Social Anxiety Disorder

Social anxiety disorder

SAD – Social Anxiety Disorder

In some situations, a person’s shyness and nervousness, especially before reaching adulthood, does not mean that they have social phobia. Depending on individual personality traits and life experience, people feel different levels of comfort in social situations. It is common for everyone to feel nervous in demanding situations, for example during an exam, on a date, when going on stage for the first time, or when giving a public presentation. However, in Social Anxiety Disorder, also known as social phobia, everyday routines and usual relationships become more difficult, causing significant anxiety, fear, and embarrassment. In this condition, a person worries not only during social situations, but also beforehand, in anticipation of them, and afterwards.

In such cases, the content of the fear can vary, but most often it is the worry that the person will become the object of criticism and judgment.

For example, they may fear doing something shameful, inappropriate or embarrassing, or appearing inappropriately dressed… As a result, they are constantly tense, anxious, and excessively monitoring their own facial expressions, remarks, and behaviors. At the same time, their self-esteem decreases and self-critical thoughts increase.

Social anxiety disorder can be a chronic mental health condition, but in the course of psychotherapy it is possible to work on developing skills for managing anxiety. Medication treatment may be needed to restore emotional balance and to prepare you for a course of psychotherapy. Please consult a specialist to assess your condition.

How does social anxiety disorder manifest?

In social anxiety disorder, fear and anxiety significantly reduce quality of life.

The person avoids social interactions as much as possible, becomes isolated, and tries to leave the house only when absolutely necessary. These symptoms negatively affect relationships, work, and other important areas of life, which in turn further increases anxiety.

Emotional and behavioral symptoms

Fear of presenting oneself negatively

Fear of embarrassment or humiliation

An intense fear of interacting or speaking with strangers

Fear of blushing, sweating, or a trembling voice

Avoidance of activities and people

Fear of being the center of attention and avoiding it

Avoidance of participating in activities

Reviewing your own actions and conversations afterwards to search for possible “mistakes”

Expecting the worst-case scenario in any situation

Anxiety often manifests somatically, that is, physically:

Flushing

Tremor

Feeling nauseous

Sweating

Epigastric discomfort

Rapid heartbeat

Dry mouth

Dizziness

A sensation of a lump stuck in the throat

Feeling of difficulty breathing

Muscle tension

The person recognizes that their fear and anxiety are unfounded or inappropriate, yet they are unable to control or correct them.

In social phobia, quality of life is significantly reduced, and it becomes difficult for the person to cope with everyday responsibilities, so they avoid social situations, including:

parties and social gatherings

School or work

meeting new people

Communicating with strangers, for example in a shop

Romantic relationships

Entering a room where others are already seated and the meeting has begun

making eye contact

Eating in public ...

When should we seek help from a specialist?

The symptoms of social anxiety disorder can change over time. When your overall level of stress increases, the symptoms may become more intense; conversely, there may be periods when they ease. However, without appropriate treatment, anxiety symptoms tend to return again and again.

Consult a doctor if you avoid social activities or relationships because of fear or anxiety.

What can cause social anxiety disorder?

Genetics.

If any of your relatives has an anxiety disorder or another mental health condition

Environmental factors.

Socioeconomic stress factors

Biological factors.

A chemical imbalance in the brain that leads to an anxiety state. Hyperactivity of one of the brain structures—the amygdala—may generate an excessive fear signal.

What complications can arise if the condition is left untreated?

Without treatment, social anxiety disorder can take control of your life. Anxiety can interfere with work, school, relationships, and your ability to enjoy activities. This disorder can lead to:

Low self-esteem

Persistent catastrophizing of events

Negative self-attitude

Hypersensitivity to criticism

Poor social skills

Isolation and difficulties in social relationships

Low academic performance and career setbacks

Use of drugs and alcohol

Suicidal thoughts and attempts

Other anxiety disorders and certain other mental health conditions, especially depression and problems related to drug and alcohol dependence, are frequently seen together with social anxiety disorder.

How is social anxiety disorder treated?

Psychotherapy

Cognitive-behavioral therapy (CBT): helps a person identify and replace negative thoughts about themselves. It also helps them develop skills to feel more comfortable in social situations. In exposure-based CBT, you gradually work with the situations that you are afraid of.

Medication:

Medications that help restore the brain’s chemical balance. Beta blockers are often used to reduce physical symptoms.

See also

→ Cognitive Behavioral Therapy (CBT) for Social Phobia

See also

→ Panic attack

Source: Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(Suppl 1):S1. doi:10.1186/1471-244X-14-S1-S1. Carpenter JK, et al. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018;35(6):502–514. doi:10.1002/da.22728