Social Anxiety Disorder: Symptoms, Causes, Treatment, Coping

Social Anxiety Disorder (Social Phobia)

Social Anxiety Disorder (SAD), which is also referred to as Social Phobia, is a disorder that causes a person to feel intense fear in social situations that involve interaction with other people, or in public performances, such as public speaking.

People with social anxiety often fear that they are being watched, judged, and evaluated by other people. It is often confused with shyness or low self-esteem. According to the Social Anxiety Association, Social Anxiety Disorder is the third largest psychological problem in the world today. [Ref. ILLINOIS LIBRARY]

The fear that people with social anxiety experience is brought on by many different types of social situations, including speaking in public, speaking to strangers or meeting new people, using public restrooms, speaking on the telephone, eating, drinking, or writing in public, attending parties or large gatherings, talking to authority figures, talking to co-workers, shopping, community or job-related meetings, crowded places, and entertaining.

As you can see, social anxiety can affect the quality of a person’s life quite deeply.

Social anxiety is a mental health disorder that is difficult to understand because it is amongst the last anxiety conditions discovered by doctors, and hence, not widely read by doctors, though psychiatrists are the most familiar. Even though the medical community is finally starting to recognize and treat the symptoms of social anxiety, people who suffer from the disorder are still misdiagnosed many a time.

The fear often causes a multitude of physical symptoms, such as heart palpitations, tremors, sweating, diarrhea, confusion, blushing, nausea, difficulty talking, muscle tension, dry mouth, muscle twitches, dizziness, shortness of breath, chest pain, difficulty swallowing, and paleness.

This disorder also brings on other problems, such as feelings of being overwhelmed, feelings of embarrassment, self-consciousness, distorted thoughts, an overwhelming feeling of needing to escape, and feelings of inadequacy. Even the anticipation of being in a social situation can cause a socially anxious person to feel fearful.

Because people with SAD often have panic attacks, some researchers believe that social anxiety disorder has a biological, or biochemical cause. Other researchers do not believe that this is so. However, studies are currently being done to see if there is a possibility of social anxiety disorder being inherited through bloodlines.

Often, people become socially anxious due to having a bad social experience. Another possibility is learned behavior. If a parent had social anxiety or demonstrated negative social behaviors, a child can easily learn those behaviors, and develop social anxiety.

Many famous people suffer from social anxiety disorder, including Jerry Seinfeld, Kim Basinger, Donny Osmond, Barbara Streisand, Sir Laurence Olivier, Susie O’Neill, Rebecca Gibney, Gary MacDonald, and Simon Palomares. As performers, many of these stars have learned to deal effectively with their social anxiety disorder. Their bravery in dealing with their social anxiety has been a great encouragement to other sufferers of SAD everywhere.

Symptoms

Social Anxiety Disorder (or Social phobia) is distinguished by feelings of apprehension around others and nervousness. There is also a deep feeling of humiliation or embarrassment when a person with social anxiety is faced with a group or single social situation, so much so that they fear being watched or unpleasantly evaluated by others. Other symptoms include:

• Feeling of self-consciousness around others
• Feeling that others are judging or staring at you
• Feeling that others see your nervousness
• The inability to relax around others
• Fear of being seen as stupid
• Avoidance of or escaping from most social interactions or the need to endure a lot of distress if socializing
• Sweating
• Racing heart
• Trembling
• Abdominal discomfort
• Breathing problems
• Dry mouth
• Physical tingling
• Lack of concentration
• Weakness of the legs
• Urge to urinate frequently
• Blushing
• Twitching of muscles

These are the most common symptoms experienced by people who have social anxiety. You may experience other symptoms, or these symptoms in different degrees. If you are having symptoms that are new or severe, you should seek medical help.

Fears and Phobias Related to Social Anxiety

When some people think about social anxiety, they imagine every type of fear from shyness to fear of public speaking. What they might not always understand is that this condition can become obvious in other ways also, producing fears in areas that you may not even be able to imagine. Along with this, the fears and phobias stemming from social anxiety may also relate to, or sometimes even generate, other kinds of conditions. Therefore it’s highly important to distinguish if apparently strange forms of fears and phobias are a sign of a bigger problem.

