If you’ve ever felt awkward or uncomfortable in a social setting, you’re certainly not alone. It’s common to feel a little out of place when joining a new group or social scene.
But if that discomfort becomes a hindrance to branching out and connecting with new people or just completing the things you need to live life, then you might be dealing with social anxiety, a type of anxiety disorder that can cause problems for some people.
“Also known as social phobia, social anxiety disorder is a debilitating fear of being in a situation with unknown people,” says Dr. Neil Leibowitz, chief medical officer with Beacon Health Options, a national behavioral health services company headquartered in Boston that serves 1 out of 9 people across all 50 states.
Social anxiety is “an intense fear of being watched and judged by others and is so strong that it’s beyond the afflicted person’s control,” he explains. “It often causes people to avoid all social contact because doing ‘normal’ social things, such as small talk, makes them too uncomfortable.”
While feeling awkward when introducing yourself, starting up conversations and making eye contact with others “can feel uncomfortable at first, these responses are typical and will often dissipate as we develop a sense of comfort in that new situation,” says Awstin Gregg, senior vice president and behavioral health expert and therapist at Vertava Health, a national behavioral health care system for mental health and substance use conditions headquartered in Nashville, Tennessee.
But that’s not the case with someone who has social anxiety. For people with social anxiety, “this sense of heightened anxiety doesn’t dissipate quickly. Instead, the anxiety can increase, leaving the person feeling overwhelmed and seeking an escape route,” Gregg says.
Much more than just shyness, social anxiety is “one of the most common mental disorders,” Leibowitz says, and “it can interfere with going to work or school, developing relationships or doing everyday things.” It often occurs when a person is asked to:
— Speak in public.
— Talk to strangers.
— Meet a new date.
— Go to parties.
— Start conversations.
In some cases, the discomfort in social settings becomes so overwhelming “that the person begins to avoid opportunities where they may have to interact with others, such as going to school or work, placing an order at a restaurant or paying for items at a checkout counter. All of these can be a non-starter for a person with social anxiety disorder,” Gregg explains.
Social anxiety can become a type of phobia, where the individual experiencing it develops an intense fear associated with any and all social environments. “For example, people with social anxiety often fear being judged by others. Despite acknowledging that the fear is irrational, the person feels unable to overcome that fear and will seek to avoid situations as a result,” Gregg says. “This can ultimately lead to a disruption in that person’s daily functioning and overall wellness.”
Leibowitz notes that “the causes of social anxiety disorder likely involve both genetic and environmental factors.” There are several areas in the brain that involve fear and anxiety, and exactly why these might be overactive in some people and not others isn’t clear.
What is known is that it tends to be more common in females than in males, and it often starts during early adolescence. “It’s often seen in families, but it’s not known why some family members get it while others don’t,” he adds. Some research has suggested that “misreading other people’s behavior may play a role in exacerbating social anxiety disorder, along with undeveloped social skills.”
Beyond genetic factors, “other possible explanations include traumatic life events, such as abuse, violence, death or illness. Bullying, humiliation or rejection can also increase the risk of social anxiety disorder,” Leibowitz explains.
Signs and Symptoms of Social Anxiety
Signs and symptoms of social anxiety can include emotional, behavioral and physical elements, Gregg explains. These include but are not limited to:
— Fear that others are judging or scrutinizing you.
— Intense worry that you’ll say or do something that will embarrass you.
— Fear of initiating conversations or talking to strangers.
— Fear of saying something that will offend someone.
— Heightened anxiety related to an upcoming social situation or event.
— Avoiding situations where you may be the center of attention, such as public speaking.
— Overanalyzing your words and actions after a social interaction and scrutinizing the ways you believe you failed in that interaction.
— Avoidance of social situations that require interaction with others.
These worries and fears can lead to physical symptoms that may include:
— Rapid heartbeat.
— Muscle tension or a rigid body.
— Nausea or diarrhea.
— Shortness of breath or an inability to catch your breath.
— Dizziness and lightheadedness.
— An out-of-body sensation.
Leibowitz says these symptoms may start just before an event or can start in the weeks leading up to an event. And they can linger afterwards as you rehash or worry about everything you said and did in a social setting.
Treating Social Anxiety
The good news with social anxiety is that it’s treatable. Gregg says working with a mental health professional such as a counselor, clinical social worker, marriage and family therapist, psychologist or psychiatrist can help.
“Talk therapy can help identify symptoms and associated thoughts that lead to anxiety. Treatment can be conducted in a one-on-one environment and eventually include group therapy as well. A psychiatric consultation can also help identify if a medication can assist in alleviating symptoms of anxiety.”
Leibowitz says that psychotherapy, medication or both can help, and that “cognitive behavioral therapy is particularly useful in treating social anxiety disorder as it teaches different ways of thinking, behaving and reacting to situations that cause anxiety. It also helps people learn and practice social skills.”
Medications that may be used to treat social anxiety include:
— Anti-anxiety medications. These medications “start working right away to reduce the anxiety, but they can’t be taken indefinitely as people develop an intolerance and sometimes a dependence on them,” Leibowitz says.
— Antidepressants. Although these medications are primarily used to treat depression, they can help with some cases of social anxiety. The downside is that “they take longer to start working — up to several weeks — and can have some side effects, such as nausea or difficulty sleeping.”
— Beta-blockers. This class of medication is used to control blood pressure and other heart conditions primarily, but can also “address the physical symptoms of severe anxiety, such as rapid heartbeat or tremors,” Leibowitz says. As such, these medications “are often used to address the performance aspect of social anxiety, such as giving a speech.”
Living Better With Social Anxiety
Leibowitz notes that some degree of social anxiety is very common and is typically not a situation that needs advanced treatment. But if you do find that your social anxiety is interfering with daily tasks, it might be time to speak with a mental health professional to get a proper diagnosis.
“A good diagnosis is essential to successful treatment,” Leibowitz says. Along with that, he adds, it’s “important to rule out medical conditions such as a thyroid disorder or other psychiatric diagnosis” that can cause similar symptoms. “Evaluation by a psychiatrist is ideal, or by another professional who works closely with a psychiatrist in a team-based setting.”
Lastly, Gregg underscores that “social phobia doesn’t have to be a detriment to your wellness. On the contrary, it’s a very treatable condition with the help of mental health professionals dedicated to assisting you with therapy, medication and overall lifestyle improvements.”
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