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Social Anxiety

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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 proportions.

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:

  • Blushing

  • Difficulty talking or thinking clearly

  • Nausea and dizziness

  • Sweating and tension

  • Trembling

  • 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

  • Public speaking

  • 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.

Role 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 ejaculation.
We recommend some therapy programs which you can purchase online to deal with these issues.

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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 situations.

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 relationships.

People with anxiety may experience fear of a specific situation, such as speaking in public, but most sufferers fear more than one social situation.

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 chemical.

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 anxiety.

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 situations.

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 being obese.

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 respect.

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 lives.

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 anxiety.

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.