One of the fears and phobias that spring from an anxiety disorder is a strong aversion to using the phone. Since the sufferer will be required to talk with the individual on the other end of the line, whether it’s a stranger or even a person they are acquainted with, they could become tongue-tied or make silly mistakes.

And ultimately the apprehension about making mistakes and being judged adversely becomes so terrible that they simply can’t pick up the telephone, either to answer or make a call. This is a highly individual example of a phobia related to public speaking and in certain ways made even worse since the exchange is one-to-one, with all missteps being instantly recognizable.

Among the least expected examples of fears and phobias that become apparent as a consequence of a social anxiety disorder is known as a walk disturbance. In this situation, you get so self-conscious in public that you are hypersensitive even regarding the way you walk.

This can become particularly acute while you are walking past a crowd of people and you think that they are all looking at you. Walking turns into a challenge, and occasionally you may even stumble and fall. In some ways, this is a form of performance anxiety, wherein walking, the most basic of functions, can’t be accomplished when being watched.

Then you will find other issues that probably have some relationship to the phobias and fears of social anxiety, either triggered by it or having a role in making it even worse. To provide an example, due to the feelings of isolation that people with anxiety disorders experience, they frequently wind up battling clinical depression also. Or if they try to get rid of the symptoms of an anxiety attack by self-medicating with drugs or alcohol, they could find themselves with substance abuse issues.

Social anxiety can be linked to other conditions as well, including post-traumatic stress disorder and bipolar disorder.

Regardless of whether a person has a generalized anxiety disorder that impacts their entire life, or whether the fears and phobias become apparent in a highly specific and maybe even bizarre fashion, it’s essential that an accurate diagnosis is made.

Bearing in mind how social anxieties can be the source of other mental disturbances, or interact negatively with existing ones, no healthcare provider desires to be in a position of relieving the symptoms of one condition while being oblivious to another one that should be treated. Figuring out all these factors is the secret of giving the sufferer the treatment that’s essential.

Causes and Risk Factors

The causes of social anxiety disorder are many. The risk of developing social phobia for relatives of people with social phobia is about 3 times higher than that of an unencumbered family. Studies impressively show that genetic factors are of crucial importance for the development of the disease.

In addition to a biologically based susceptibility to the development of social phobia, learning processes such as avoidance learning also play an important role. The theory of avoidance learning states that first an anxiety reaction to certain stimuli is learned.

For example, one student stutters when answering a question from the teacher, and the other students laugh. In this way, social situations in which the student feels valued can be linked to fear and shame. In the next step, the student will try to avoid such situations by, for example, skipping school and otherwise avoiding contact with classmates because he feels less fear and shame. Reducing fear works internally as a reward for avoiding social situations.

So, as is the case with most mental disorders, social phobia arises from a complex interaction of genes and the environment. Probable causes for the condition are:

• Genetic: social phobia runs in families. On the other hand, it’s not obvious how much may be because of genes and how much because of learned behavior.

• Structure of the brain: amygdala, present in the brain, may play a part in governing one’s fear response. Those having an overactive amygdala may have a greater response to fear, thus triggering increased nervousness in social situations.

• Brain chemistry: natural chemicals present in the body have a pivotal role to play in the development of social phobia. A disproportion in serotonin (a neurotransmitter) may be a contributing factor; it regulates the moods and emotions of a person.

• Negative incidents: children who have experienced bullying, teasing, denial, mockery, or humiliation are more liable to social phobia. Family clashes and sexual abuse are also linked to the condition.

Social phobia, more often than not, commences in the early to mid-teens; risk factors associated with the condition are:

• Gender: women are more likely than males to have social phobia.

• Family history: is a predisposing factor.

• Disposition: children who are shy, introverted, timid, or restrained are at greater risk of developing social anxiety disorder.

• Environment: social phobia may also be a learned behavior. The disorder could also develop when you see the anxious conduct of others. Also, the condition is common in children whose parents are more authoritarian.

