SLBMI Anxiety Disorders Center>> Anxiety Related Disorders That We Treat>> Social Anxiety

Social Anxiety Disorder (SAD)

Extreme anxiety about being negatively judged by others. Performance would be criticized causing embarrassment or ridicule. This intense anxiety leads to avoidance of social situations.

Fear of being criticized or embarrassed makes some people avoid certain ordinary social situations—like public speaking, performing, going to parties, eating in restaurants, writing in front of others, or using public restrooms. People with a social phobia feel so threatened by certain social situations that they either avoid them completely or suffer terribly when they cannot avoid them. Our staff wrote Dying of Embarrassment the first book on social phobia for consumers.

“I could have died from embarrassment. My face turned beet red.”

These common expressions graphically illustrate the experience of social anxiety and the discomfort it causes. Indeed, social anxiety is common. Almost everyone experiences some nervousness or awkwardness around others at one time or another. There are, however, some individuals whose social concerns become magnified and out of proportion to the situation. For these people, social anxiety is a serious difficulty may disrupt daily functioning and interfere with career and relationships.

Charles is an attorney. He had attended all of the best schools. For the first several years of his practice, he appeared to be on the way to a successful career. As he made the transition from doing research and assisting with clients to having to meet directly with clients and argue cases in court, his performance and self-confidence began to suffer. He was fearful of making a mistake. This fear became so excessive that he quit his job at a prestigious law firm and attempted to establish a solo practice. His fear of humiliating himself finally grew to the point that he even found it difficult to interact with his secretary.

What is Social Anxiety Disorder (SAD) or Social Phobia?

An individual with Charles’ symptoms would be diagnosed as having SAD, also known as social phobia. While the diagnosis might suggest that Charles does not like “social” situations, this is hardly the case. In fact, individuals with SAD like people, which may make their anxiety all the more confusing for them. Charles and others with this kind of phobia dread social contact because they experience a recurrent fear of scrutiny or criticism by others. A person with SAD fears that he or she will behave in a way that will be embarassing or humiliating. In essence, social phobia is a fear of disapproval. The motivation behind this avoidance is not unlike the person who is afraid to ride elevators and subsequently, chooses to take the stairs.

Margie is 27-year-old college student. She found herself repeatedly dropping and adding classes and changing her major so she could avoid classes where public speaking was involved. Margie feared that if she had to speak to her classmates, they would notice her hands shaking and she would be humiliated by her lack of self-control. She also worried about going to restaurants, where she would have to hold a glass. Unless she could grip a glass with both hands, she was convinced her hands would shake so badly that she would slosh her drink all over herself and her companions. By the time she sought treatment, she had begun to have difficulty signing a check or credit card receipt in front of other people, for fear her hand would shake.

Is SAD Common?
Literally millions of people suffer from SAD. However, compared to some other anxiety disorders, social phobia has received less attention in the media. One group of experts has called social phobia the “neglected” anxiety disorder, although this has changed somewhat in recent years. Individuals with SAD often believe that no one else shares their problem. This belief could not be further from the truth. Recent studies suggest that as much as 17% of the population in the United States are significantly affected. Another 20% or more have less distressing forms of social phobia because they are able to avoid the situations they dread. Survey research has, in fact, consistently listed one social phobia, fear of public speaking, as the number one fear in this country.

What Kinds of SAD are there?

There are two primary types of SAD, Specific and Generalized.

Specific SAD: Specific social phobias involve a focused area of fear, discomfort and avoidance. Through relatively comfortable in most social situations, individuals with a specific social phobia dread one or a limited number of particular situations.

Common examples of these situations include:

• Public Speaking
• Entertaining an Audience
• Eating in Restaurants
• Writing in Public
• Using Public Rest Rooms
• Taking Tests

Generalized SAD: In contrast to specific social phobias, people with generalized social phobias fear a wide variety of what may seem to be unrelated situations involving other people. However, the common theme in both the specific and generalized forms of social phobia is the fear of disapproval. The individual with a generalized social phobia dreads many, if not all, situations in which there is a chance of making a mistake or behaving foolishly in front of other people.

What about Dating Anxiety?
Most people have been nervous on a date, but severe dating anxiety is a form of SAD. Experts disagree whether to classify it as a specific or a generalized social phobia. Nonetheless, dating anxiety can prevent some individuals from having any intimate relationships.

Joe is an account representative. He frequently gives sales presentations to large groups of people. He also has a number of male friends with whom he enjoys going to movies and sporting events. Despite Joe’s ease in many social situations, he is fearful of asking a woman for a date. He is afraid she’ll say no, because then he would feel rejected. He is also afraid she’ll say yes. Once on a date, he worries he would do something to embarass himself. Consequently, Joe does not date.

“Bashful Bladder” Syndrome (Paruresis)
One form of SAD is called Paruresis, sometimes called “Bashful Bladder.” Paruresis involves difficulty using restrooms because of the fear of disapproval. The condition most often occurs in men. A common concern of the person with Paruresis is that others will think he is “weird” if he cannot urinate quickly. The anxiety includes physical responses that can actually make it more difficult to urinate. The person then gets stuck in a vicious cycle. The harder he tries to urinate, the less he is able to. The more difficulty he has urinating, the more anxious he becomes, making it even more difficult to urinate. And so on. In addition to the distressing symptoms typical of SAD, Paruresis can involve persistent bladder pain and infection.

Performance Anxiety
Fear of performing can also be thought of as a form of social anxiety. “Performance anxiety” is when a person worries that his or her performance will not meet a desired standard, resulting in disapproval from others. Terms such as “test anxiety,” “writer’s block” and ”stage fright” all refer to problems involving performance anxiety. Even actors, broadcasters, musicians, sports figures and others used to working in front of people are vulnerable to performance anxiety. People can develop anxiety about performing almost any task if they feel someone else might be evaluating them. Performance anxiety can cause a person to procrastinate or avoid a task altogether, to take an excessively long time to complete a task, or to try too hard and end up performing poorly.

