Social Anxiety Disorder
DISCLAIMER: This article is for educational purposes and to help people to stop romanticising such illnesses as if they are "fun"and "cool" to have. Do not self-diagnose yourself or self-prescribe medicine just because you read this. Mental health medicine is very dangerous and can have adverse effects to your life in the long-term.
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We all know the feeling of being nervous or uncomfortable in a social situation. Maybe you’ve clammed up when meeting someone new or gotten sweaty palms before making a big presentation. Public speaking or walking into a roomful of strangers isn’t exactly thrilling for everybody, but most people can get through it.
If you have social anxiety disorder, though, the stress of these situations is too much to handle. You might avoid all social contact because things that other people consider “normal” — like making small talk and eye contact — make you so uncomfortable. All aspects of your life, not just the social, could start to fall apart.
Social anxiety disorder (also known as social phobia) is one of the most common mental disorders, so if you have it, there’s hope. The tough part is being able to ask for help. Here’s how to know if your social silence has gone beyond shyness to a point where you need to see a doctor.
When Does It Happen?
Anyone with social anxiety disorder can experience it in different ways. But here are some common situations that people tend to have trouble with:
- Talking to strangers
- Speaking in public
- Dating
- Making eye contact
- Entering rooms
- Using public restrooms
- Going to parties
- Eating in front of other people
- Going to school or work
- Starting conversations
Some of these situations might not cause a problem for you. For example, giving a speech may be easy, but going to a party might be a nightmare. Or you could be great at one-on-one conversations but not at stepping into a crowded classroom.
All socially anxious people have different reasons for dreading certain situations. But in general, it’s an overwhelming fear of:
- Being judged by others in social situations
- Being embarrassed or humiliated — and showing it by blushing, sweating, or shaking
- Accidentally offending someone
- Being the center of attention
What Does It Feel Like?
Again, the experience may be different for everyone, but if you have social anxiety and you’re in a stressful situation, you will have a combination of physical symptoms like:
- Rapid heartbeat
- Muscle tension
- Dizziness and lightheadedness
- Stomach trouble and diarrhea
- Inability to catch breath
- “Out-of-body” sensation
You may start having symptoms and getting anxious immediately before an event, or you might spend weeks worrying about it. Afterward, you could spend a lot of time and mental energy worrying about how you acted.
What Causes It?
There’s no one thing that causes social anxiety disorder. Genetics likely has something to do with it: If you have a family member with social phobia, you’re more at risk of having it, too. It could also be linked to having an overactive amygdala — the part of the brain that controls your fear response.
Social anxiety disorder usually comes on at around 13 years of age. It can be linked to a history of abuse, bullying, or teasing. Shy kids are also more likely to become socially anxious adults, as are children with overbearing or controlling parents. If you develop a health condition that draws attention to your appearance or voice, that could trigger social anxiety, too.
How It Affects Your Life
Social anxiety disorder prevents you from living your life. You’ll avoid situations that most people consider “normal.” You might even have a hard time understanding how others can handle them so easily.
When you avoid all or most social situations, it affects your personal relationships. It can also lead to:
- Low self-esteem
- Negative thoughts
- Depression
- Sensitivity to criticism
- Poor social skills that don’t improve
Diagnosis
A doctor may ask questions about the person’s medical history and carry out a physical exam to rule out any physical causes of their symptoms. They may then refer the person to a mental health professional.
A mental health professional will ask the person about their symptoms, including when they occur, how often they occur, and when they started.
Clinicians use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to diagnose mental health conditions, including social anxiety disorder.
The diagnostic criteria for this condition include:
- having a persistent fear about one or more social situations that might involve scrutiny from others (such as conversations, social interactions, being observed, or performing in front of others)
- having a fear of acting in a way that others will judge negatively or that might lead to rejection or offense (such as a fear of seeming anxious or of doing something embarrassing)
- avoiding situations that might cause feelings of anxiety
- experiencing symptoms that persist for 6 months or longer, cause significant distress, or impair the person’s work, social life, or other key areas
Treatment
Various treatment options can help people manage their symptoms, gain confidence, and overcome their anxiety.
Without treatment, however, social anxiety disorder may persist throughout life — though it may feel better or worse at certain times.
Healthcare professionals will usually recommend treatment with psychotherapy, medication, or both. The sections below will look at these options in more detail.
Psychotherapy
Psychotherapy, or talking therapy, helps people understand their experiences and develop effective coping methods.
There are many types of psychotherapy, including:
- CBT
- interpersonal therapy
- psychodynamic therapy
- family therapy
CBT is a common treatment. It aims to help the person recognize and change negative thoughts or beliefs about social situations. It also aims to change people’s behaviors or reactions to situations that trigger anxiety.
CBT can help a person recognize that their own thoughts, not those of others, can determine how they react and behave.
Exposure therapy, or cognitive delivered exposure, can also help. With this approach, the person gradually works up to facing the situations they fear with a therapist and in a safe environment.
Medications
A range of medications can help people manage the symptoms of social anxiety disorder.
The three main types are antianxiety medications, antidepressants, and beta-blockers. The sections below will look at these options in more detail.
Antidepressants
Selective serotonin reuptake inhibitors, which people mainly use as antidepressants, can also help with the symptoms of social anxiety disorder. They may take several weeks or months to take effect.
Some examples include:
Serotonin-norepinephrine reuptake inhibitors, which are another class of antidepressant, can also help.
Some examples include:
Antianxiety medications
Antianxiety medications act quickly to reduce the symptoms of anxiety, but doctors will usually recommend them as a short-term solution, as they can create dependence.
Benzodiazepines are a common class of antianxiety drug. Some examples of these include alprazolam (Xanax) and clonazepam (Klonopin).
In 2020, the Food and Drug Administration (FDA) strengthened their warning about benzodiazepines. Using these drugs can lead to physical dependence, and withdrawal can be life-threatening. Combining them with alcohol, opioids, and other substances can result in death. It is essential to follow the doctor’s instructions when using these drugs.
Beta-blockers
Beta-blockers help block the physical effects of anxiety, such as sweating, tremors, and a rapid heartbeat. They do this by blocking the stimulating effects of adrenaline.
Doctors usually prescribe these drugs for specific situations, such as having to give a presentation, but not for ongoing treatment.
DO NOT self-diagnose or self-prescribe mental health medicine. They are one of the most dangerous types of medicine to self-prescribe.
