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Social Anxiety Disorder
Social phobia, otherwise known
fear of people, shyness, and social anxiety, is a persistent and
irrational fear of social events and situations.
It’s caused by a fear of the scrutiny and opinion of others (which
includes things like not being good enough or being rejected), and may
begin in adolescence, perhaps because of overprotective parents or
limited social opportunities.
Boys and girls, men and women, show social anxiety disorder in equal
It’s kinder, I think, to refer to it as social phobia. It’s not, after
all, a disease! But it can have some severe consequences. People with
social phobia are at high risk for alcohol or other drug
addiction because drink and drugs may help them to relax around people.
Does being around people make you nervous?
Symptoms of social phobia or social anxiety disorder
People with social phobia or social anxiety disorder are very anxious and
self-conscious in common social situations.
They have an intense, chronic fear of being seen or judged by others,
or doing or saying things that will embarrass them.
They tend to worry for days or weeks before a situation they fear, and the
fear may be so severe that it interferes with other things such as work,
school, and day to day activities.
Such extreme fear can mean it is difficult to make and keep friends.
Many people with social anxiety realize that their fears about being
around people are excessive and totally unreasonable, but they are unable
to overcome them.
Social anxiety disorder may occur in one situation (for example – talking
to people, eating or drinking, parties, writing on a blackboard in front
of other people, public speaking).
Or it may be so widespread – generalized social anxiety – that an
individual feels anxiety around almost everyone except family members.
Physical symptoms of social phobia include:
Difficulty talking or thinking clearly
Nausea and dizziness
Sweating and tension
In general, most psychologists would see social phobia as different to
mere shyness. Shy people can participate in social functions., but men and
women with social anxiety disorder cannot function normally in work and
social or personal relationships.
Some of the most common fears of people with social anxiety disorder are:
Going to parties and other social occasions
Eating, drinking, and writing in public
Meeting new people
Using public toilets
Treatment of social anxiety disorder
The goal of treatment is to help someone live normally. Anti-anxiety and
antidepressant medications may be helpful, to reduce the symptoms
associated with phobias, but behavioral treatments have long-lasting
benefits and are better (some medications have unpleasant side effects).
Cognitive behavioral therapy – also known as CBT – can help a
person understand and alter the thoughts causing social anxiety and teach
them how to recognize and replace thoughts which induce panic.
A process known as systematic desensitization (aka exposure therapy) can
sometimes be helpful.
This technique involves putting someone in a state of deep relaxation, and
then asking them to imagine the situations which cause anxiety, in order
from least fear-producing to most fear-producing.
This is linked to gentle and gradual exposure to the real-life
situation which causes fear. This approach can help men and women overcome
their fears of social situations very effectively.
An alternative is some practical social skills training – for
example, social contact in a group therapy to practice social skills.
playing and modeling help social phobics to be more comfortable with other
people in a social situation.
Some practical steps can reduce social anxiety disorder: taking
regular exercise, ensuring adequate sleep, and having regularly scheduled
healthy meals, as well as reducing caffeine intake, and other stimulants
such as alcohol is also helpful.
Consequences of Social Anxiety
One of the most pernicious things about anxiety is the way in which it can
ruin not only your social interactions, but your chance of getting
together with a special person in a loving relationship.
A loving relationship may not be possible with acute anxiety
Anxiety is a major cause of erectile dysfunction, premature ejaculation,
and anorgasmia in women. There is no way in which anxiety helps men and
women have a
good or satisfying sexual relationship.
The reason it causes such problems in men is that the nervous impulses
between brain and genitals, which must be sent in a particular fashion for
the correct sequence of events during sexual arousal to conclude with
orgasm, can either be inhibited by anxiety, resulting in erectile
dysfunction, or may be so accelerated that they result in premature
We recommend some therapy programs which you can purchase online to deal
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What Can You Do About Intense Anxiety?
Social anxiety disorder (also known as social phobia) is really all
about intense fear in social situations. This can cause considerable
distress and difficulty functioning in daily life.
