What is social anxiety disorder?

Social anxiety disorder is the fear of social situations that involve interactions with other people.

It could be said it is a fear and anxiety of being negatively judged and evaluated by others in life.

SAD affects many areas of a person’s life and may be confused with a panic disorder as people can experience anxiety attacks but not panic attacks.

There may be a high rate of alcoholism and other substance abuse.  Plus family difficulties, personal relationship problems, difficulties in obtaining or continuing with employment are among a number of very common experiences for people with social anxiety disorder.

Social anxiety disorder is one of the five major anxiety disorders as listed in the DSM-5 and affects 1 in 8 Irish adults at any one time. But what are the symptoms of SAD?

What are the symptoms of social anxiety disorder?

Experiencing significant distress/dread in the following situations:

1. Fear around being introduced to other people
2. Dread at the possibility of being teased or criticized
3. Fear at being the centre of attention
4. Distress if they think they may be watched or observed while doing something
5. Fear of having to say something in a formal or public situation
6. They dread meeting people, especially in authority 
7. Feeling insecure and out-of-place in social situations 
8. Embarrassed easily 
9. Meeting other peoples’ eyes is difficult if not impossible for some people with SAD
10. Having difficulty swallowing, writing, talking, making phone calls while with others
11. Anxiety, to an extent they may not be able to attend work/school
12. High levels of fear and nervousness
13. Automatic negative emotional cycles

Physical symptoms

1. Racing heart
2. Blushing
3. Excessive sweating
4. Dry throat and mouth
5. Trembling and muscle twitches
6. A feeling that the heart is either pounding too hard or fluttering (palpitations)
7. Abdominal pain and/or stomach upset
8. Clammy  and /or cold hands
9. Confusion
10. Crying
11. Difficulty talking; this may include a shaky voice
12. Muscle tension
13. Nausea
14. Walk disturbance

A child with SAD may underachieve in school to avoid attention, may cling to parents, throw tantrums, shut down or off.

What might cause someone to develop SAD?

Causes of Social Anxiety Disorder

There is no clear cause as yet. But a variety of different causes are being investigated. Some of the following have strong links to the causes of social anxiety disorder.

Negative Experiences:  

1. Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder.
2. Other negative events in life, such as family conflict or sexual abuse, may be associated with social anxiety disorder.

Genetic Causes: 

It is thought that SAD may run in families.

Chemical: 

Scientists are currently researching if the natural body chemicals we have might be playing a part. Some scientists are suggesting that serotonin may play a key role when the levels are not right. 

Brain: 

Some experts believe the amygdala, (part of the brain) which produces our emotions, may play a role. This may result in an excessive reaction in some people.

Diagnostic Criteria for Social Anxiety Disorder from  The ICD-10

This is the Classification of Mental and Behavioural Disorders of the World Health Organization (in other words the technical stuff).

All of the following criteria should be fulfilled for a definite diagnosis:

(a) The psychological, behavioural, or autonomic symptoms must be primarily manifestations of anxiety and not secondary to other symptoms such as delusions or obsessional thoughts;

(b) Anxiety must be restricted to or predominate in particular social situations; and

(c) Avoidance of the phobic situations must be a prominent feature. Includes: * anthropophobia * social neurosis Differential Diagnosis Agoraphobia and depressive disorders are often prominent, and may both contribute to sufferers becoming “housebound”.

But how do you teat SAD?

Treatment for Social Anxiety Disorder

Remember one size doesn’t fit all. So find a solution between your GP and therapist that suits you.

In saying that Cognitive Behavioral Therapy (CBT) is recommended for treatment. This can be combined with medication if needed.

Cognitive Behavioural Therapy is not one set method but rather a combination of various techniques. Its central goals are to identify irrational beliefs and thought patterns and replace them with more realistic views.

Changing negative automatic thinking in the long-term requires practice and repetition for several months. But it is a very effective treatment. It will help the person recognise negative thought patterns much quicker and also help them to replace or correct them as needed with more rational and realistic ones.

Things that can be tackled by CBT:

(list not inclusive)

1. Misperceptions you may have about your abilities and self-worth.
2. Tackle and look at any guilt, embarrassment, or anger over past situations.
3. How to be more assertive.
4. Tackling perfectionism and being able to be more realistic in thoughts and about what can be done.
5. Dealing with procrastination related to social anxiety.

The behavioural method used is Exposure training for SAD. It has to be a very gradual process as the individual needs time to adjust to each situation. 

It is the combination of cognitive (understanding our thinking processes) and behavioural (changes in our behaviour and reactions) that treat SAD and allow us to overcome it.

Medication: 

Medication can be used to treat SAD but please discuss this with GP first. It is recommended that you try therapy before taking any medication. A word of caution: only your GP will be able to advise on this, as they will know you and your medical history better than I will.

Self-Help

1. Learn a relaxation method like the 7/11 deep breathing technique. I’ve linked to my podcast where you can learn this method for free. 
2. Change your lifestyle. This can be hard but small changes can help us move forward in a big way. 
3. Start to challenge your negative thoughts. I know this may be hard at first as we can live with them for so long. But they are only thoughts and usually belong to someone else. Isn’t it time you handed these back to that person? I have a free course on changing your negative thinking in my group for mums. You can join here.
4. Build up your positive relationships and surround yourself with a positive support system. Delete or minimize, at the least, contact with negative people. Again I have a free course in my free group for mums.
5. Face your fears with the help of a therapist. But don’t allow anyone to push you, slow and steady is what is required here.

Other help and support

Do you need to relax? How to relax in your everyday life

Social Anxiety Ireland

Social Anxiety UK

Sane

Work With Me.

Remember you are allowed to ask for support. No one is an island. If you need extra support then you can also work with me. We all struggle with stress and overwhelm from time to time. If you find this has become a problem for you and you’d like some support then schedule an appointment with me.