People with social anxiety disorder may have some or all of the following feelings in social situations:
- Fear that everyone's attention is focused on them
- Fear that they will make mistakes and everyone will notice
- Feeling that everyone else is more capable in the same situation
- Fear that they are being judged by others
- Fear that they will embarrass or humiliate themselves in front of others
In feared situations, people with social anxiety disorder will feel intense anxiety. The anxiety may lead to nausea, trembling, pounding heart, blushing, sweating and stammering. For some, the anxiety will intensify into a panic attack. These symptoms of anxiety often lead to further embarrassment for the person with social anxiety.
Some people with social anxiety disorder are comfortable only with close friends and family. Others only fear specific social situations. Some become anxious when dealing with people in authoritative positions (such as bosses). Public speaking is a common social fear. Other specific social fears include using public restrooms, eating in restaurants, using a telephone, and writing in front of people.
People with social anxiety disorder often worry for days or even weeks before a feared social situation. The disorder may become severe enough to interfere with school or work, and may cause difficulty with close relationships.
Who Has Social Anxiety Disorder
According to the National Institute of Mental Health (NIMH), the following statistics show who has social anxiety disorder in the United States:
- 5.3 million adult Americans (3.7% of the population) have social anxiety disorder.
- Women are twice as likely as men to have social anxiety disorder.
- Social anxiety disorder usually begins in childhood or early adolescence and rarely after age 25.
Social Anxiety vs. Shyness
Shy people do not experience the same intense anxiety as people with social anxiety disorder. In addition, shy people don't avoid social situations to the extreme that people with social anxiety disorder do.
Shyness is not a criteria for social anxiety disorder. People with social anxiety disorder may be quite comfortable with certain people or many people, but still avoid or feel intense anxiety in specific social situations. In addition, social anxiety disorder may come to be debilitating for some people whereas shyness does not. Social anxiety disorder may begin to overtake every aspect of a person's life.
Social Anxiety and Other Conditions
Social anxiety disorder may co-occur with other anxiety disorders as well as depression. Additionally, people with social anxiety may develop problems with substance abuse or dependence when they use drinking or drugs to "self-medicate" their symptoms.
Treating Social Anxiety Disorder
Social anxiety disorder is usually treated with therapy or medication or a combination of both. As with other anxiety disorders, social anxiety disorder will become worse without treatment. Therefore, it is crucial for people with suspected symptoms to seek proper treatment as soon as possible.
The therapy used most often in treating social anxiety disorder is cognitive-behavioral therapy. Cognitive therapy helps those with social anxiety disorder learn how to cope with and change irrational, repetitive thoughts which may precede and intensify anxiety in feared situations. The therapy may also focus on self-esteem, anger, assertiveness and other issues. Behavioral therapy involves the actual practice of social skills. It may involve desensitization in feared situations. Behavioral therapy is often done in groups where participants may practice skills with people who have the same fears. However, not all people with social anxiety will feel comfortable in groups, so this therapy may be practiced one-on-one.
Medication may be an important part of recovery for many. Medication may be temporary, allowing the person to feel well enough to practice cognitive-behavioral therapy (CBT), or medication use may be used long-term. The medications most commonly used for social phobia are selective serotonin reuptake inhibitors (SSRI's). monoamine oxidase inhibitor antidepressants (MAOI's), and benzodiazepines. Beta blockers are sometimes used with performance anxiety, a specific kind of social anxiety.