Social Anxiety Disorder

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Social Phobia

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Fear of Public Humiliation

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Social Anxiety Disorder

A young woman by the name of Rose will do almost anything to avoid going to a social function.  A trip to the café will have her search for a seat facing the window, preferably in a small corner where no one will see her, or even worse…strike up a conversation with her. Rose’s greatest fear is being judged and scrutinized, and embarrassing herself with her own actions. If she is committed to attending a social event, she will dread it for days prior.  Knowing all too well…the stumble of her words, the tremble in her hands, fearing everyone is looking at her negatively.   She would spend the entire evening hiding in a corner, or standing against the wall waiting for it to end.  Rose may not realize but she is suffering from Social Anxiety Disorder.

History of Social Anxiety Disorder goes all the way back to 400BC.  Philosopher Hippocrates was first to acknowledge the individual that displays extreme shy behaviour as someone who “lives darkness as life” and “thinks every man observes him”.  Another quote from Hippocrates;  “He dare not come in company for fear he should be misused, disgraced, overshoot himself in gesture or speech, or be sick, he thinks every man observes him” describes Social Anxiety Disorder well.  The last part of the quote remains an integral part of the disorder to this day.  One that suffers with Social Anxiety Disorder has great fear of being watched and judged by others.  In the early part of the 19th century, the term neurosis and social phobia were used to define patients with overtly shy behaviour.  Throughout the decades the terms have been changed several times, ranging from “avoidant personality disorder”, “neglected anxiety disorder”, (due to lack of studies and understanding of the symptoms), onto a more recent term social phobia, and finally to the term we use today, “Social Anxiety Disorder” which was the term defined in 1994.

According to the DSM 5, (Diagnostic Statistical Manual of Mental Disorder, Fifth Edition) “A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating” (Social Anxiety Institute)

In other words, Social Anxiety Disorder is the persistent fear of social situations with anyone other than close family and friends.  The individual has an unrealistic fear of humiliation. They believe others are watching and judging their every move which leaves them feeling anxious and self-conscious to the point where social situations will either be endured at great levels of distress, or avoided all together.

Social Anxiety Disorder is difficult to define and diagnose, it is still occasionally missed by doctors.  It is also misunderstood by patients.  Being wrongly diagnosed can increase symptoms such as depression and anxiety, further deteriorating the well-being of the patient.  This disorder can affect anyone, and is “the third most common mental health disorder, behind only depression and substance abuse”.   It can begin in childhood;  however it’s generally not diagnosed until at least 13 years of age.  The onset of symptoms can begin anywhere between the ages of 8 and 13,  in fact according to the ‘DSM 5’ 75% of individuals that have Social Anxiety Disorder started experiencing those symptoms during childhood, with a 7% - 13% total prevalence in the United States. 

Symptoms can range from mild to extremely debilitating and include the following:

  • Isolating oneself from social events or situations
  • Feeling extreme anxiety in the company of others
  • Disproportionate worry of  humiliating or embarrassing oneself,  or offending other people and angering them
  • Fear of being judged
  • Prolonged and disproportionate worry and anxiety over an upcoming social event
  • Stomach upset, profuse blushing, trembling, perspiring when in the company of others
  • Confusion, ‘brain fog’
  • Increased heart rate
  • Over analyzing of actions during  social interaction
  • Expecting the absolute worst scenario from the anticipated event

Causes:  Social Anxiety Disorder comes from a combination of factors, as opposed to one single cause.

  • Environmental

Childhood trauma can be a risk factor for developing Social Anxiety Disorder, parental abuse, peer rejection, and low socio-economic status all play a role in the development.

Observing a parent or authority figure experiencing Social Anxiety also increases the risk factor. 

  • Genetic Behavior

Social Anxiety Disorder tends to also run in the family.  If a biological parent or sibling has an anxiety disorder then this can be passed through the genes onto the child. 

  • Biological

The amygdala is a part of the brain that responds to fear.  Studies have shown a higher level of activity within the amygdala during social interaction in those who suffer from Social Anxiety Disorder.  As well, if a child experiences continuous trauma or peer rejection then this reaction caused initially by the amygdala can possibly become a conditioned response to social interaction.

Social Anxiety Disorder has a high comorbidity (co-occurrence) rate with other anxiety disorders such as Obsessive Compulsive Disorder (OCD), Major Depressive Disorder (MDD), Substance Abuse Problems and Agoraphobia.  Those who suffer from comorbid anxiety disorders have been shown to suffer at a greater level on the spectrum of anxiety disorders than if they suffer from Social Anxiety Disorder alone. 

The criteria required to be diagnosed with this disorder includes the duration of symptoms for at least 6 months, and that the social situation causes symptoms of anxiety that the individual acknowledges as disproportionate to the situation.  Their fear significantly interferes with work, school and relationships and is not a result of another mental illness or drug use.

Treating Social Anxiety Disorder is possible with a higher success rate if found early.  A combination of Cognitive Behavioral Therapy and medication has shown to be very effective.  Teaching the individual a unique and new way of interpreting social situations and to dismiss the former negative thoughts and learn new and improved thought techniques, combined with understanding the thought process that contributes to the anxiety is the key element in Cognitive Behavioral Therapy.  Selective Serotonin Reuptake Inhibitors (SSRI’s) are regularly prescribed to those with anxiety disorders, as studies have shown that low levels of serotonin (a neurotransmitter in the brain that regulates mood) is correlated with depression and anxiety.  SSRI’s will in effect ‘hold’ the serotonin a little longer within the brain’s neural pathways which in turn can be effective for depression as well as Social Anxiety Disorder.

As mentioned, Social Anxiety Disorder is very difficult to diagnose.  It regularly goes untreated in many sufferers which will not only lead to reduced quality of life but may also lead to financial distress.  Many people with this disorder are unemployed due to the great difficulty of holding steady employment. As you can imagine the struggle one would have facing the work environment on a daily basis especially if that job requires daily social interaction and confrontations. Despite the amount of research on Social Anxiety Disorder, it is still one of the least understood and common mental illnesses in America today.




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