Social Anxiety Disorder

Social anxiety is a loose term that simply refers to the experience of feeling anxious in social situations. Almost everyone feels socially anxious at some time or another. Social Anxiety Disorder is a term used when people find their social anxiety to be troubling and distressing to such a degree that it interferes with the quality, satisfaction or enjoyment of life.

Various terms have been used to describe the experience of persistent and disabling social anxiety including the terms social phobia and social anxiety disorder.

What is social anxiety disorder?

The core feature of social anxiety disorder is a strong desire to convey a favourable impression of oneself to other people along with insecurity about one’s ability to do so. People with social anxiety disorder have an excessive fear of negative evaluation or scrutiny by others.  They worry that they will act in a way that will be embarrassing, incompetent or socially unacceptable. They believe that such behaviour would be catastrophic will impact on their self-worth or status and will result in rejection.

Some people with social anxiety disorder have a fear of only one or two specific situations although most sufferers feel anxious across a much wider range of social situations.  Typical situations that people with social anxiety disorder fear include:

Commonly feared situations

  • Public speaking
  • Eating and / or drinking in public
  • Writing in public
  • Urinating / defecating in public toilets
  • Greeting people
  • Entering a room of people
  • Meeting authority figures
  • Having visitors at home
  • Being teased
  • Initiating romantic relationships
  • Being assertive with a shop assistant
  • Contributing in small groups
  • Attending a party
  • Working while someone watches
  • Using the phone in public
  • Phoning a stranger
  • Making conversation
  • Meeting strangers
  • Being the centre of attention
  • Chairing a meeting
  • Disagreeing with people
  • Maintaining eye contact
  • Making a verbal report to a group

Exposure to a feared social situation produces an anxiety response – sometimes even a full-blown panic attack. The anxiety response is usually rapid and may include a range of anxiety symptoms including:

Typical anxiety symptoms

  • Pounding heart
  • Blushing
  • Sweating
  • Trembling or shaking
  • Nausea
  • Shortness of breath
  • Tightness in the throat or chest
  • Increased pitch of voice
  • Dizziness or lightheadedness
  • Tingling in the fingers or feet
  • Feeling of dry mouth
  • Hot or cold flushes
  • Feeling of blood rushing to the head
  • Feeling unreal
  • Experiencing a mental blank
  • An urge to flee

People with social anxiety disorder may become preoccupied with their physical anxiety responses and fear that these symptoms will be obvious to everyone. They also assume that others will regard these symptoms as being unacceptable in some way and that they will make negative interpretations about them (e.g that they are weak, socially incompetent or anxious).

Because the anxiety caused by feared social situations can be so intense many people with social anxiety disorder attempt to avoid the feared situations whenever they can. But often they have little choice but to endure anxiety provoking situations particularly if the negative consequences of non-attendance outweigh the negative consequences of attendance.  The anxiety and avoidance usually lead to problems with occupational and social functioning such as failure to apply for or receive promotions at work or reduced social invitations and interactions. Many people with untreated social anxiety disorder find it hard to establish and maintain romantic relationships.

How Common is Social Anxiety Disorder and Who Gets It?

Social anxiety disorder generally starts in the mid teens and seldom occurs for the first time after the age of 25 years. Very often the person describes being shy in high school having avoided asking questions or standing up in front of the class.  In more severe social anxiety disorder the person may describe being very shy since they were a young child.

Social anxiety disorder is slightly more common in women than men and has been reported to be the third most common mental disorder after substance abuse and major depressive disorder. In any one year approximately 6.6% of males and 9.1% of females suffer from social anxiety disorder. Up to 13% of the population will suffer from social anxiety disorder during their lifetime.  About 40% of the population have problems with shyness at some time in their life.

People with social anxiety disorder often have lower levels of education (perhaps because of difficulties with classroom attendance and participation) and are more likely to be single, divorced or separated (perhaps due to difficulties with meeting potential partners socialising once in a relationship and communicating openly about problems in the relationship).

About 70% of people with social anxiety disorder develop a depressive disorder at some point during their lifetime and many also develop other anxiety disorders.  Some people with social phobia use alcohol to help them cope with social situations and as a result may develop problems with alcohol use.

Social anxiety typically improves to some degree as people move into middle age and older age even in the absence of intervention. However this is a long time to wait improvement is not guaranteed and untreated social anxiety can result in many lost opportunities in life including damage to career pathways, friendships and reduced likelihood of establishing successful romantic relationships.

What Causes Social Anxiety?

Genes

There is some evidence to support the idea that a person’s genes can make them more likely to develop an anxiety disorder.  If a person’s parents, grandparents, aunts or uncles have an anxiety or emotional disorder of some kind there is a greater chance that that person will also develop an anxiety disorder.

Personality

Your genes seem to control how “emotional” you are.  Although higher levels of emotion make people more likely to develop emotional disorders such as social phobia, panic attacks, depression, generalised worry and so on being emotional also means you are more likely to be sensitive, caring and thoughtful.  Being emotional has its good side too!

Modelling from family members

Family behaviour may also contribute to the development of social anxiety.  If a child observes his or her parents or siblings behaving fearfully in social situations, avoiding social contact or always striving to behave “perfectly” in social situations then the child may learn to do so as well.

Life events

Some people can recall particular distressing or embarrassing incidents that  occurred in their childhood or teens which seemed to them to be a turning point in the development of their disorder (e.g being teased about blushing in school, hearing people laugh when they spoke to the class, etc.). In many cases social anxiety symptoms are likely to have been present prior to this with the anxiety becoming significantly worse after the identified events took place.

Chemical imbalance

The observation that certain types of antidepressants may be effective in the treatment of social anxiety has led to the notion that particular chemicals play an important role in social anxiety.  However it is unknown whether an imbalance in these chemicals causes social anxiety or whether social anxiety eventually leads to an imbalance of chemicals.

How to Get Help for an Adult with Social Anxiety Disorder

The clinical psychologists and psychiatrists at Mindcare Centre have the necessary skills to help identify whether social anxiety disorder is relevant and to provide evidence based treatment for all degrees of severity.

Contact us today to book an assessment with one of our experts. Phone 02 9212 4445during business hours or email us now.

Where to Find More Information about Social Anxiety Disorder

There are many good resources for learning more about social anxiety. Helpful books include “Overcoming Social Anxiety and Shyness” by Gillian Butler and “Diagonally-Parked in a Parallel Universe: Working Through Social Anxiety” by Signe A. Dayhoff.

An excellent educational internet resource can be found at the Centre for Clinical Interventions.

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