Do you have an intense fear of social situations? How do you do with public speaking? Are you afraid of constantly being judged and criticized by others?
If so, you could have one of the most common mental disorders in America: social anxiety disorder, or social phobia. In this disorder, the person is afraid of looking bad or being humiliated in front of others. The person may have a lack of social skills. These fears can build into panic attacks. Because of this, the person may avoid certain social situations, or have severe distress over them.
Another common feature of social anxiety is anticipatory anxiety, or having fears about a social situation and being judged before it happens. The person may be aware that their fears are unsubstantiated and unreasonable, but they can’t control it. It just exists for them. They can’t get around them.
In general, the person feels that something is wrong with them in social situations, but they can’t figure it out what “it” is. Before or during the situation, the person may feel their heart pounding. They may sweat, shake, and get an upset stomach. Your muscles might tense up. In more severe cases, the person may have something called “derealization” where you literally “black out” and can’t remember anything about the situation. Say you’re giving a report, and ten minutes later, you’re done, but you can’t remember what you said. All you knew was that you were so anxious and nervous for it, and are now so relieved it is over.
Some common situations that provoke these feelings include eating or drinking in front of others, using the phone, going to the bathroom in public places, interacting with others in parties or on dates, giving reports or asking questions, and in general being the center of attention. Because of the nature of this disorder and where it can lead (it can significantly affect your life), the person may develop panic disorder and/or depression.
The disorder is more common in women than men. It most often surfaces in adolescence or early adulthood, but can also originate in childhood.
Psychologists believe three vulnerabilities cause social anxiety disorder:
Biological: You have a biological vulnerability to it. One of your neurotransmitters is serotonin. A neurotransmitter is a special chemical used in the brain to transmit messages from one nerve cell to another. Sometimes these chemicals get out of balance, making for some wonky brain situations where the chemical can’t send the message properly. This can cause the brain to react in a certain way to situations, including the provocation of anxiety. There’s also a genetic part to this because the disorder appears to run in families.
Psychological: The person may have had an embarrassing social situation at one point that later helped develop the disorder.
Environmental: The person has some stressful situations that help bring out the disorder.
These factors together are part of the diathesis stress model. The model helps to explain the relationship with genetics and the person’s environment in causing a disorder. In this model, the person has a biological vulnerability to develop a disorder (diathesis), and psychological situations and environmental stress “pushes a person over the edge,” creating the disorder.
The diagram below is a schematic of this model. When a biologically vulnerable individual has negative environmental situations (or stressors), they have a negative outcome and develop the disorder. When the vulnerable individual doesn’t face these stressors, they don’t develop the disorder. However, if the person doesn’t have the vulnerability (or is a “resilient individual”), they will not develop the disorder, regardless of whether their experiences are positive or negative.
Social anxiety disorder is best treated with cognitive behavioral therapy (CBT). In this theory, the therapist helps the person uncover the dysfunctional thinking patterns that create anxiety in social situations. The person learns to react differently to social triggers. Systematic desensitization involves exposing the person gradually to more anxiety-ridden situations. The person is exposed to the situation in a safe environment with the therapist to work through his/her fears. With this treatment, the prognosis, or outcome of social anxiety disorder, is generally good, with the person leading a productive life.