Social Anxiety Disorder

Social anxiety disorder, also called social phobia is said to be the third most common mental disorder.  This is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations.  The intense nervousness and self-consciousness comes from a fear of being closely watched and being judged or criticized by other people.

Social anxiety disorder can make a person feel scared they’ll make a mistake, perhaps be asked to make a very basic decision, or just answer a simple question that requires them to think of reply that is somehow different from their normal day to day conversation and communication. Being put on the spot to respond instantly to a question can be quite terrifying to someone with social anxiety disorder, no matter how normal or straightforward the question may appear to someone who has confidence and is able to communicate more easily. 

The fear of embarrassment or of being humiliated in front of others can be great. While one person can take a casual comment as just a throw away remark, to someone suffering from social anxiety, the same comment can feel totally mortifying. .The fear can be made worse by a lack of skills and experience in dealing with social situations – if something scares you, you’ll often try to avoid it where possible. While it may feel easier in the short term, the downside is that of course you then can never become good or confident at doing whatever “it” is.

The anxiety can build into a panic attack.  As a result of the fear, the person can become increasingly tempted to start avoiding social situations altogether. They may also only mix with the few people they feel comfortable with and trust like perhaps immediate family members.

People with this problem may spend a good deal of their time one step removed from face to face contact, relating to others via their computer. Their experience of life can be largely gained from reading books, watching the news, TV programmes online information, and most, communication taking place via social media platforms such as Facebook. They console themselves with the idea that they have lots of friends, but these are often “virtual” and “online”.

Anticipatory anxiety is the fear of a situation before it even happens, for example dreading the date of a forth coming wedding to which you have been invited, and have accepted the invitation. You find yourself panicking about what sort of an idiot you will make of yourself in front of all those people. In many cases, you are aware that the fear is unreasonable, yet on your own somehow you just can’t seem to overcome it.

This social anxiety disorder can distort one’s ability to think reasonably and logically. The person predicts all sorts of catastrophes, which make them dread any social event, as they “know” it will be awful. And even when it is fine, this does not stop the catastrophosising about how lucky you were that you just got away with it that time….. but wait for the next!

Without treatment, social anxiety disorder can interfere with the person's normal daily routine.  Ordinary dealings with people at work, communicating effectively with peers and more personal relationships can be an ongoing battle. The ever-present fear and reluctance to say yes to social activities can turn into a vicious cycle, whereby eventually others automatically expect you to refuse, and so no longer invite you to anything.

People with social anxiety disorder often find difficulty:

• Meeting people for the first time
• Eating or drinking in front of others.
• Writing or working in front of others.
• Being the centre of attention.
• Interacting with people, including dating or going to parties.
• Asking questions
• Silence during conversations
• Using public toilets.
• Talking on the telephone.

Social anxiety disorder can be linked to other mental illnesses, such as depression, panic disorder, obsessive compulsive disorders. 

Researchers from MIT, Boston University (BU), and Massachusetts General Hospital (MGH) in the Archives of General Psychiatry in July this year, have taken brain scans of patients with social anxiety disorder. Their research is exploring if it is possible to predict which people with this problem are likely to be helped by cognitive behavioural therapy (CBT), and who is more likely to be helped by medication.  Cognitive behavioural therapy aims to enable people to change their thoughts and behaviour patterns which can otherwise lead to anxiety. For social anxiety disorder patients, that might include undertaking “behavioural experiments” to gather data and check out whether others are actually watching or judging them. If you avoid some one’s gaze, you will never know if they are looking at you!  Likewise, if you smile, and they smile back, perhaps they are not mentally criticising you. Currently both CBT and medication are used to treat social anxiety, though the National Centre for Clinical Evidence (NICE) guidelines suggest that CBT is likely to be particularly helpful, and should be the first choice of treatment, before offering medication.

Having worked over the years with a number of people who suffer from social anxiety, including extreme fears of blushing and sweating, it has been extremely satisfying to see people who have blossomed in confidence, begun and maintained new and satisfying relationships, and say that the quality of their life has improved immeasurably.