For people with social anxiety disorder, something as simple as going out with friends can be terrifying. If you have a social anxiety disorder you may long for connection while at the same time feeling debilitated by social interactions. This causes you to feel isolated and alone.
At My LA Therapy, our social anxiety specialists can help you break free from the loneliness and insecurity that emerges as a result of social anxiety. We will help you heal the underlying causes of your fear of social interactions and help you learn to connect with people and enjoy your social life once again.
Social anxiety disorder, also called social phobia, is the second most common type of anxiety disorder (after specific phobias) and the third most common mental disorder in the U.S. (after alcohol dependence and depression). It is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations. The anxiety involved (intense nervousness) and self-consciousness can often build into a panic attack leading to avoidance of situations. In many cases, people with social anxiety disorder feel that there is “something wrong” but don’t recognize their feeling as a sign of illness; they are aware that the fear is unreasonable, yet are unable to overcome it.
SOCIAL ANXIETY DISORDER DSM-5 DIAGNOSIS
- Marked fear or anxiety about one or more social situations in which you are exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). In children, interaction must occur in peer settings and not just with adults.
- You fear that you’ll act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
- The social interactions:
- Almost always provoke fear or anxiety [Physical symptoms of anxiety include: including confusion/”out of body” experience, pounding heart/fast heartbeat, sweating, shaking, blushing, trouble catching breath, muscle tension, upset stomach/nausea, and diarrhea. In children, the fear or anxiety may be expressed by crying, clinging to a parent, throwing a tantrum, freezing, shrinking, or failing to speak in social situations].
- Are avoided or endured with intense fear or anxiety.
- The fear, anxiety, or avoidance is:
- out of proportion to the actual threat posed by the social situation and to the sociocultural context.
- Persistent, typically lasting for 6 months or more.
- Causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition
- Not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
- Clearly unrelated or is excessive, if another medical condition is present.
- Specified by “performance only” – if the fear is restricted to speaking or performing in public.
SOCIAL ANXIETY DISORDER FACTORS AND CAUSES
- Biological (Genetics) – Social anxiety may be somewhat more likely to occur when it is also present in a first-degree relative (parent, sibling, or child). In other words, anxiety disorders tend to run in families; you’re more likely to develop social anxiety disorder if your biological (blood) relatives have the mental health condition (inherited traits).
- Psychological (Past Negative Experiences, Temperament, & Brain Structure) – You may have had a general time of major life stress or loss. This is including the amount and severity of trauma you’ve gone through since early childhood. Specifically, the development of social anxiety disorder may stem from embarrassing or humiliating social experiences in the past. Personality aspects, often called your temperament (your risk may increase if you’re more sensitive, more inhibited or more negative than the norm) can also be affected. For example, children who are shy, timid, withdrawn or restrained when facing new situations or people may be at greater risk. Finally, changes in brain functioning also may play a role in developing disorders (the way your brain regulates the chemicals and hormones your body releases in response to stress). Specifically, social anxiety disorder is currently related to abnormal functioning of brain circuits that regulate the “fight or flight” response center in the brain (a structure in the brain called the amygdala that controls fear, causing increased anxiety in social situations).
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- Environmental (Beliefs & Behaviors) – Social anxiety disorder may be a learned behavior. People may develop their fear from observing the anxious behavior of others or seeing what happened to someone else as the result of their behavior. Further, there may be an association between social anxiety disorder and parents who are more controlling or protective of their children. Children who are sheltered or overprotected by their parents may not learn good social skills as part of their normal development. Also, work-related performance problems or excessive absences increase. Meeting new people, giving a speech in public or making an important work presentation may trigger social anxiety disorder symptoms for the first time. These symptoms usually have their roots in adolescence, however. Facial disfigurement, stuttering, Parkinson’s disease and other health conditions can increase feelings of self-consciousness and may trigger a social anxiety disorder in some people. The use of and withdrawal from addictive substances, including alcohol, caffeine, and nicotine, can also worsen anxiety and during periods of stress.
