Social Anxiety Disorder or just shy?

Symptoms & Presentation

Social Anxiety Disorder, also known as Social Phobia, is a mental health disorder where the affected person has fear of, or anxiety about, various social situations. Social situations can include interactions with one person or a group of people in settings such as a social gathering, a job interview, a party, or even in public places like restaurants or the grocery store where they must ask a question or respond to another person.

The anxiety or fear occurs when the person with Social Anxiety Disorder must communicate with one or more people in these settings. The person’s anxiety/fear is typically related to worries about being negatively evaluated by others, or looking anxious in front of others. In other words, the person fears that they will be exposed as socially anxious and this further heightens the fear and anxiety experienced.

Oftentimes, people with Social Anxiety Disorder also fear that they will blush, stutter, start to tremble or sweat, or show any other visible signs of anxiety in front of others. This is perceived as embarrassing or shameful to them so, in turn, the person typically will escape the situation to prevent being exposed or will avoid the situation altogether.

In addition to the fear of appearing anxious, people with Social Anxiety Disorder also fear being viewed as boring or unintelligent. These individuals often have an underlying belief that they are not ‘smart enough,’ not ‘good enough,’ not “likeable,’ or are otherwise inferior in some way. These thoughts are generalized to beliefs that others will perceive them in the same manner as they see themselves. Individuals with Social Anxiety Disorder often have deep-rooted self-esteem issues. Even activities such as eating in front of others or being watched while working or completing a task can provoke extreme anxiety and fear. These individuals have an intense focus and concern about what others will think about them and this persistent worry controls many aspects of their lives.

Example of A Person’s Experience with Social Anxiety Disorder: The Case of Marie

Marie has always considered herself shy and as far as she can recall, everyone from friends, family members, and teachers have always commented on how shy and quiet she is. Marie tended to dislike being labeled as “shy,” but she eventually became accustomed to it and began to identify with this trait. As an adolescent, Marie remembers that she had difficulty making eye contact with authority figures, like teachers or even with her family doctor or dentist. She became embarrassed to have meals in certain situations and when she would join her peers afterschool to have burgers at the nearby fast food restaurant, she would typically only order a soda, as she was embarrassed to eat in front of people she didn’t know well, especially boys.

As Marie entered college, she recalls that she would only take classes where she was aware that class presentations were not required. If the class syllabi was unavailable ahead of time and she later learned that a presentation was required, she would immediately drop the course. Marie was unable to keep this up much longer, as she once earned a C in a class where she would have gotten an A because she did not show up on the day a presentation was due. She was so fearful of public speaking that she couldn’t bear enduring the anxiety. Marie finally switched to online classes and was able to graduate.

In her 20s, Marie continued to struggle, as her social anxiety grew more severe. Her avoidance of social situations and speaking in front of others began to affect her professionally, as she struggled attending job interviews. Marie finally received a prescription for anxiety medication in order to go to an important job interview and although she felt anxious, she was able to pass the interview and was hired. However, Marie found that things like being watched by her boss while working or even asking her boss for a few days off for the holidays brought about excessive anxiety, sometimes to the point where she was unable to go through with certain conversations with others. Marie also feared confrontation with others and she often let co-workers joke with her inappropriately or bully her due to her fear of speaking up for herself. She once tried to confront a co-worker and her voice began to tremble. After that day, she avoided situations like the break room or other common employee areas. Marie found that she experienced severe stomachaches, was unable to eat, and had trouble sleeping if she anticipated that she would need to confront a feared social situation.

This case example presents a classic profile of Social Anxiety Disorder. Most people have some features of social anxiety and this is normal; however, symptoms become problematic when they affect several areas of a person’s life; occur for long periods of time (i.e., symptoms don’t go away or diminish after a severe stressor has passed); or when the person avoids or feels the need to escape social situations because the anxiety is too excessive or severe to cope with.

Treatment

Social Anxiety Disorder is a very treatable mental health problem with interventions that are applied at a gradual pace to increase the client’s comfort and confidence with treatment. Many people struggling with the disorder often avoid treatment, fearing that their issues are far too severe to ever improve. This avoidance of treatment is likely, in itself, a feature of the disorder, as the person tends to avoid anything that will provoke or trigger their anxiety.

Treatment is often delivered from a Cognitive Behavioral perspective and involves exposure-based interventions, where the person gradually introduces feared situations into their daily life and attempts to remain in the feared situation for longer periods of time. This helps the person with Social Anxiety Disorder to realize that the situation itself does not produce anxiety, but instead the thoughts and beliefs that they have associated with the social situation are causing the anxiety and fear.

A therapist would work with the person to identify these negative, and often unrealistic, beliefs associated with social situations and replace these beliefs with more positive and reality-based alternative beliefs. The therapist also works with the client in creating a fear hierarchy where feared situations are listed in rank-order. The client then gradually confronts each situation/fear on the list from the least anxiety-provoking to the most anxiety-provoking. The client is also taught relaxation strategies, which helps significantly when they are exposed to a feared social situation.

If you struggle with anxiety in social situations, contact me to today to discuss how Cognitive Behavioral Therapy (CBT) can help you.

Author
Dr. Michael Messina

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