Social anxiety disorder is an intense, persistent fear of being watched and judged by others. People with SAD fear that they might do something or act in ways that would be humiliating or embarrassing. Many people with social anxiety disorder also have severe physical symptoms, such as rapid heart rate, nausea, and sweating, and can feel overcome by these symptoms when they encounter the fearful situation. Fear, anxiety, and avoidance significantly interfere with an individuals usual routine, employment or academic functioning, or social activities or relationships, or produce clinically significant distress or impairment in social, occupational, or other important areas of functioning. The fear or anxiety is not proportionate to the real threats presented by social situations and to the sociocultural context.

People with social anxiety disorder frequently avoid social or performing situations, and when the situation cannot be avoided, they feel considerable anxiety and distress. Some individuals with this disorder experience no anxiety when it comes to social situations, and experience performance anxiety instead. Their anxiety might be specific to a particular type of social or performance situation, or it might happen in all situations. For others, the anxiety is related to a particular social situation, such as speaking with strangers, mixing in a party, or performing in front of an audience. Others might feel anxious about a variety of situations--talking to the salesperson, dating, asking for favors, eating or drinking in front of others.

Social anxiety often begins in childhood. Some of the common personality and behavior traits seen in kids with social anxiety include crying, temper tantrums, latching onto people they know, being extremely shy, refusing to talk in front of the class, and being afraid or timid in new settings and around new people. As an adult this might translate to fear of social situations, such as meeting new people, going on dates, being on an interview, answering a question in a group, or having to speak with the cashier at the store. Social phobias may also be specific; when individuals are afraid of one particular situation, or of certain situations related to one particular fear (such as being embarrassed at work, or around friends).

Anxiety is a fear that occurs when anticipating an event, while a phobia is a irrational fear of specific objects or situations Severe social anxiety is also known as social phobia, demonstrating the deep-seated fears that socially anxious individuals feel, as well as the extreme measures that they use to avoid being exposed to high-pressure situations. Social phobia is often comorbid with other anxiety disorders; in one study, 60% of children with social phobia had another disorder (generally, anxiety); 10% had generalized anxiety disorder, attention deficit/hyperactivity disorder (ADHD), or a specific phobia. About a third to one-fifth of adolescents with generalized social phobia had another disorder, most commonly anxiety related to agoraphobia (27%) followed by panic disorder (20.5%), separation anxiety disorder (18.1%), PTSD (17.1%), and specific phobia (12.8%). Lifetime rates of co-occurring oppositional defiant disorder occurred in a substantial minority of adolescents and were higher among those who had generalized social phobia (12.5 percent, as compared to adolescents with non-generalized social phobia. Although overall, 18.6% of adolescents with social phobia presented with lifetime mood disorders, adjusted odds ratios indicated these associations were predominantly attributable to other anxiety disorders or behavioral disorders. For about half of individuals diagnosed with social anxiety disorder, it appears that specific traumatic or humiliating social events were associated with onset or worsening of the disorder; such events seem particularly associated with particular social phobias, such as public speaking (Stemberg et al., 1995). In social anxiety disorder, also called social phobia, daily interactions produce considerable anxiety, fear, self-consciousness, and embarrassment, as one fears being scrutinized or judged by others. Research has also highlighted the role of subtle avoidance and protective factors, and shown how attempts to avoid a fearful negative assessment or to employ protective behaviors (Clark & Wells, 1995) may increase the difficulty in social interactions, worsening the anxiety over the long term.

For about half of people diagnosed with social anxiety disorder, it appears that a particular traumatic or humiliating social event is associated with the onset or worsening of the disorder; such an event appears particularly associated with particular social phobias, for instance, regarding public speaking (Stemberg et al., 1995). About a third to one-fifth of adolescents with generalized social phobia had another disorder, most commonly anxiety related to agoraphobia (27%), followed by panic disorder (20.5%), separation anxiety disorder (18.1%), PTSD (17.1%), and specific phobia (12.8%). This group had lower rates of co-occurring disorders, with a statistically significant (p=.05) incidence of a major co-occurring substance use disorder among 13 percent of those with generalized social phobia, as opposed to just 7.2 percent of those with non-generalized social phobia.

People with SAD might be predisposed to exaggerated fear reactions, which, in turn, increases anxiety. People who have overactive amygdala (the part of the brain that detects fear) may have heightened fear responses, leading to increased anxiety in social situations.

Treatment

It makes sense that we would avoid situations that make us feel uncomfortable. However, doing so only makes us feel better in the short-term. If we don’t learn to face our discomfort it takes over and our lives become smaller in the long-term. It is equally important that we resist the temptation to numb those feelings of anxiety with alcohol and drugs. These may temporarily decrease anxiety but can become a crutch. In the long-term substance use actually worsens anxiety and can lead to addiction.

The process of facing our fears is called exposure therapy. Basically, you slowly increase exposure to situations that you are afraid of. Exposure therapy involves learning coping skills and gradually increasing the intensity of what is causing discomfort and fear. Exposure therapy is very successful, because over time, an individual learns he or she is capable of handling situations triggered by a fear.

Aside from exposure therapy, individuals may find cognitive behavioral therapy (CBT) helpful. CBT-related techniques can help you recognize distorted thoughts and change the way you see yourself and the world. CBT teaches you different ways to think, behave, and respond to situations, which helps you feel less anxious and afraid.

If you fear that your social skills are lacking it may be beneficial to join a therapy group specifically for social anxiety. This will allow you to learn about the ways others with social anxiety treat and overcome their fears in social situations as well as practice and refine social skills.

Medication is also an option for social anxiety disorder. SSRI and SNRI antidepressants are commonly used to treat depression, but they also can help treat the symptoms of social anxiety disorder. They may take several weeks to start working. Antidepressants may also cause side effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe, especially if the dose starts off low and is increased slowly over time.

Beta-blockers can help control some of the physical symptoms of social anxiety disorder, such as rapid heart rate, sweating, and tremors. Beta-blockers are commonly the medication of choice for the “performance anxiety” type of social anxiety disorder.

Benzodiazepines, which are anti-anxiety sedative medications, are powerful and begin working right away to reduce anxious feelings. These have the potential to be addictive so are generally recommended for short-term use. If you take medication for social anxiety disorder, call your doctor immediately if you develop any side effects, including feeling down and depressed. Do not stop medication without talking to your doctor first. Suddenly stopping an anxiety medication may cause serious side effects.

Summary

A person with social anxiety disorder experiences symptoms of anxiety or fear in some or all social situations, such as meeting new people, dating, being on a job interview, answering a question in a classroom, or having to speak with the cashier at the store. Some of the common personality and behavior traits seen in children with social anxiety disorder are crying, temper tantrums, latching onto people they know, being extremely shy, refusing to talk in front of the class, and being afraid or timid in new settings and around new people to parents, or refusing to speak in social situations. Severe social anxiety is also known as social phobia, a reference to the deep, acute fears that socially anxious individuals feel, as well as the extreme measures that they use to avoid being exposed to high-stress situations.

Resist the temptation to numb uncomfortable feelings. Alcohol and drugs can decrease anxiety in the short-term, but over time, it may worsen anxiety and cause addiction or a substance use disorder. Remind yourself that every time you face an uncomfortable situation without a crutch you are retraining your brain and making it easier for your future self.

You can work through social anxiety with a trained professional using medication and/or therapy. The most common types of therapy for social anxiety are exposure, CBT, and skills groups. While avoiding high-stress situations can make you feel better in the short-term, it can keep you from becoming more comfortable with social situations and learning to deal with them over the long-term. Recovery IS possible.

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