Social Anxiety Disorder

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The Journal of Clinical Psychiatry (1998:59, Supplement 17, 4:9) suggests two different major subtypes of Social Anxiety Disorder, generalised and specific. Generalised Social Anxiety Disorder is when the person fears a wide range of different social situations. Specific Social Anxiety Disorder is when the person fears only one specific social situation, such as public speaking, or only a couple of specific social situations.

Is shyness the same as social anxiety?

Is shyness the same as social anxiety?  Yes and No.  Shyness is a manageable emotion we experience when confronted with a social situation in which we feel unsure or uncomfortable.  Most people at some stage in their life have experienced being shy.  Children who are shy often grow out of this when they become teenagers or adults.  Even some adults can feel shy every now and then, but it doesn’t stop them from doing the activities that they enjoy.  On the other hand social anxiety is ‘extreme’ shyness.  It is almost always accompanied by physical symptoms of anxiety and almost always results in avoidance behaviour.  When shyness develops into social anxiety, interacting with people on all different levels can become very difficult, impacting on the person’s life in a severe and debilitating way.  

Social Anxiety Disorder is a recognised psychiatric condition, included in the Diagnostic and Statistic Manual of Psychiatric Disorders in 1980. Since this time, diagnostic criteria has been widely improved, allowing for correct diagnosis of Social Anxiety Disorder and more appropriate treatment options to be put in place.

The information contained in this site is designed for those whose “shyness” has reached a level consistent with “social anxiety”.  The term “social anxiety” will be used throughout this site, rather than “extreme shyness”.

Who develops social anxiety disorder?

Social Anxiety Disorder is equally common in men and women and is found across all cultures. The World Psychiatric Association estimates that 3 per cent of the population suffer from this condition at any one time. Other studies suggest the figure to be as high as 8 - 15%.

Characteristically, Social Anxiety Disorder develops in the mid-teenage years. The World Psychiatric Association suggests that approximately 40 percent of people with Social Anxiety Disorder will develop the condition prior to the age of ten, and approximately 95 per cent will develop the condition before the age of twenty.

If left untreated, Social Anxiety Disorder can add to the onset of other developmental problems, and other conditions such as depression, eating disorders, avoidant personality disorder, drug and alcohol abuse, and sometimes suicide.

Common situations feared...

The most common situations that are feared by people who have Social Anxiety Disorder include the following:

• Speaking in public
• Eating and drinking in public
• Writing in front of others
• Meeting new people
• Being the centre of attention
• Meeting or talking with people in positions of authority
• Meeting or talking to members of the opposite sex
• Being watched doing something
• Being teased
• Being criticised
• Using the telephone

Common symptoms experienced...

When the person who has Social Anxiety Disorder is confronted by the feared situation, or even just thinks about the feared situation, extreme symptoms of anxiety result. The symptoms of Social Anxiety Disorder include any, or all of the following:

• High levels of anxiety when exposed to the feared situation (palpitations, trembling, sweating, tense muscles, dry throat, blushing, dizziness, sinking feeling in the stomach)
• An overwhelming feeling of wanting to escape
• Feelings of self consciousness and inadequacy
• Avoidance of the feared situation, which can often lead to isolation from friends, family and society
• Reliance on drugs or alcohol to get the person through the feared situation

How do people develop social anxiety?

There are a number of theories as to the causes of Social Anxiety Disorder.

Research suggests that there is a genetic component in the development of Social Anxiety Disorder, as well as both familial and environmental factors.

The biological contribution to the development of Social Anxiety Disorder has been well researched. Various studies indicate an increased risk of developing Social Anxiety Disorder in persons whose relatives have the condition. (Fyer, Mannuzza, Chapman et al : 1993). Another study of female identical twins suggests a 30 per cent heredity for phobias (Kendler, Neale, Kessier :1992).

Behavioural theories include direct conditioning, observational learning and information transfer. These three perspectives suggest that Social Anxiety Disorder develops from exposure to a traumatic event, observing someone else in a traumatic situation, and receiving information about social situations verbally and non-verbally (Ost, Hugdahl: 1983: Ost: 1987).

Family environmental factors have been suggested to influence the onset of Social Anxiety Disorder. Decreased opportunities to engage children in social interactions, and avoidant or controlling parenting techniques have also been suggested in the development of the condition (Rubin, LeMare, Lollis: 1990: Barrett, Rapee, Dadds:1996)

There are several factors that researchers have identified that help to keep people socially anxious:

Ronald M. Rapee, in his book Overcoming Shyness and Social Phobia (1998), suggests the following factors as maintaining people's social anxiety; thinking style, focusing attention on the wrong things, and avoidance of feared situations.

Thinking Style
People who have Social Anxiety Disorder are very concerned with negative evaluation - the belief that other people will judge them in a negative way, or think badly of them. It is common knowledge that we cannot be liked by everyone, but for people with Social Anxiety Disorder, it is the end of the world if they are not liked by everyone. This type of thinking style is extreme, and unrealistic, and results in excessive feelings of worthlessness in the person with Social Anxiety Disorder.

Focusing attention on fear
People who have Social Anxiety Disorder tend to focus too much attention on negative stimulus. Often, people with this condition will focus the majority of their attention on other people's reaction to them, and their own physical symptoms of the anxiety they are experiencing. They will wonder what others are thinking of them, how they look to others, and how they are coming across, rather than focusing on the task at hand. More often than not, people who have Social Anxiety Disorder will focus primarily on negative stimulus, or what they perceive to be negative stimulus from their audience.

Avoidance
Most people who have Social Anxiety Disorder will avoid social situations that result in anxious feelings. Of course the outcome of this is that the more the individual tells herself that she cannot do task, or enter the social situation that she fears, the more she will convince herself that she can never do the task, and as a result, will tend to avoid the situation all together. This avoidant behaviour often leads to isolation from family, friends and society, loneliness and depression.

Can social anxiety be treated?

The World Psychiatric Association suggests that yes, Social Anxiety Disorder responds well to treatment. Medications, in conjunction with various psychological therapies have been seen to be the most successful in the treatment of Social Anxiety Disorder.

Medications found to be the most effective to treat the condition include RIMA's, MAOI's and SSRI's. 

Cognitive therapy, behaviour therapy and graded exposure therapy are seen to be the most effective psychological approaches to the treatment of Social Anxiety Disorder (Shear, Beidel 1998). These therapies encourage the sufferer's of Social Anxiety Disorder to think more rationally and confront the feared situations, with the overall benefit of decreasing levels of anxiety.

Other techniques useful in treatment of Social Anxiety Disorder include, self esteem therapy, relaxation techniques, correct breathing techniques, assertion and perception training, social skills training, meditation, and focusing skills.

The World Psychiatric Association suggests that as few as 25 per cent of people who have Social Anxiety Disorder currently receive treatment. Treatment options need to be introduced as soon as a diagnosis is made to alleviate the impairment to the sufferer's life, and to prevent the further development of other related conditions such as depression, avoidant personality disorder, eating disorders and drug and alcohol abuse.

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Disclaimer...

This site is not intended as a means of disseminating medical advice. If medical advice is required it is advisable to seek expert medical assistance. This site contains links to other sites, practitioners and therapists providing health related materials, treatment and therapies. However, the content and materials, treatment and therapies provided by these third party sites, practitioners and therapists, are not produced by nor are they the responsibility of the author of this site.