When do people develop SAD?
The onset of SAD typically appears between the age of 15 and 20, although it can occur at other times as well. Some adults with a Social Phobia remember discomfort giving reports or talking in front of the class, which dates back to elementary school. In fact, current thinking about childhood anxiety disorders suggest that refusal to go to school may be a sign of an early form of social phobia. Some individuals with SAD have a history of shyness or inhibition as children.

What is the typical course of the disorder?
Some social phobias are easier to live with than others, but they often don’t improve without treatment. Their effect on the life of the sufferer may vary from mild discomfort in only a few circumstances to extreme, debilitating avoidance of many or most social situations. Due to the restricted lifestyle that can result from social avoidance, it is not uncommon for individuals with SAD to become depressed. Sometimes other anxiety disorders are also present. Further complicating the problem, individuals with social phobia often find that alcohol and drugs can help to reduce their anxiety (and they are readily available in situations that are often most feared), thus putting the individual at risk for substance abuse.

What causes SAD?
Despite our increasing knowledge about the course of the disorder, little is known about its origin or cause. At present, it is believed that a combination of environmental and biological factors play a role in its development.

Can SAD be treated?
Yes. Most individuals with a social phobia can achieve a more fulfilling lifestyle and become more comfortable in social situations. Treatment should begin with a comprehensive evaluation. It is vital to take a good look at anything that could be a contributing factor to the problem. Then, a treatment plan should be developed that is tailored to the particular needs of the individual. Often, treatment includes a well-balanced combination of several approaches.

Cognitive Behavior Therapy:
The primary goal of cognitive behavior therapy for social phobia is to help people modify the way they think, feel, and behave in social situations. Though everyone’s therapy is somewhat unique, there are several common components of cognitive behavior therapy. All clients are educated about the nature of social phobias and maladaptive beliefs and social expectations are gradually identified, challenged, and altered. Treatment may also include behavioral experiments, or “exposures,” which are designed to help people confront feared situations in a step-by-step manner. Clients are taught anxiety-management skills to assist them in this process. Some individuals with social phobias may experience additional anxiety due to a lack of certain skills, like how to give a presentation or how to deal with conflict. Thus, treatment may also focus on improving these social skills.

Medications:
A variety of medications have been used to treat SAD. Beta-blockers (blood pressure medications) like propranolol sometimes reduce the physical symptoms (e.g., trembling hands, increased heart rate) that accompany performance anxiety. Another type of medication called benzodiazepines (e.g., Xanax, or alprazolam) has also been used to treat the symptoms of SAD. One group of antidepressant medication, monoamine oxidase inhibitors, such as Nardil (phenlzine), has been relatively effective with SAD. However, these drugs have several common side effects and require dietary restrictions. A growing body of research suggests another class of antidepressants called the Selective Serotonergic Reuptake Inhibitors, or SSRI’s, are also effective as a treatment for SAD. These drugs are usually safer to take and have fewer side effects than the earlier classes of antidepressants. One of the SSRI;s, a drug named Paxil (paroxetine), has been approved by the FDA specifically for the treatment of SAD. However, no one medication is right for everyone. There are many factors that should be discussed with your physician before deciding whether to take medication and which medication to take.

Other Treatments: In addition, supportive therapy may be a helpful adjunct in the treatment of SAD. Support groups and/or therapy groups may be useful as well. Family involvement in the treatment process may be recommended.

What if someone I know has SAD?
People who have SAD frequently feel isolated and alone. They often feel ashamed of their problem and attempt to hide it. If they have gathered the courage to tell a friend or family member about their problem, they may have been met with well-meaning but unhelpful remarks, such as “Big deal!” Everyone is nervous getting up in front of a group of people.” It can be difficult for others to understand the overwhelming anxiety that people with social phobias experience. If you suspect that someone you care about has SAD, encourage him or her to be evaluated by a professional. If the person’s problem is interfering with your life and the person is not willing to seek help, you can contact a professional yourself to learn how best to deal with the situation.

Where can I find help?
While it would be reassuring to say that the average psychologist, psychiatrist, therapist, social worker, or counselor is skilled in the type of treatment approaches described above, this is not the case. There may be only a handful of professionals in your area skilled in the cognitive-behavioral treatment of anxiety disorders and, specifically, in the treatment of SAD. Contact resources in your community such as a university medical center or an anxiety disorder treatment center and ask about the kind of treatment available. If you live in a community in which this kind of facility is not available, contact the Anxiety Disorders Association of America (301) 231-9350 or your local Mental Health Association. They may be able to provide you with information as well as the names of practitioners in your area. Finally, do not hesitate to ask questions of professionals you contact for help. They should be able to give you satisfactory answers and should not be offended by your questions about their credentials and experience in the treatment of anxiety disorders.

Please know that we are here to help you.

Treatment for Social Anxiety:
Now that you have read more about Social Anxiety, the next step is to seek help.

Frequently, people are hesitant to make the first step. Please know that our Institute is nationally recognized and our clinicians are ready to work with you.

In order to receive help the first step is to contact our Intake Coordinator.

For our Macklind office call 314-534-0200.

For our West County office call 636-532-9188.

Our toll free number is 877-245-2688.

Our Intake Coordinator will match you to one of our clinicians who will evaluate your concerns and make recommendations to you.

The first step is an important one and only you can place the call.

Remember, we are here to help you.

Your insurance coverage will also be reviewed by the intake coordinator.

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