What is social anxiety disorder (SAD)

Let us make one thing very clear about social anxiety- it is not shyness. Newspaper reports have often made this mistake, suggesting that medicine is prescribed for shyness when in fact it is being prescribed for those experiencing severe social anxiety. And yes, the same newspapers that frequently report on positive mental health stories and the related social responsibility. Whilst it is easy to compare the two, shyness and SAD, in reality one is a general disinclination to be the centre of attention and the other is a dread fear of almost any situation in which other people are involved resulting in almost indescribable terror of social settings.

In social anxiety, other people are the zombies and vampires of horror movies, scary creatures to be avoided at all costs. There is no delusionality in social anxiety; sufferers don’t really see others as shambling, brain eaters or bloodsuckers but the fear is the same.

The condition of social anxiety will frequently cause difficulties in all aspects of a person’s life including their work or schooling, social lives and in turn, their closest relationships with their nearest and dearest.

One study conducted by Kessler and colleagues, the National Comorbidity Study in the USA identified that more than 13% of people may experience social anxiety to some level with very few of them seeking or receiving help unless they develop a second condition. Depression is roughly twice as likely to occur in sufferers of SAD than none sufferers. It is not uncommon to see considerable self esteem issues in those with SAD and as many as one in five will have an alcohol problem.

People experiencing social anxiety often feel self conscious and are very anxious about how they appear to other people. It is common for sufferers to worry about social settings or ‘opportunities’ for awareness of others to fall on them usually believing such attention will be negative in some way. Rumination on past events also occurs with analysis of these events serving to hopefully identify a reason for eliminating this need to reflect but in actuality only serving to reinforce further concern and continuing the cycle.

One particularly difficult aspect of social anxiety is that by trying to avoid attention one might actually draw more scrutiny. The person who enters a busy room and avoids introducing themselves might be noticed due to this omission and then really does receive a negative reaction or disapproval. The patron of a bar who shiftily hides around the periphery, avoiding any small groups who come close might actually appear unfriendly or even suspicious thus creating the ire they so desperately wanted to avoid. Any cues from those people are then used to enhance the social anxiety sufferer’s belief that known contacts and strangers judge them harshly.

Behaviours associated with social anxiety disorder

Like most anxiety disorders, social anxiety is maintained by numerous behaviours that are within the sphere of control of the sufferer. Those who have SAD tend to avoid the situations that they fear, experiencing a sense of relief from the anxiety when they are assured they don’t have to experience the real event. Imagine the upcoming party and the feelings of dread as the gathering draws nearer. Eventually the worry and concern becomes so great the decision is made to withdraw and the excuses are made. This feels good even if some guilt is felt.

When avoidance isn’t possible reassurance is often sought to excess. Asking those they trust if the party will be quiet or if they can leave early if things get too much. Loved ones and friends who are aware of the discomfort felt often are keen to offer this reassurance as they feel it is a great step forward beyond the avoidance and of course want to take any opportunity to make their friend or family member feel better.

Other safety behaviours often come into play too including finding quiet spots and hideaways, drinking to calm the nerves or using unhelpful medicines such as benzodiazepines.

All of these things serve to make life a little easier but enhance the anxiety in the long term and therapy is often built around the removal of these mechanisms.

Treatment of Social Anxiety Disorder

Much is known about how to successfully treat SAD these days and this will be covered in a future article entitled Treatment of the Anxiety Disorders – Dispelling the myths that lock anxiety in place.

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Further reading on social anxiety disorder:

Treatments That Work – Managing Social Anxiety by Hope, Heimberg and Turk  (Clinicians only).

Treatments That Work – Managing Social Anxiety Workbook by Hope, Heimberg and Turk  (for those diagnosed with social anxiety by a qualified therapist or psychologist and usually used alongside cognitive behavioural therapy)