The Anxiety and Depression Association of America estimates that 16.1 million adults in the U.S. suffer from Major Depressive Disorder each year. That is roughly 6.7 percent of the population.
Depression is the leading cause of disability in the U.S. for those aged 15 to around 45 years of age. When your mental health is bad it can have a devastating impact on your quality of life and prevent you from completing even the most basic daily tasks.
But what can be done about it? How can you restore the balance in your life and improve your quality of life?
Social Anxiety Self-Test
What Is Social Anxiety Disorder?
Social anxiety disorder is characterized by an intense fear of being judged, negatively perceived, or rejected in a social setting. Individuals with this disorder may also fear appearing or acting visibly anxious or being perceived as stupid, awkward, or boring.1
People with social anxiety disorder may avoid social activities and often experience significant anxiety and distress when they cannot avoid social activities. They may also experience physical symptoms like rapid heartbeat, nausea, sweating, and panic attacks. These individuals often feel powerless over the anxiety they feel.1
Social anxiety disorder can create several challenges for those who have it. For example, they may decline job opportunities that involve interacting with new people or avoid going out with friends.1
Sometimes, the symptoms are so extreme that they significantly interfere with daily routines, performance at work, and social interactions. Those with social anxiety disorder are also at an increased risk for developing major depressive disorder and alcohol use disorders.1
Self-Medicating
- 15 million (7%) American adults suffer from social anxiety disorder 2
- Over 75% of those with social anxiety disorder experience their first symptoms during childhood or early teenage years2
- Less than 5% of individuals with social anxiety disorder seek treatment in the year following initial onset 1
- Over 75% of those with social anxiety disorder experience their first symptoms during childhood or early teenage years2
Triggers
- Meeting new or unfamiliar people4
- Talking to people at school or work4
- Having to speak in class 4
- Talking to a cashier in a store 4
- Using a public restroom 4
- Eating or drinking in front of others 4
- Performing in front of others 4
- Talking to strangers 3
- Public speaking 3
- Going on dates 3
- Making eye contact 3
- Starting conversations 3
Different individuals with social anxiety disorder will experience a different combination of triggers. One person may find making eye contact difficult but going on a date easy, while another may have the exact opposite experience.3
Symptoms
Emotional and Behavioral Symptoms
- Fear of situations in which others may cast negative judgments
- Fear of being embarrassed or humiliated
- Fear of appearing anxious
- Fear of interacting with or talking to strangers
- Fear of displaying physical symptoms, such as blushing, sweating, trembling, or having a shaky voice
- Avoidance of activities or speaking to people out of fear of embarrassment
- Fear of being the center of attention
- Anxiety associated with the anticipation of a feared activity or event
- Intense fear or anxiety in social situations
- Analysis of performance and identification of flaws in interactions after a social situation
- Expectation of severe consequences after a negative experience during a social situation
Physical Symptoms
- Blushing
- Fast heartbeat
- Trembling
- Sweating
- Upset stomach or nausea
- Trouble catching breath
- Dizziness or lightheadedness
- Feeling like the mind has gone blank
- Muscle tension
Causes
While researchers do not know the exact cause of social anxiety disorder, biological and environmental factors most likely play a role in its development. Some possible causes include: 5
- Inherited traits. Anxiety disorders usually run in families. Researchers are unclear how much of this is due to genetics and how much is due to learned behavior.
- Brain structure. The amygdala in the brain can play a role in controlling someone’s fear response. Individuals with an overactive amygdala might have increased fear responses, increasing anxiety in social situations.
- Environment. Social anxiety can develop as a learned behavior and may develop after an embarrassing social situation. There may also be an association between social anxiety disorder and having parents who model anxious behavior in social situations or who are controlling or overprotective.
Risk Factors
- Family history. Someone with biological parents or siblings with social anxiety disorder is more likely to develop it.
- Negative experiences. Children who experience teasing, bullying, ridicule, rejection, or humiliation may be more likely to develop social anxiety disorder. Other adverse life events, like family conflict, abuse, or trauma, can create a higher risk.
- Temperament. Children who are shy, timid, withdrawn, or restrained in new situations may have a higher risk of developing social anxiety disorder.
- New social or work demands. Meeting new people, giving a speech in public, or giving an important presentation at work may trigger symptoms of social anxiety disorder at any age, even though they are more likely to develop in teenage years.
- Having an appearance or condition that draws attention. Someone who has a facial disfigurement, stutter, or tremors may feel increased self-consciousness, which can trigger social anxiety disorder.
Impact
If social anxiety disorder is not treated, it can lead to various issues regarding work, school, relationships, or daily activities. These negative impacts can include: 5
- Low self-esteem
- Trouble asserting self
- Negative self-talk
- Hypersensitivity to criticism
- Poor social skills
- Isolation and challenging social relationships
- Low academic and employment achievement
- Substance abuse
- Suicide or suicide attempts
Other mental health disorders often occur alongside social anxiety disorder, particularly major depressive disorder and substance abuse problems. 5
Prevention
It is impossible to predict what will cause someone to develop an anxiety disorder like social anxiety disorder. Specific actions may reduce the impact of anxious symptoms. These steps include: 5
- Get help early. Anxiety is harder to treat the longer it goes untreated, like most mental health conditions.
