Social Anxiety Disorder

Social Anxiety Disorder.

What is Social Anxiety Disorder? It is a term often used for Social Phobia, often first developing in mid-teens or early adulthood, though sometimes children may develop the disorder. Children or adolescents who become the subject of vicious teasing in middle school understandably can come to fear social situations with peers. Critical parenting and other psychosocial factors may also predispose to the disorder. Females tend to develop the disorder somewhat more than males. Consistent with many other anxiety disorders, there appears to be some contribution of genetic risk. There has been some evidence an exaggerated fear response stemming from over-activation in the brain’s amygdala, but there have been studies which have not always supported this. The lifetime course of the disorder varies in individuals. Some may experience social anxiety during school or college years, others to some degree throughout adulthood, while others may have single episodes, and some may have episodes which recur under stress. As with all classified psychiatric and mental disorders, it is important to differentiate between normal levels of being shy, introverted, or a little anxious speaking in front of people, and the more severe levels of anxiety which have some significant negative impact on social, occupational or health functioning. Ruling out metabolic or medical factors which can manifest as heightened anxiety is often advised.

People who suffer social anxiety may experience overwhelming anxiety, a sense of panic, and excessive self-consciousness in many social situations. They may believe or fear that people are thinking negatively about them, that they are being judged or criticised, and often fear being embarrassed or humiliated. They may find speaking in front of groups difficult, fear intimate relationships or dating, and may even find speaking to unfamiliar individuals or in small groups difficult. They often fear being embarrassed or even humiliated. Social Anxiety Disorder may have broad range impact or be more limited regarding impact and focus of the phobia. Others may have more specific fears such as not feeling comfortable eating in front of others, changing at the gym, using public restrooms, may have a fear of talking to the opposite sex or possibly speaking to authority figures. For others, fears may be multiple or occur in many situations. Fears may extend to how one sits, avoiding other’s eyes, and social interaction or events may cause anticipatory anxiety for days or even weeks. Discomfort in social situations can also cause difficulties in work environments or academic settings where there are high collaboration, leadership and communication demands. This often leads individuals to seek treatment. Individuals with a social anxiety disorder are somewhat distressed by their symptoms and desire better communication or closer relationships. This often differentiates the socially anxious individual from conditions such as Asperger’s or schizoid personality disorders.

Individuals with the disorder often experience physiological symptoms that are common in other anxiety disorders. This can include flushing, increased perspiration, tremulousness, gastrointestinal complaints, clammy hands, racing heartbeat, tunnel vision, and tightening of the vocal cords. These may cause further self-consciousness and anxiety. The discomfort anxiety often leads to avoidance of social situations. This creates a classic pattern of reward regarding anxiety relief when escaping or avoiding the social situation and tends to further reinforce the anxiety. Often people with the disorder have some awareness of their difficulty, and this may cause some co-existing dysphoria or depression. Other co-existing orders include other anxiety disorders, mood disorder, alcohol or substance abuse problems, avoidant personality disorder, and eating disorders such as bulimia.

Cognitive Behavioral Therapy with an emphasis on exposure can reduce symptoms of social phobia. Exposure therapy involves gradually placing oneself in anxiety-provoking situations and associating the feared stimulus with a response of relaxation or indifference. This is also known as systematic desensitisation and is a very effective evidence-based treatment of phobia, including social phobia.

Credits: American Psychiatric Association, Clinical Psychology Associates.