• Work demands: having to give a speech in public, meeting new people, and making work presentations may prompt social phobia symptoms for the first time. These manifestations generally commence during adolescence.

• A health condition that tends to draw everyone’s notice: stuttering, disfigurement of the face, Parkinson's disease, etc. may increase feelings of shyness and embarrassment, and could cause social phobia in certain people.

  See here for → Self Help Strategies for Social Anxiety

Social Anxiety Disorder Treatment

Psychotherapy (psychological counseling) and medication are used to treat social phobia. The therapeutic measures are carried out in close consultation with the patient, and a combination treatment of psychotherapy and medication is often used. Social phobia can be treated both as part of a single therapy and as part of group therapy.

Psychotherapy/Counseling

Counseling helps ameliorate the symptoms of the disorder in most people. You will be taught how to identify and alter negative thoughts about yourself. Cognitive behavioral therapy or CBT is the commonest type of counseling. CBT is based on the suggestion that your thoughts decide how you behave; not other people or situations. An undesirable situation will not change; however, you can alter the way you think and act.

Counseling will also help you work up to facing the situations that you fear the most. It will help you become better skilled at handling fear-inducing situations and helps develop self-confidence to face them. Your counselor will also teach you stress management techniques for relaxation and rejuvenation.

The effectiveness of cognitive behavioral therapy is best proven when the person concerned speaks about his thoughts and fears and becomes aware of the irrationality of his thoughts.

For example, many people with social phobia fear that a disaster will happen when other people realize that they are fearful or insecure, sweat, shiver, and blush. It is discussed with the patient that these fears are unfounded. On this basis, patients are instructed to calm themselves down, that is, to counter calming thoughts with disastrous thoughts. In the further course of the therapy, the patients then expose themselves to the fear-triggering situations in practice and learn to use the strategies that were previously practiced there.

Studies have also shown good results in particular fear-related forms of deep psychological or psychodynamic psychotherapy. The concrete fear in social situations is often based on a deeper, unconscious fear, which "feeds" the symptoms like a hidden source from the depths again and again. 

This can be based on experiences, for example, that caregivers in childhood did not offer sufficient security to build stable self-esteem, or that this was shaken by experiences of humiliation or neglect. Although the person concerned is then aware that he has nothing to fear in social situations today, the "old fear" of not being valuable enough or being rejected is always coming up unconsciously. In therapy, the connection to "old fear" is established and processed in a lasting relationship with the therapist.

Other interventions such as relaxation procedures (autogenic training, progressive muscle relaxation), social skills training, and hypnotherapy can also be helpful for social anxiety disorder.

Medications

Various medicines are used to manage social phobia. However, the first type of drug tried for unrelenting symptoms of the disorder is selective serotonin reuptake inhibitors or SSRIs.

The mental health provider may also prescribe:

• Anti-depressants
• Anti-anxiety medications
• Beta-blockers, which block the stimulating effect of adrenaline, and decrease blood pressure, heart rate, and shaking of voice and limbs.

Antidepressants are drugs that are often used to treat depression but also have an effect on anxiety. The so-called selective serotonin reuptake inhibitors, which include active ingredients such as citalopram, sertraline, and paroxetine, have proven particularly effective in the treatment of social phobia, but other antidepressants are also effective (e.g. venlafaxine).

The drugs cause a change in the concentration of transmitters between nerve cells, so-called neurotransmitters, and have no potential for dependency.

The medication must be taken regularly because this is the only way to achieve an effective blood level. To cut down the side effects, the physician will begin with a low dose and will gradually increase to a full dose.

When treating social phobia, caution should be exercised with drugs that directly relieve anxiety, such as benzodiazepines offered. With prolonged use, there is a risk of developing addiction. Since alcohol also has a short-term anxiolytic effect, it is not uncommon for those affected to drink alcohol regularly to calm themselves down. So here too there is a risk of developing alcohol addiction.

For some, the manifestations of social anxiety disorder may weaken over time, and the medicines may be discontinued; whilst others may need the drugs for several years to prevent recurrences.