- Keep a journal. Tracking life events can help identify what is causing the anxiety and what activities help it subside.
- Set priorities in life. Careful management of time and energy, including focusing some of it on enjoyable activities, can reduce anxiety symptoms.
- Avoid using unhealthy substances. The use of alcohol and drugs, including caffeine and nicotine, can create anxiety or make existing anxiety worse. Quitting any of these once addicted can also create feelings of anxiety.
- Having an appearance or condition that draws attention. Someone who has a facial disfigurement, stutter, or tremors may feel increased self-consciousness, which can trigger social anxiety disorder.
Treatment
Psychotherapy
Psychotherapy is also known as talk therapy and helps patients understand their experiences and form new coping mechanisms. Some popular types of psychotherapy include. 6
- Cognitive behavioral therapy (CBT)
- Interpersonal therapy
- Psychodynamic therapy
- Family therapy
CBT is considered the best treatment method and helps individuals identify their negative thought patterns and behaviors and alter them into positive ones. 7 This form of psychotherapy can also change behaviors and reactions associated with situations that trigger anxiety. 6
Exposure therapy is also helpful for people with social anxiety disorder. In this kind of therapy, the individual gradually works towards engaging in the situation they are afraid of with a therapist and in a safe environment. 6
Medications
Antidepressants
Different types of antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), help with the symptoms of social anxiety disorder. 6
Examples of SSRIs include paroxetine (Paxil, Paxil CR), sertraline (Zoloft), and fluoxetine (Prozac, Sarafem). Examples of SNRIs include venlafaxine (Effexor, Effexor XR), desvenlafaxine (Pristiq), and duloxetine (Cymbalta). 6
Beta-Blockers
Beta-blockers help stop the physical effects of social anxiety disorder, including sweating, tremors, and rapid heartbeat, by blocking adrenaline’s stimulating effects. Doctors usually prescribe these for specific situations but not for ongoing treatment. 6
Antianxiety Medications
Antianxiety medications are fast-acting and reduce the symptoms of anxiety. Doctors usually prescribe this kind of medication as a short-term solution because it can create dependence. 6
A common class of antianxiety medications is benzodiazepines. Examples of this type of drug include alprazolam (Xanax) and clonazepam (Klonopin). These drugs can lead to physical dependence, and withdrawal from them can be life-threatening. Combining them with alcohol, opioids, and other substances can cause death. 6
Tips for Overcoming Social Anxiety
Increase Attendance at Social Situations Gradually
People who have social anxiety disorder usually avoid social situations that trigger feelings of anxiety. This avoidance can make the anxiety worse over time, even though it reduces the anxiety in that moment.8
Gradually increasing exposure to feared social situations, sometimes with the help of a therapist, can allow for a potentially positive experience with the situation. This positive experience can reduce the anxiety associated with that situation and boost confidence in the individual’s ability to overcome fear. 8
Take Time to Relax
Engaging in certain activities can cause feel-good chemicals to release into the brain, relieving stress and anxiety. These activities can include listening to music, reading, playing a video game, or meditating. Doing one of these activities before going into a feared social situation can reduce some anxious feelings. 8
Reframe Thoughts
Holding onto the idea of being shy or socially anxious will reinforce the fears associated with interacting with others. One CBT-related technique involves reframing, which helps individuals recognize that they can change their perception of themselves. For example, “I am shy” can turn into “I acted shy at a previous gathering.” 8
Avoid Relying on Alcohol
Support
Educate Yourself
Communicate
Communication is another excellent way to offer support. This communication can look like having an honest conversation about your feelings with a trusted friend or family member if you struggle with social anxiety disorder. If you suspect a loved one is struggling with social anxiety disorder, it may be helpful to set them aside and express your concern while assuring your support for them. 9
Know When to Seek Help
If the effects of social anxiety disorder begin to cause problems in your life or the life of someone you love, such as avoidance of social situations at school, at work, with friends, or with family, it is time to seek help from a professional and get the necessary treatment. 9
Sources
- https://adaa.org/understanding-anxiety/social-anxiety-disorder
- https://www.mhanational.org/conditions/social-anxiety-disorder
- https://www.webmd.com/anxiety-panic/guide/mental-health-social-anxiety-disorder
- https://www.medicalnewstoday.com/articles/176891#summary
- https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
- https://www.medicalnewstoday.com/articles/176891#treatment
- https://www.nhs.uk/mental-health/conditions/social-anxiety/
- https://www.medicalnewstoday.com/articles/176891#tips-for-overcoming-it
- https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness