Social Anxiety

Social Anxiety

People with social anxiety disorder (or social phobia) are extremely anxious about what they will say or do in front of other people. This includes public speaking and day-to-day social situations.


But it is more than just being shy or nervous before public speaking. The fear can begin weeks or months before an event. It can cause a fast heartbeat and make it hard to focus.


Some people fear only one or a few types of social situations. For other people, many situations cause stress. This problem affects your daily life. You may be so stressed or afraid that you avoid public situations, including missing work and school.


Social anxiety disorder causes both emotional and physical symptoms:


  • It can make you nervous, sad, or easily upset before or during a social event. You may worry a lot or be afraid that something bad will happen.
  • The anxiety can cause you to blush, sweat, and feel shaky. Your heart may beat faster than normal, and you may have a hard time focusing.


When you have social anxiety disorder, common social situations-such as eating in public, writing in front of other people, using a public restroom, or speaking in front of others-can cause overwhelming fear and anxiety.


You may be more afraid of people noticing your anxiety than of the actual feared situation. A vicious cycle can emerge of avoiding orworrying about the social event (such as speaking in public) because you are afraid others will see you as weak, anxious, or foolish-this, in turn, leads to more anxiety. This may lead to avoiding or limiting contact with other people.


Symptoms of social anxiety disorder may differ in adults and children. Adults and teenagers with social anxiety disorder usually recognize their fears of being publicly humiliated are unreasonable or excessive. But children who have this disorder may not.


Expressions of anxiety in adults or adolescents include:


  • Having persistent but unreasonable fear of a situation that involves unfamiliar people or being judged by others. The fear is that you will be embarrassed or humiliated by something that you say or do.
  • Developing severe anxiety or panic attacks when in the feared situation.
  • Recognizing that your fears are excessive or unreasonable.
  • Avoiding social situations that you fear or enduring them with intense anxiety or distress.
  • Avoiding or anxiously anticipating feared situations so much it interferes with daily activities and relationships.
  • Worrying about being anxious.


Expressions of anxiety in children include:


  • Worrying about being embarrassed in front of their peers but not usually in front of adults or teenagers.
  • Expressing anxiety by frequently crying, throwing tantrums, "freezing" in social situations, or "shrinking back" from unfamiliar people.
  • Denying or not realizing the fears are excessive or unreasonable.
  • Fearing performance situations, such as having to speak in front of the class. This fear doesn't come and go. It is continuous and lasts for 6 months or longer.


People with social anxiety disorder often underachieve at work or at school to avoid the attention of a promotion or to avoid being forced to participate in a group. They tend to have few friendships and have trouble dating or developing relationships. In prolonged or severe cases, many people develop other psychological conditions (such as depression or substance abuse).


Social anxiety disorder is among several types of phobias that many people experience, such as agoraphobia or specific phobia (fearing an object, like a spider, or a frightening situation, such as being stuck in an elevator).


The exact cause of Social Anxiety Disorder is under investigation. Like many other emotional disturbances, Social Anxiety Disorder is a complex issue with many possible contributing factors. The following are several theories regarding the causes of Social Anxiety Disorder.


Genetic predisposition


Just as physical features such as hair and eye color are inherited, sensitivity to criticism or social scrutiny may be passed on from one generation to the next. It's possible that the child of one or two shy parents may inherit genetic code that amplifies shyness into social anxiety disorder.


Through his research at Harvard University, Jerome Kagan, Ph.D., found evidence of this genetic predisposition. He studied children from infancy through early adolescence. He found 10-15% of children to be irritable infants who become shy, fearful and behaviorally inhibited as toddlers, and then remain cautious, quiet and introverted in their early grade school years. In adolescence, they had a much higher than expected rate of social anxiety disorder.


Kagan also found a physiological accompaniment of anxious temperament in these children: a high resting heart rate. Their resting heart rates rose even higher in the presence of mild stresses. Additionally, when exposed to new situations, these children exhibited substantial behavioral restraint — becoming quiet, avoiding interaction and even retreating from the scene. Parents of these children have increased rates of social anxiety disorder and other anxiety disorders.




Social anxiety emerges at different developmental stages. Babies develop a fear of strangers at seven months, not before. Separation anxiety is quite clear in some children—perhaps more obvious in three-year-olds we take to daycare than in five-year-olds going off to kindergarten. Being alone is difficult for children ages six to eight, but actually becomes desirable as they approach puberty and adolescence.


