Social Anxiety Disorder: Not Just Shyness

We all get nervous in social situations at times.But for some people, fear of social situations is lasting and severe. It needs to be treated.

Suzanne was an intelligent woman in her thirties. She had been lonely for much of her life. She stayed in the same clerical job because she feared working with people at a higher level. She wanted to meet a man but thought he would reject her. She would not go to restaurants or parties. She was afraid others might think she was a sloppy eater. The few times she agreed to go, her heart pounded. She began to blush and sweat. Her doctor finally referred her to a psychologist. She learned she had a treatable problem—social anxiety disorder.

What Is Social Anxiety Disorder?

Symptoms of social anxiety disorder are:

  • An extreme fear of being judged by others
  • Strong fears of doing something embarrassing
  • Fear of everyone looking at you
  • Avoiding the social situations you fear
  • Intense nervousness in social situations

Social anxiety disorder often starts in childhood or adolescence. The disorder is long term. Stress may make it seem worse.

How Does It Differ From Shyness?

Shyness and social anxiety disorder may seem the same. The main difference is the person's reaction. People with social anxiety disorder often avoid social situations. They also have intense physical symptoms.

Many people with social anxiety disorder do not get diagnosed. They may be too embarrassed to discuss their symptoms.

People with this disorder are also more apt to have depression, or alcohol or drug problems. This can make diagnosis and treatment more difficult.

Physical Symptoms

Physical symptoms often happen with social anxiety. They may be:

  • Pounding heartbeats
  • Excessive sweating
  • Blushing
  • Dry throat and mouth
  • Shaky voice and trembling
  • Nausea
  • Problems breathing
  • Lightheadedness

The person is also afraid they will show these symptoms. They fear being harshly judged for them. This can make the symptoms worse.

What Causes Social Anxiety Disorder?

The exact cause of social anxiety disorder is not known. Genes may play a role. Bad experiences or stressful events may make it more likely to happen.

What Treatment Is Available?

Many people with this condition find treatment helpful. Common treatments are:

Therapy

Cognitive-behavioral therapy (CBT) helps people learn:

  • How their thoughts affect their reactions to situations
  • How to change the way they think about themselves and others—in feared situations

Some people may also have exposure therapy. This means they are exposed to situations that cause the anxiety. This happens a little at a time, increasing a bit more each time. As they do this, they practice coping with the anxiety. Relaxation methods may be used. This helps them succeed and not feel embarrassed.

CBT may be best used in a group. People get a chance to practice with others. They get to learn social skills and new ways of acting. It can be applied to different situations.

Medication

Medicine may also help social anxiety disorder. It works best when used with therapy. Different medicines work for different people. It depends on how the condition affects them. Medicines may include certain types of antidepressants, sedatives, or others.

The Next Step

Suzanne benefited from treatment. In a few months, she began to feel more confident in new social situations. A year later, she has a boyfriend. She also took a promotion at work. She still gets anxious in some situations. However, it does not keep her from doing the things she wants to do.

If you or someone you know has social anxiety disorder, it can be treated. Seek help from a counselor with experience treating this problem. You can get help to overcome your fears. You can feel more comfortable interacting with other people. And you can lead a happier life.

RESOURCES:

Anxiety and Depression Association of America
https://www.adaa.org

Social Anxiety Association
http://socialphobia.org

CANADIAN RESOURCES:

Canadian Mental Health Association
http://www.ontario.cmha.ca

Canadian Psychiatric Association
http://www.cpa-apc.org

REFERENCES:

Phobias. Mental Health America website. Available at: https://mhanational.org/conditions/phobias. Accessed June 28, 2021.

Social anxiety disorder. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/social-anxiety-disorder. Accessed June 28, 2021.

Social phobia. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/social-phobia/. Accessed June 28, 2021.

Last reviewed June 2021 by EBSCO Medical Review Board