Frequently asked questions
Here is a list of questions that are frequently asked by individuals with social anxiety disorder. If you are at all concerned about your symptoms, please consult your doctor.
COMING SOON! The Frequently Asked Questions section will soon contain video clips of professional experts in social anxiety disorder talking about the condition.
- Why haven't I heard about social anxiety disorder before now_
- How many other people are affected by social anxiety disorder_
- What causes social anxiety disorder_
- Am I imagining or exaggerating my problems_ My family tell me I am 'just shy'.
- What is the difference between social anxiety disorder and shyness_
- What is the difference between social anxiety disorder and panic disorder_
- What do you mean when you say social anxiety disorder can cause considerable 'burden' or 'disability'_
- I feel very down and depressed. Is this part of social anxiety disorder_
- Now that I think I have social anxiety disorder, what can I do about it_
- I think I may have social anxiety disorder, but I am afraid to go to my doctor. What if he says it's all in my head_
- What kinds of treatment are available for social anxiety disorder_
- What kind of improvement can I expect with treatment_
- How long would it take for me to feel better_
- I have been on medication for a while now, but I do not feel that it is making me any better. Should I stop taking it_
Social anxiety disorder was, and often still is, referred to as 'social phobia' but there is increasing support that 'social anxiety disorder' is the best descriptor because it describes the main symptoms of the disorder better. The 'phobic avoidance' behaviour - that is, when an individual avoids doing something that they feel anxious about, such as going to a party - usually results from the social anxiety. Until recently, awareness of social anxiety disorder has been poor, both amongst sufferers themselves and their doctors.
How many other people are affected by social anxiety disorder_
One of the most remarkable things about social anxiety disorder is how common it is. About 10-15% of people in the world suffer with this condition at a significant level - meaning it interferes with their life. Recent estimates suggest that 5-7% of individuals visiting their primary care doctor (that is, your general or family practitioner) have social anxiety disorder at a level where it interferes significantly with their life.
What causes social anxiety disorder_
At this time the exact cause of social anxiety disorder is unknown. Brain chemicals, particularly serotonin and dopamine, have been suggested to be involved in the underlying mechanism, and there is some evidence that there could be a genetic cause. Many individuals with social anxiety disorder can see that other members of their family share their anxiety in social situations, although they may hide it or cope with it in a different way. Parenting style may also have some effect. That is, the way some parents may discourage their children from certain social activities, whereas other parents would be more inclined to actively encourage their children to take part.
Am I imagining or exaggerating my problems_ My family tell me I am 'just shy'.
A lot of people are not aware that social anxiety disorder is a recognised medical condition. Most people have experienced shyness at some time, and so it is natural for friends and family members to misinterpret the anxiety and avoidance of social situations that a person with social anxiety suffers from as merely shyness. It is difficult for someone who has not suffered from social anxiety disorder to understand just how different it is from normal shyness. Experts hope that increasing awareness of social anxiety disorder through Internet sites, like this one, and magazine and newspaper articles will help sufferers and the people around them to understand the seriousness of the condition.
What is the difference between social anxiety disorder and shyness_
Social anxiety disorder is not merely shyness, or even extreme shyness. The situation is similar to the difference between sadness and depression; everyone feels sad at some time, but not everybody gets depressed. Shy individuals experience a relatively small amount of anxiety, even in the situations that bother them the most. The level of anxiety they experience is not enough to make them avoid the situation all the time. Individuals with social anxiety disorder, however, experience extreme anxiety in certain 'triggering' social situations, for example when they have to make eye contact with somebody else, or speak to someone (directly or on the telephone).
Basically, individuals have an intense fear of being scrutinised by others. They expect to be humiliated or embarrassed. It is sometimes described as feeling 'anxious about being anxious'. Being the centre of attention is probably the worst thing that could happen to someone with social anxiety disorder. Being looked at, being scrutinised - in a way, just a fear of embarrassment. The anxiety is so severe that these individuals will avoid situations that make them feel uncomfortable. As a result, there can be huge effects on their work, home and social lives. The social isolation brought about by their condition can lead to depression. In other cases, individuals can develop harmful coping mechanisms, such as excess alcohol consumption, to rid themselves of feelings of anxiety and to enable them to get through social situations.
Many people with social anxiety disorder do not consider themselves to be shy. They may enjoy being with people and really wish that they could participate in social occasions, but their overwhelming anxiety holds them back.
What is the difference between social anxiety disorder and panic disorder_
In panic disorder individuals are anxious about having a panic attack in a particular situation, such as crossing bridges and tunnels, or using aeroplanes, buses or subways - places where a panic attack would be frightening. In social anxiety disorder, the fear is always in a social setting, usually when someone has to make eye contact with somebody else or speak to someone else. Although some of the symptoms are similar, such as increased heart rate, trembling and sweating, there are certain feelings that are characteristic of social anxiety disorder. Most sufferers report that they blush, or 'flush' as they often call it, when they are socially anxious. Speech-block is also common.
The following are descriptions of the physical symptoms patients with social anxiety disorder experience during anxious moments:
"I start blushing and it moves up my whole head ... I start breathing faster and my hands start shaking and my voice wavers and my eyes water and I start getting very red ... my heart beats faster."