Visiting Self-help groups and involvement in initiatives by those affected are important ways to escape the vicious circle of fear and social withdrawal. Not only is mutual support important, but also a commitment to more knowledge and acceptance of social fears in society and to better treatment options.

If outpatient treatment is not sufficient or is not possible due to very severe symptoms, inpatient treatment in a specialist clinic with special psychotherapeutic treatment options for patients with anxiety disorders is advisable.

Prognosis

The prospects of a cure depend not insignificantly on the duration of the illness and the accompanying illnesses. With a long history and an accompanying addiction disease, the prospects of a cure are less favorable than if treatment is started after a short period of illness and there are no comorbidities.

Overall, studies show that psychotherapy, as well as medication, are effective. It is assumed that up to two-thirds of the treated patients experience a significant improvement in symptoms.

Is Social Anxiety a Disability?

Yes, social anxiety disorder (SAD) can be considered a disability under the Americans with Disabilities Act (ADA). The ADA defines a disability as "a physical or mental impairment that substantially limits one or more major life activities." SAD can substantially limit a person's ability to perform major life activities such as:

• Working: People with SAD may avoid job interviews, promotions, or public speaking because of their anxiety. They may also have difficulty working in a job that requires a lot of social interaction.

• Communicating: People with SAD may avoid talking to strangers, making phone calls, or giving presentations because of their anxiety. They may also have difficulty expressing themselves in social situations.

• Learning: People with SAD may avoid going to school or taking classes because of their anxiety. They may also have difficulty paying attention in class or participating in group activities.

• Caring for oneself: People with SAD may avoid going to the doctor or dentist because of their anxiety. They may also have difficulty taking care of their hygiene or managing their finances.

• Engaging in recreational activities: People with SAD may avoid social activities, such as parties or clubs, because of their anxiety. They may also have difficulty enjoying activities that they used to enjoy because of their anxiety.

• Participating in civic activities: People with SAD may avoid volunteering or participating in community events because of their anxiety. They may also have difficulty voting or contacting their elected officials because of their anxiety.

How to qualify for social anxiety disability

To qualify for disability benefits under the ADA, a person with SAD must show that their anxiety disorder substantially limits their ability to perform one or more major life activities. They must also show that their anxiety disorder is not a result of their current employment or education.

The severity of social anxiety disorder can vary from person to person. Some people with SAD may only have mild symptoms that do not interfere with their daily life. Others may have severe symptoms that make it difficult to function in everyday situations.

Social anxiety disorder (SAD) can be considered a disability under the Social Security Administration's (SSA) Listing of Impairments. This means that if you have SAD and your symptoms meet the criteria in the listing, you may be eligible for Social Security Disability Insurance (SSDI) benefits.

The SSA's listing for SAD requires that you have severe symptoms that significantly limit your ability to function in one or more major life activities. These major life activities include:

• Work
• Self-care
• Learning
• Communicating
• Interacting with others
• Enjoying life

To meet the criteria for the listing, you must have at least three of the following symptoms:

• Intense fear of being judged or scrutinized by others: This fear must be so severe that it causes you to avoid social situations.

• Physical symptoms of anxiety: These symptoms may include sweating, trembling, blushing, nausea, or dizziness.

• Avoidance of social situations: You must avoid social situations to the point where it interferes with your ability to work, go to school, or participate in other activities.

• Impairment in concentration or memory: Your anxiety must make it difficult for you to concentrate or remember things.

• Depression: You must have symptoms of depression, such as sadness, hopelessness, or loss of interest in activities.

If your symptoms meet the criteria in the listing, you will be considered disabled for SSDI purposes. However, even if your symptoms do not meet the listing, you may still be eligible for benefits if you can show that your anxiety disorder prevents you from working.

How to apply for and claim disability for social anxiety

If you have SAD and believe that it is substantially limiting your ability to perform major life activities, you may be eligible for disability benefits under the ADA. You should contact an attorney who specializes in disability law to discuss your case.