- Other Complications – Low self-esteem; Trouble being assertive; Negative self-talk; Hypersensitivity to criticism; Poor social skills; Isolation and difficult social relationships; Low academic and employment achievement; Substance abuse, such as drinking too much alcohol; Suicide or suicide attempts; Other anxiety disorders, major depressive disorder, substance abuse problems and certain other mental health disorders can often occur with social anxiety disorder.
SOCIAL ANXIETY DISORDER TREATMENTTreatment can be very effective and often includes a combination of:
- Supportive care – Because symptoms can be related to health problems, it’s important to be in regular/good contact with and be evaluated by a healthcare provider. If symptoms of anxiety are present, your doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose a social anxiety disorder, the doctor may use various tests to rule out physical illness as the cause of the symptoms. If no physical illness is found, you may be referred to a mental health professional, who is specially trained to diagnose and treat mental illnesses.
- Psychotherapy – Mental health professionals (such as psychotherapists, social workers, or professional counselors) use specially designed interview and assessment tools to evaluate a person for social anxiety disorder. People with social anxiety disorder suffer from distorted thinking, including false beliefs about social situations and the negative opinions of others. Without treatment, a social anxiety disorder can negatively interfere with the person’s normal daily routine, including school, work, social activities, and relationships. Thus, the most effective treatment is cognitive behavioral therapy (CBT), including approaches such as systematic desensitization or real-life exposure to the feared situation.
- Medications – There are several different types of drugs used to treat social anxiety disorder, including selective serotonin reuptake inhibitor (SSRI) antidepressants; anti-anxiety medications called benzodiazepines; and beta-blockers, often used to treat heart conditions, may also be used to minimize certain physical symptoms of anxiety, such as shaking and rapid heartbeat.
SOCIAL ANXIETY SUPPORT
- Stick to your treatment plan to help prevent relapses or worsening of symptoms – Take medications as directed. Keep therapy appointments. Consistency can make a big difference, especially when it comes to taking your medication. Don’t give up if treatment doesn’t work quickly/remind yourself it takes time. Facing your fears can be difficult, but treatment can help you feel like you’re not a hostage to your symptoms.
- Get help early – Anxiety, like many other mental health conditions, can be harder to treat if you wait.
- Self-care – Get enough rest/sleep, eat healthy, and try to be physically active/exercise every day. Avoid substances even caffeine, as it can make anxiety worse. Don’t forget to celebrate successes.
- Reach out – Consider joining a support group to connect with others facing the same problems and who may understand you. Participate in activities by staying involved in work, social and family activities. Socialize (Don’t let worries isolate you from loved ones or enjoyable activities. Social interaction and caring relationships can lessen your worries).
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- Break the cycle and learn about anxiety – This knowledge can help you understand what you’re feeling, and then you can develop coping strategies to help you respond effectively. Mindfulness strategies may be helpful in learning how to tolerate anxiety and reduce avoidance behaviors; Relaxation techniques, such as deep breathing, progressive muscle relaxation or yoga, may help cope with stress while reducing anxiety symptoms.
- Take action – Work with your mental health provider. They will help you take small steps: Eat with a close relative, friend or acquaintance in a public setting; Make eye contact and return greetings from others, or be the first to say hello; Give someone a compliment; Ask a retail clerk to help you find an item; Get directions from a stranger; Show an interest in others — ask about their homes, children, grandchildren, hobbies or travels, for instance; Call a friend to make plans.
- Prepare for social situations – Prepare for conversation, for example, by reading the newspaper to identify an interesting story you can talk about; Focus on personal qualities you like about yourself; Practice relaxation exercises; Adopt stress management techniques; Set realistic goals; Pay attention to how often the embarrassing situations you’re afraid of actually take place; Join a group that offers opportunities to improve communication and public speaking skills, such as Toastmasters International. You may notice that the scenarios you fear usually don’t come to pass; When embarrassing situations do happen, remind yourself that your feelings will pass, and you can handle them until they do.