Solitude becomes more important as anxiety about physical appearance and performance in school increases. We also know that traumatic or stressful life events occurring at an early developmental stage may increase the risk of social anxiety disorder.


Chemical Imbalances


Individuals with social anxiety disorder (and other emotional disorders) probably have abnormalities in the functioning of some parts of their anxiety response system. Most often, the symptoms of long-term social anxiety disorder can be attributed to an improper chemical balance in the brain.


There are several key neurotransmitters, namely Serotonin, Norepinephrine and Gamma-aminobutyric acid (GABA), which are produced in the brain and directly affect the way we feel about a given thought or situation.


Scientists believe that at least four brain areas are critical to our anxiety-response system:


  • brain stem (cardiovascular and respiratory functions).

  • limbic system (mood and anxiety).

  • prefrontal cortex (appraisals of risk and danger).

  • motor cortex (control of muscles).


These structures are richly supplied with these three important neurotransmitters: norepinephrine (NE), found in neurons arising primarily from a part of the brain stem called the locus ceruleus; serotonin (5-HT), found in neurons beginning in the raphe nuclei of the midbrain; and gamma aminobutyric acid (GABA), found in neurons that are widespread throughout the brain.


In terms of emotive response, this neurochemical process is vital to sustaining a sense of emotional well-being. Examples of brain regulation include control of thinking, control of physiologic functions, and control of behaviors.


For example, thoughts can range from safe to dangerous, serious to humorous, etc. Physiologic functions, such as regulation of blood flow, the nervous system and the muscular system, fluctuate from resting states to initial arousal, then to marked arousal/anxiety and finally to extreme anxiety or panic. Behaviors from deep sleep to moderate activity to extremes of fighting, fleeing or freezing are all played out endlessly in each of us.


Many factors can contribute to a chemical imbalance, but treatment is essential in order to experience complete relief from those symptoms.


Treatment for social anxiety disorder involves psychological counseling and sometimes medicines (such as antidepressants) to reduce associated anxiety and depression.


A combination of medicines and professional counseling may be effective for long-term treatment for people who have generalized anxiety and fear over many social situations. For those who fear only one or a few social situations (such as public speaking or eating in front of others), professional counseling to overcome the fear may be all that is needed.


Unfortunately, many people don't seek treatment for anxiety disorders. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.


If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them.


Initial and ongoing treatment


Initial treatment of social anxiety disorder is based on how bad your emotional and physical symptoms are and how able you are to function in daily activities. People who have social anxiety disorder often have depression also. They may also have alcohol or substance abuse problems. Your doctor may ask you certain questions to see whether you might be drinking too much or abusing drugs.


Social anxiety disorder often goes undetected for years before treatment is sought. By that time, you may have developed behaviors that accommodate the fears. These habits or behaviors must be overcome to successfully manage social anxiety disorder.


First, your doctor must determine whether you are generally anxious about all social encounters or whether a specific situation triggers anxiety.


Treatment with a combination of medicines and professional counseling is often effective for generalized social anxiety disorder (fear of most public interaction). Some people need treatment throughout their lives, while others may recover completely after a period of treatment with counseling and medicines.


It is possible to overcome the fears associated with social anxiety disorder. Working through fears with a specific type of therapy-cognitive-behavioral therapy that includes exposure therapy-may be the best approach for treating your anxiety. It is important to continue professional counseling even if you are taking medicines to reduce anxiety.


Types of counseling most often used to treat social anxiety disorder include:


Cognitive-behavioral therapy, which helps you identify anxieties and the situations that provoke the anxiety. At first you may feel uncomfortable while addressing the feared situations, but it is an important part of your recovery.


Several types of cognitive-behavioral therapy are used to treat social anxiety disorder, including:

  • Exposure therapy. You will be guided by a professional counselor to imagine you are facing the feared situation until you no longer fear it, such as eating in public. Next, you may go with your counselor to a public place and eat until, eventually, you can eat by yourself in public without fear.
  • Social skills training. This therapy helps you develop the skills you need in social situations through rehearsing and role-playing. Your anxiety is reduced as you become more comfortable with and prepared for the feared social situations.
  • Cognitive restructuring. This therapy helps you learn to identify and improve fearful thinking to help you better handle social situations. 
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