It may mean only certain situations are feared or it can be a generalized
disorder: this anxiety disorder usually means a person has intense fear of
being judged by other people or of being embarrassed buy his or her own
actions. These fears often occur when there is some perceived or
real scrutiny from others.
The most common aspect of the disorder is fear of social interaction,
characterized by excessive blushing, sweating (hyperhidrosis), palpitations, stammering
or rapid speech, and panic attacks with associated intense fear.
Unsurprisingly, depression is a common additional problem. It is common
for men and women with social anxiety disorder to use alcohol or drugs to
reduce the symptoms. Eating disorders or other kinds of substance abuse
are also fairly common in cases of social anxiety disorder.
Someone with social anxiety may find psychotherapy, medication, or
cognitive behavior therapy, whether individually or in a group, to be
helpful in dealing with social phobia.
The cognitive and behavioral components of any therapy change thought
patterns and alter an individual’s physical reactions to anxiety-producing
Needless to say, such a so-called “disorder” has become a major source of
revenue for drugs companies: prescribed medications
include selective serotonin reuptake inhibitors (SSRIs) such as Zoloft and
Prozac; other drugs used for treatment include SNRIs and monoamine oxidase
inhibitors (MAOIs), as well as beta blockers, and newer antidepressants
such as mirtazapine.
Of course, shyness is not new. Descriptions of shyness can be found as far
back as 400 B.C., but the first mention of the term social phobia as
a psychiatric condition was made in the early 1900s.
The concept that social anxiety was different to other phobias originated
with Dr Isaac Marks in the 1960s, and the definition was revised in 1989
to recognize the common co-occurrence of avoidant personality disorder.
It was a “call to action” by doctor Michael Liebowitz
and psychologist Richard Heimberg that produced research into the disorder
of “social phobia” or “social anxiety”.
In the 1990s, paroxetine was the first prescription drug approved for
treatment in the USA, though others have since followed. The problem of
acute anxiety can be extremely challenging, not least because people who
struggle with it often do so alone.
Social anxiety disorder
Also known as
social phobia, is an anxiety disorder where the sufferer has
an extreme irrational fear of social situations.
The subject experiences nervousness, anxiety and embarrassment from the
fear of being closely watched and judged by the people around.
A person with social anxiety disorder is terrified of making mistakes so
experiencing embarrassment or humiliation in public.
As sufferers avoid the public view, they lack experience of interaction
with others and lack social skills which brings about further isolation.
In the worst cases, sufferers undergo anticipatory anxiety, a fear of a
situation before it happens, for days or weeks before the event.
Unfortunately, the person is often aware that the fear is unreasonable,
but is unable to overcome it.
If left untreated, this anxiety disorder can interfere with a person’s
normal daily routine, including school, work, social activities, and
People with anxiety may experience fear of a specific situation, such as
speaking in public, but most sufferers fear more than one social
Some situations that frequently provoke anxiety include are eating in
public, working in front of others, interacting with people including
dating or going to parties, or using public toilets.
The symptoms include mental confusion, pounding heart, sweating, shaking,
blushing, muscle tension, upset stomach and nausea.
Children with this disorder can express their anxiety by crying, trying to
hide, clinging to a parent or throwing a tantrum.
There are many causes: the main ones being biological, psychological and
environmental factors. It can have a biological cause, when it is
triggered by an imbalance of the neurotransmitter serotonin, a brain
If the chemical balance of the brain is upset, neurological messages
cannot get through the brain properly, and the result is a state of high
Alternatively, the disorder may be psychological, the result of an
embarrassing or shameful experience at a past social event. Or it could be
caused the person’s environment.
Fear can develop from observing the behavior of others, by seeing someone
who is ridiculed for a reason which is not apparent. Also children who are
overprotected by their parents may not learn proper social skills as part
of their normal development.
Treatments available for social anxiety.
The most common proffered by the medical profession is an array of drugs
designed to handle the symptoms.
