation worse.

How can a child get over their fears if they avoid them? They can’t. And, even though it will probably make your child feel better short-term (not having to deal with his/her fears), in the long-term, it could lead to long-term phobias and multiple anxiety disorders.

So, if your child becomes upset when faced with a social situation, don’t immediately remove them from it, rather, listen to them, help them process what is happening, and teach them how to cope with their feelings, so they can work past the fear.

The thing you do not want to happen is for your child to learn that crying and throwing tantrums will get them out of things they don’t want to do.

Start Out Slow [8]

You can help your child conquer their social anxiety by encouraging them to invite their closest friend over to spend the night or just do something fun (make sure it’s something your child enjoys).

Note: You may have to act like a buffer for your child. In other words, you may have to initiate conversation for the children at first. It may take a couple of “playdates” before your child feels comfortable enough to initiate conversation for himself/herself.

Be patient with your child and allow them to progress at their own pace. Once your child feels really comfortable with this friend, ask them to invite another close friend over. Repeat the process until your child feels comfortable. Then, encourage them to ask another friend and so on.

Once your child has a handful of friends they feel comfortable with, schedule a group playdate with all of them. Eventually, your child will feel more at ease hanging with their friends in social settings.

Model Healthy Ways of Coping with Social Anxiety

One of the best things you can do for your child is to teach (model) healthy ways of coping with anxiety in social settings. How do you handle social anxiety? What do you do? What do you tell yourself? How does it make you feel? When was a time that you experienced social anxiety, and what did you do to push past it?

Answering these questions will make your child feel that you can relate to what they are going through.

As a result, they will feel less alone and more comfortable talking to you about their feelings and fears. Don’t forget to listen and not judge. Just be supportive, positive, and validating, and let them know that “this too shall pass,” but until that time comes… you are there for them.

Outlook 

The prognosis for social anxiety disorder sufferers is good. In addition, those who have successfully completed cognitive-behavioral therapy, with or without medication and self-help techniques, have the best success rates as compared to those who only do self-help techniques and/or medications.

In fact, according to the National Institute of Mental Health, most people who previously suffered from social anxiety disorder continue to see progress (i.e. reduced anxiety) well after completing cognitive-behavioral therapy.[6]Therefore, researchers suggest that the key to success lies with therapy.

Furthermore, it appears that therapy methods like repetition and reinforcement of rational concepts and techniques is the key to long-term social anxiety relief. [6]

Helpful Resources

  • Social Anxiety Fact Sheet – Social Anxiety Association fact sheet covers social anxiety triggers, signs and symptoms, and various treatment options.
  • Social Phobia – This Teens Health article was developed for teens with the goal of providing them with a detailed overview of social phobia (i.e. causes and tips for coping with it).
  • Shyness and Social Phobia: A Self-Help Guide – The mental health group, Moodjuice, offers beneficial self-help strategies for better managing social anxiety symptoms.
  • Shy No Longer – The Centre for Clinical Interventions offers self-help workbooks with step-by-step suggestions on how to effectively cope with and overcome social anxiety.
  • Self Help Strategies for Social Anxiety (PDF) – Anxiety BC offers information on how to “develop a toolbox” of strategies that will help you cope with and overcome social anxiety.
  • What is Comprehensive Cognitive-Behavioral Therapy? – This social anxiety article by the Social Anxiety Institute describes the function and process of cognitive-behavioral therapy when addressing the physical and emotional symptoms of social anxiety disorder.

References

  1. Mayo Clinic. (2018). Social anxiety disorder (social phobia). Retrieved from https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
  2. Social Anxiety Institute. (2018). What is social anxiety? Retrieved from https://socialanxietyinstitute.org/what-is-social-anxiety
  3. Help Guide. (2018). Social anxiety disorder. Retrieved from https://www.helpguide.org/articles/anxiety/social-anxiety-disorder.htm#treatment
  4. http://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis
  5. Social Anxiety Association. (2018). Social anxiety fact sheet: What is social anxiety disorder? Symptoms, treatment, prevalence, medications, insight, prognosis. Retrieved from http://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis
  6. National Institute of Mental Health. (2018). Social anxiety disorder: More than just shyness. Retrieved from https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml#pub5
  7. Goldstein, C. (2018). What to do (and not do) when children are anxious. Child Mind Institute. Retrieved from https://childmind.org/article/what-to-do-and-not-do-when-children-are-anxious/
  8. Martinelli, K. (2018). How to help anxious kids in social situations. Child Mind Institute. Retrieved from https://childmind.org/article/how-to-help-anxious-kids-in-social-situations/
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Your Guide to Social Anxiety Disorder
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Your Guide to Social Anxiety Disorder
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About the Author Ree Langham, Ph.D. Psychology

Dr. R. Y. Langham holds a Bachelor of Arts in English from Fisk University, a Master of Marriage and Family Therapy (M.M.F.T.) in Marriage and Family Therapy from Trevecca Nazarene University, and a Ph.D. in Family Psychology from Capella University.

She is currently a child and family psychologist, medical, health & wellness contributor, copywriter, researcher, and psychological consultant for Livestrong magazine, Upwork, Blue Cross/Blue Shield, and Disorders.org.

Dr. R. Y. Langham has over a decade of experience writing, and editing medical, health & wellness, dating, marriage, love, and psychological articles for a variety of popular magazines, newspapers, companies, and websites.

Moreover, she worked as a Medical Analyst and Copyeditor for CIGNA for over 3 years. In 2011, she published her first psychological thriller, “Fallen Apple.” She has gone on to publish a children’s book and three other books in the “Apple Series.”

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