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Social Anxiety Disorder

By Laura McDonald, LCSW

Social Anxiety Disorder is a disorder in which a person has an irrational and excessive fear of social situations. The fear usually relates to embarrassing oneself in public and concerns about being judged by others. It is the third most common mental disorder and it is the most common type of anxiety disorder in the United States. Social Anxiety Disorder has a significant impact on a person’s behavior and emotions. There are many signs and symptoms of Social Anxiety Disorder which a person can experience. Some of these symptoms include: feeling very anxious about interacting with others, such as talking on the telephone or attending a work or social function; having significant difficulty making and maintaining friendships; avoiding social situations altogether; excessive worry about others realizing that the person is feeling very nervous; and not wanting to be the center of attention. Some of the physical signs include: upset stomach, blushing, shaking, sweating, nausea, and/or muscle tension. Usually, a person is aware that his/her fears are irrational, and as previously mentioned, may avoid situations which will trigger them.

Causes of Social Anxiety Disorder can both be genetic and/or environmentally based. First, brain chemistry is one possibility. One chemical in the brain called serotonin can trigger social anxiety disorder when an imbalance occurs. Serotonin is a neurotransmitter that modulates emotions and mood. Secondly, anxiety disorders may be an inherited trait. However, learned behavior can play a role, too. These different reasons make it unclear as to the exact cause in each case. Additionally, a brain structure called the amygdala can impact a person’s reaction to fear. A person with an overactive amygdala is more apt to experience excessive anxiety during social interactions. Lastly, negative childhood experiences such as rejection, bullying, or other forms of embarrassment can dramatically increase the likelihood of social anxiety. A person who has a family background of emotional, physical, or sexual abuse is also more vulnerable to developing social anxiety disorder.

Psychotherapy and medications are the most common forms of treatment for Social Anxiety Disorder and can be used in combination. Cognitive Behavioral Therapy (CBT) is presently the most effective type of therapy for Social Anxiety Disorder. CBT used in combination with medication can often help to greatly enhance the effectiveness of this type of therapy. CBT is based on the notion that a person’s thoughts, not the external situation, can affect how one may choose to react or behave. By altering one’s thoughts, one can learn to behave differently. CBT may also involve exposure therapy. This therapy helps the person to begin to gradually confront the situations which cause him/her the greatest amount of anxiety.

Medications used to treat Social Anxiety Disorder usually include antidepressants and anti-anxiety medications. Selective Serotonin Reuptake Inhibitors (SSRIs) are frequently prescribed first. Over time, medication may no longer be necessary.

Self-help techniques can also help to decrease one’s anxiety in social situations. Some examples of these include: having a meal in a public place with a close friend or relative, initiating contact with someone by saying hello, paying a person a compliment, asking for directions, and talking on the phone for longer periods of time. Joining a support group (either Internet-based or local) and/or finding an enjoyable hobby are other ways to reduce social anxiety.

Although social anxiety disorder can be painful and difficult to live with, the good news is that it is highly treatable and over time, a person can learn to overcome it and/or to significantly reduce its negative impact on their life.