Here are some of the things that you can do to get a disability for social anxiety:

• Get a diagnosis from a mental health professional. This will document your anxiety disorder and the severity of your symptoms.

• Document your symptoms and how they have affected your life. Keep a journal of your anxiety symptoms and how they have affected your ability to work, go to school, or participate in social activities.

• Keep a record of your treatment, including medications, therapy, and other interventions. This will show that you are taking steps to manage your anxiety disorder.

• Talk to your employer about your disability and request accommodations. Your employer may be able to make changes to your work environment that will help you to function better.

• File a claim for disability benefits with the Social Security Administration (SSA). The SSA will review your claim and determine if you meet the criteria for disability benefits.

The SSA will consider a number of factors when making a decision on your disability claim, including the severity of your symptoms, the impact of your anxiety disorder on your daily life, and your treatment history. If you are approved for disability benefits, you will receive monthly benefits that can help you cover your living expenses.

If you are denied benefits, you can appeal the decision. You may want to consider talking to an attorney who specializes in disability law to help you with your appeal.

Coping Social Anxiety Disorder: How to Calm Social Phobia

Some coping methods that may be helpful to ease your social anxiety include:

• Reach out to people with whom you feel safe and comfortable
• Join a group that will provide you with opportunities to enhance your communication and public speaking skills
• Do enjoyable activities, like, exercise, dancing, pottery, gardening, etc, when anxious
• Get adequate sleep
• Eat a well-balanced, wholesome diet
• Practice meditation

With time, these methods will help you control your symptoms of the disorder and put off recurrences as well.

  Find here → 3 Fear Busting Self Help Strategies for Social Anxiety

See also for Ways to Relieve Anxiety:
1. Techniques to Reduce Stress and Anxiety
2. Meditation Techniques for Anxiety and Stress Relief

3. 11 Must-Know Natural Remedies for Anxiety

Shyness vs Social Anxiety

Most people who have heard of social anxiety, and understand what it is, mistakenly believe that shyness is the same thing as social anxiety. Others who have not heard much about social anxiety; also don’t realize that there is a difference between being shy and suffering from social anxiety. Just because someone is shy does not mean that they have social anxiety, and just because a person has social anxiety does not mean that they are shy.

A person can be a little shy - simply because they are shy. People who are simply shy do not suffer from intense fear like people who have social anxiety do. Shy people are still able to interact socially. They may be a little nervous, and they may blush. They may be quieter than other people typically are - but they do not suffer from social anxiety.

Social anxiety on the other hand causes intense fear that does not allow people to function normally in social interactions or situations. Shy people do not typically avoid social situations, whereas people with social anxiety disorder almost always try to avoid social interactions and situations.

People who have social anxiety are not necessarily shy either. Once social anxiety has been effectively treated, and the person is able to interact socially without fear, they do not blush, they are not typically quieter than other people, and they don’t have any nervousness that anyone else would not experience depending on the social situation - such as public speaking, asking someone out on a date, or interviewing for a job.

The truest test to differentiate between shyness and social anxiety is the level of fear that is experienced. As stated, the level of fear that someone with social anxiety experiences can be absolutely debilitating. 

A person who is simply shy would not experience this fear, just as they typically do not experience the symptoms of social anxiety which include: rapid heartbeat, tremors, sweating, diarrhea, confusion, nausea, difficulty talking, muscle tension, dry throat, dry mouth, muscle twitches, dizziness, shortness of breath, feelings of smothering, chest pain, difficulty swallowing, and paleness. The only physical symptom that Shies and people with social anxiety share are blushing.

Children with social anxiety often act out by crying or throwing tantrums. Children are often shy - but it doesn’t mean that they have social anxiety. The best thing to do with shy children, to avoid turning their natural shyness into social anxiety is not to pay any heed to the shyness. Don’t point it out to the child, or to other people. Most children outgrow shyness on their own. Social anxiety is not outgrown, and in most cases becomes more severe as time passes.

  Read also: How to Overcome Shyness

Conclusion

Social anxiety disorder or social phobia does not have to be suffered alone and it is treatable with the proper support and medical intervention.