"Almost always it starts with a rapid heartbeat, and of course when you talk then you can't breathe, so your voice goes up and down and is erratic and it sounds like you've been running. Real red and hot in the face ... the whole thing starts with a general hotness of the body and pounding of the heart ... my legs shake and my arms shake."
Social anxiety disorder often begins early in life, most commonly during teenage years - at a crucial time when relationships are being formed with other people (for example with the opposite sex). Many individuals with social anxiety disorder drop out of school or college because it's too painful for them to speak up in class or respond to a teacher. The same thing can happen at work. An individual may take a job that will allow them to avoid a social situation that makes them anxious. As a result, they may underachieve, often not making the most of themselves and ending up in a job that is of a much lower standard than they would have been able to attain otherwise.
Individuals with social anxiety disorder also follow a pattern of frequently changing employment. Often they may only stay in a job for a few weeks before feeling anxious about somebody watching them, or having to speak to their boss or a customer, so they quit. And then there is the risk that in time, maybe 10-15 years after developing social anxiety disorder, an individual will become depressed about their situation, or will start to drink too much alcohol to try and overcome their anxiety in social situations. Social anxiety disorder can be tremendously destructive to someone's work, family and social life, until of course they get successful treatment and then they can begin to do the many things they've been afraid of before.
I feel very down and depressed. Is this part of social anxiety disorder_
Although depressed mood is not a symptom of social anxiety disorder itself, many people with social anxiety disorder may go on to develop depression at some point in their lives, due to their social isolation, problems with relationships, or difficulties at work.
Here's how one patient with social anxiety disorder described his depression:
"At my worst, I would shut myself in my bedroom for 3 months at a time. There was no point to my life, I didn't want to live anymore."
It is important to emphasise, however, that the depression, as well as the social anxiety disorder, is treatable. If you are at all worried about your symptoms, please consult your doctor for advice.
Now that I think I have social anxiety disorder, what can I do about it_
It is important that if concerns arise about social anxiety disorder a doctor is consulted. Effective treatment is available. Doctors are starting to use SSRIs more often than other medications. Psychotherapy and counselling have also been shown to help. If left untreated, symptoms may worsen and become severe. There is a risk that depression may develop. A family or general physician will be able to provide information about available treatment.
In the past, few doctors knew about social anxiety disorder. Indeed, social anxiety disorder has been called the 'neglected anxiety disorder'. In recent years, however, there has been a lot more research on the condition, resulting in many articles in medical journals and textbooks. It is likely, therefore, that most family doctors will know about social anxiety disorder and will take their patients' problems seriously.
Doctors will also be able to reassure patients who turn out not to have social anxiety disorder, and advise them on their worries. It is important that anyone who suspects they may have social anxiety disorder does not avoid seeking medical advice because of concerns about what the doctor will think of them. Doctors will not think that their patients are wasting their time. As with any illness, doctors know that it is better to seek help early than to wait until the condition gets worse.
What kinds of treatment are available for social anxiety disorder_
There are two kinds of treatment for social anxiety disorder. One is psychological therapy. Cognitive behavioural therapy, for example, encourages patients to face the situations they have avoided and helps them to improve the way they think about themselves in those situations. It is effective, but does require a lot of work. Another approach is to use medications. There are several drugs that are effective in treating social anxiety disorder, and doctors discuss with individual patients which treatment will suit them best. Doctors sometimes recommend a combination of psychological therapy and medication.
What kind of improvement can I expect with treatment_
The goal of treatment in social anxiety disorder is to reduce the anxiety that individuals feel in certain social situations and to stop them avoiding these situations. On beginning treatment a doctor will be looking for specific changes - maybe anxiety about talking to a boss or colleague is reduced and this is no longer avoided. A doctor will probably use a questionnaire to help him/her assess the change in how an individual receiving treatment feels. It could be that the individual will be asked to complete this questionnaire themselves, or the doctor may ask them a series of questions. The Liebowitz Social Anxiety Scale (LSAS) is one example of this type of questionnaire; the Social Phobia Inventory (SPIN) is another. An abbreviated version of the SPIN, the Mini SPIN, is accessible here on social-anxiety.org.
How long would it take for me to feel better_
More commonly, doctors are treating social anxiety disorder with an SSRI. The length of treatment really depends on the individual and their doctor. Some patients may experience a clinical benefit within the first four weeks of treatment, but an adequate trial of treatment is generally 6-8 weeks. A clinical improvement could be expected within this time, but treatment may need to be continued for several months to achieve a full clinical remission. It is recommended that treatment is continued for at least one year. For some individuals who still have significant symptoms after a year of treatment, or maybe those who are also severely depressed, treatment may need to be longer.
Certain medications may suit some patients but not others. Patients should not give up treatment if they do not feel they are getting better or if they suffer from side effects. It is vital that patients keep their doctors informed of progress and any side effects experienced. If the medication prescribed for an individual patient isn't right, the doctor may decide to change the medication or adjust the dose to one that suits the patient better.