Among the different types of medications used in treatment are
antidepressants, like Paxil, tranquilizers (benzodiazepines), such as
Xanax, Librium, Valium, and Ativan.
Beta-blockers, often used for heart conditions, may also be used to
minimize physical symptoms of anxiety, such as shaking and rapid
heartbeat. These drugs have, of course, a range of side effects.
A much better form of treatment is cognitive-behavior therapy (CBT) and
social skills training.
CBT is a form of psychotherapy designed to modify your thoughts
and behaviors in order to positively influence the emotions. Sufferers are
encouraged to imagine a specific social situation, and with the help of
the therapist adjust to situations that they would otherwise avoid.
Social skills training involves various role-playing exercises designed to
help people learn appropriate behaviors and decrease anxiety in social
It is always good to remember that this problem can be dealt with by
proper treatment and counselling. Anxiety is one of those problems that
can ruin lives but can cured by the proper course of action.
Researchers at Rhode Island Hospital have shown that obesity is a major
cause of social anxiety disorder – indeed, there are two reasons for this.
The first is that the severe obesity itself may cause anxiety, and the
second is that there is social anxiety associated with the consequences of
Interestingly enough the Diagnostic and Statistical Manual (DSM edition
4)suggested that social anxiety disorder was only to be diagnosed if
anxiety was not connected to any underlying medical condition.
But the working group proposed for the 5th edition of the Diagnostic and
Statistical Manual that the criteria for diagnosis of social anxiety
disorder could be modified so that people with conditions such as
stuttering, obesity, and Parkinson’s disease could also be diagnosed with
social anxiety disorder provided that their anxiety was excessive or not
related to the medical condition.
You see the thing is this: at the time of writing the DSM 4th edition,
information about anxiety among individuals with conditions like obesity
was lacking – and this study from Rhode Island Hospital was one of the
first to investigate anxiety levels amongst obese patients whose obesity
was so serious that they were seeking to have bariatric surgery (better
known as gastric band surgery).
Amongst these patients were 135 individuals who had social anxiety
disorder according to the Diagnostic and Statistical Manual 4th edition,
40 individuals who were diagnosed as having modified social anxiety
disorder associated with obesity, and another 600+ individuals who seemed
to have no history of emotional or psychiatric disorder.
The study revealed that both the obese patients and the individuals
diagnosed with social anxiety disorder in its own right had poor social
functioning when they were adolescents when compared to the 600 control
individuals, but there was no difference between the people with obesity
and the people with social anxiety disorder in its pure form in this
The effect of losing weight fast on social anxiety disorder is not
reported in this study. But investigations revealed that people with
obesity had experienced similar social functioning over a five-year period
before the study. Also, the group of individuals defined with what we
might call “pure” social anxiety disorder had far more time out of work in
the previous five years due to emotional disorders and psychopathology
than the other two groups did.
So it’s beginning to appear that the social disruption, the anxiety, and
the distress about social anxiety disorder that is experienced by people
with a formal diagnosis of social anxiety disorder according to the
Diagnostic and Statistical Manual 4th edition is indeed of a different
kind of anxiety to the anxiety reported by those people who are obese.
Yet it transpired out that the levels of disruption of social life and
distress about the social anxiety were far higher in the obese group than
they were in the formally diagnosed social anxiety disorder group.
Perhaps, for a person with obesity, the change in anxiety and social life
functioning is more distressing because it occurs later in life (i.e. as
their weight changes), than it is for the people who experience social
anxiety disorder in a generalized way for a very long period of their
The results aren’t completely clear, but it does seem to suggest that
social anxiety related to weight or obesity has significant consequences
compared to individuals who have social anxiety disorder according to the
definition in DSM-IV. Perhaps, therefore, such people could potentially
benefit hugely from treatment of some kind that could reduce their
It’s no use investigating obesity as an isolated condition; anxiety
related to weight gain can hinder the identification of social anxiety
disorder. As a result it seems sensible that such a proposal for DSM 5th
edition should indeed be implemented.