Stopping Social Anxiety Disorder

You get nervous at work. You’re afraid to speak to your coworkers, much less, accept an invitation to go to lunch with a group of them. You dread going to the conference room for large meetings like the plague. The thought of speaking up is excruciating. You could have social anxiety disorder.

Social anxiety disorder (SAD) is when everyday interactions cause significant anxiety, self-consciousness and embarrassment because you fear being scrutinized or judged negatively by others. In this disorder, fear and anxiety lead to avoidance that can disrupt your life. Severe stress can affect your relationships, daily routines, work, school or other activities.

Feelings of shyness or discomfort in certain situations aren’t necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on personality traits and life experiences. Some people are naturally reserved and others are more outgoing.

In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interfere with relationships, daily routines, work, school or other activities. Social anxiety disorder typically begins in the early to mid-teens, though it can sometimes start in younger children or in adults.

An estimated 12.1 percent of adults in the United States experience social anxiety disorder at some time in their lives. Women nearly twice as often develop social anxiety disorder compared to men.

Signs and symptoms of SAD can include constant:

·       Fear of situations in which you may be judged negatively.

·       Worry about embarrassing or humiliating yourself.

·       Intense fear of interacting or talking with strangers.

·       Fear that others will notice that you look anxious.

·       Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice.

·       Avoidance of doing things or speaking to people out of fear of embarrassment.

·       Avoidance of situations where you might be the center of attention.

·       Anxiety in anticipation of a feared activity or event.

·       Intense fear or anxiety during social situations.

·       Analysis of your performance and identification of flaws in your interactions after a social situation.

·       Expectation of the worst possible consequences from a negative experience during a social situation.

For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.

Performance type of SAD is when you experience intense fear and anxiety during speaking or performing in public but not in other types of more general social situations.

When social situations can’t be avoided, more subtle ways of trying to prevent criticism are relied upon, such as using alcohol as a social lubricant, mentally rehearsing conversations or staying quiet. But these strategies can backfire and actually cause the criticism they were trying to prevent.

SAD is most likely to be caused by a combination of nature and nurture. Studies have shown that two identical twins are more likely to have anxiety problems than two non-identical twins, which tells us that our genes probably play a role.

Our individual temperaments also seem important. Children who are extremely shy are more likely to develop SAD later in life, although most children will grow out of their shyness.

Many people with SAD describe experiencing “social traumas” early in life, including bullying, abuse or feeling humiliated while giving presentations at school.

Overly critical or perfectionist parents may also set unrelenting social standards that their children feel unable to meet. Social anxiety ensues, as the children assume they will therefore fail to meet everyone’s expectations.

SAD can be persistent without effective treatment, so it is important to seek help early. Cognitive behavior therapy (CBT) is the psychological treatment with the most evidence to support its effectiveness. CBT involves identifying and challenging negative thoughts and self-images by gradually confronting the feared social situations. As the perceived social threat starts to diminish during treatment, so too do the distressing physical symptoms of anxiety.

CBT has been effectively delivered individually and within groups. Internet-based therapy is also proving to be effective for some people, suggesting that the Internet can be therapeutic and not just a form of avoidance. Medication like Paxil may also be helpful.

Managing social anxiety opens up a world of choices to engage with life and pursue what is truly important and valuable, without excessive fear of rejection. The goal isn’t to become the most outgoing, gregarious, or confident person at the party. The goal is to attend the party if you choose, without having to hide in a corner.