Social anxiety disorder (sometimes called 'social phobia') can be simply described as an excessive fear of social situations, which can lead to embarrassment. It may be a fear of talking to people in authority - perhaps your boss_ You might fear that you are being judged negatively by others, and worry that you might act in a way which is embarrassing or humiliating.
"My worst fear of all is that I might get embarrassed, and look stupid in front of everyone else..."
People with social anxiety disorder find that showing their fear reinforces their negative thoughts.
"I am anxious about being anxious..."
Doctors, such as ourselves, who are aware of social anxiety disorder are adamant that the condition should not be dismissed as shyness. We recognise that you suffer tremendous anxiety in social situations, especially if you have to make eye contact or talk directly to someone. We know people usually tell you that you are just shy.
"Everybody said I had extreme shyness, and they thought I would grow out of it..."
You may experience anxiety in almost all situations involving social contact, such as parties, at work, or whilst shopping. Or perhaps your anxiety is confined to one or two specific situations - the most common situations that individuals report feeling anxious in are whilst performing or speaking in public.
To help cope with your fears, you may avoid anxiety-causing situations, arranging your life around the symptoms. As a result, social anxiety disorder may significantly intrude on your quality of life, and hinder family, working and social relationships.
"At work I found it almost impossible to set up appointments to meet with potential clients. I would sometimes drive two hours for an appointment, and then turn around because of my anxiety..."
The following points will help you learn more about social anxiety disorder:
- Tell-tale symptoms of social anxiety disorder
- Who is affected by social anxiety disorder_
- Effects of social anxiety disorder on everyday life
- Possible causes of social anxiety disorder
- Effective treatments for social anxiety disorder... the road to recovery
- Common complications of social anxiety disorder
- What is being done to learn more about social anxiety disorder_
A comprehensive patient information booklet 'Help is at Hand' is also available from the Royal College of Psychiatrists, at www.rcpsych.ac.uk/public/help/welcome.htm
Tell-tale symptoms of social anxiety disorder
"I was out shopping and I had to write a cheque for something. I thought the cashier might be watching me write, and I started blushing, my face got really hot, and my hands started shaking..."
In social situations, such as going shopping, using the telephone, or when faced with meeting strangers, when you experience high levels of anxiety you may:
- blush - face going red and feeling hot, sometimes called 'flushing';
- sweat;
- experience a rapid heart beat or 'palpitations';
- tremble - it may just be shaky legs or hands;
- have a dry mouth;
- or your voice may quiver, you could stammer, or you could experience speech-block.
To make matters worse, outward symptoms such as blushing or a quivering voice can make you worry that others can see you are worried, and so you may become even more anxious.
"There was this meeting after work and I was talking to a group of about 15 people. Someone started asking me personal questions - it was scary for me because I have the feeling that I am different from other people. My heart started beating really quickly, I started breathing faster, my eyes watered and I turned red. I was really embarrassed and I just wanted to get out of there..."
Do you feel anxious in social situations, such as at a party or when out shopping_ Are you nervous at work and do you avoid talking to others_ If you have some of the symptoms described, go and talk to your doctor about social anxiety disorder.
You can get a feel for how severe your symptoms are by filling in an abbreviated version of the Social Phobia Inventory (SPIN) Mini SPIN here on social-anxiety.org. Or read about the personal experiences of Jim and Sue, two sufferers with social anxiety disorder.
Who is affected by social anxiety disorder_
Here are some key facts:
- social anxiety disorder affects approximately 10-15% of people in the community, at some time in their lives;
- the condition usually starts during early teenage years;
- anyone can get social anxiety disorder.
Social anxiety disorder can stop you doing your best at school.
"The teacher would say 'if you have any questions raise your hand' and I was so afraid somebody would look at me that when I had questions I just never asked them. I got so lost and confused I just gave up..."
In the world of work, having social anxiety disorder can affect the kind of job you choose - perhaps a job that gets you away from other people, avoiding contact with customers/other workers. Often, individuals with social anxiety disorder will work in a low paid, low skill job, even though they are capable of a more rewarding occupation.
"I would get jobs that I really enjoyed but, over a matter of a couple of days or maybe even a couple of weeks, I would feel so anxious about somebody watching me that I would quit. I've quit about 30 or 40 jobs because of it..."
You find it difficult meeting new people and might be less likely to be married or in a long-term relationship than unaffected individuals.
"I was married but am now separated from my wife. I'd like to meet someone else, but I just don't feel like I can..."
Possible causes of social anxiety disorder
There is no clear explanation of why some people suffer from social anxiety disorder. You might be more likely to get it if a close family member also has it. The family environment you grew up in may also affect the way you think about yourself and how you deal with social contact.
Effective treatments for social anxiety disorder... the road to recovery
Today there are a number of effective options for the treatment of social anxiety disorder. These can provide a remarkable improvement in symptoms. Getting treatment for social anxiety disorder can allow you to take part in, and enjoy, the kinds of social encounters that most people take for granted.
Choosing the best treatment is based on the opinion of your doctor and
your preference. Doctors are starting to use SSRIs more often for the
treatment of social anxiety disorder.
Drug therapy
- SSRIs (selective serotonin reuptake inhibitors)
Read how SSRI treatment helped Jim and Sue - two individuals with social anxiety - here on social-anxiety.org.
Other types of drug treatment which may be given include:
- MAOIs (monoamine oxidase inhibitors);
- benzodiazepines.
Psychological treatment, of which there are two well-known forms, cognitive behavioural therapy (CBT) and exposure therapy can be of use for social anxiety disorder. CBT can help change the way you think about yourself and others, focusing on your thoughts in social situations. Exposure therapy allows you to confront fears and teaches you how to relax in anxiety-causing situations. There is also some evidence that hypnotherapy and interpersonal psychotherapy can be of use for social anxiety disorder.
Counselling
You may benefit from speaking to a counsellor about your condition. Support groups exist for people with social anxiety disorder and their families/carers, a list of these is provided on social-anxiety.org at Where to find help.
Common complications of social anxiety disorder
If you have social anxiety disorder you will avoid certain forms of social contact. You may even find it difficult to approach your doctor to seek medical help. It doesn't help if people tell you that you don't have a problem, or that you're 'just shy'. But, if you leave social anxiety disorder untreated, other complications can arise. You may become depressed about the effect the condition is having on your life. People with social anxiety disorder are often prompted to seek treatment only when they start to feel depressed. This could be 10-15 years after the onset of your anxiety. Or you may begin to rely on things like alcohol to help you deal with social situations in which you feel uncomfortable. However, you might become dependent, and this will make your symptoms worse. And, of course, the underlying problem still remains.
"It wasn't long before I realised that if I had a little drink before I went out it made me feel more relaxed and more myself again..."
It is important that you recognise the symptoms of social anxiety disorder and seek treatment for them, as this can prevent the development of complications.
What is being done to learn more about social anxiety disorder_
Research is ongoing into the cause of, and treatment of social anxiety disorder. Sufferers, their families and doctors are now becoming increasingly aware of the condition, and the impact it has on a person's everyday life.
If you are worried that you or someone close to you might have social anxiety disorder, do not suffer in silence. Please visit your doctor for advice.