Social Anxiety

BIBLIOGRAPHY

Social anxiety refers to the fear of being humiliated, embarrassed, negatively evaluated, or rejected in social situations. A common human experience, social anxiety exists on a continuum of severity from infrequent and mild feelings of discomfort in social situations to chronic and pervasive distress in many different social settings. An individual’s experience of social anxiety may be limited to one specific type of social situation, such as public speaking, or it may be so pervasive that anxiety and fear are experienced in nearly any situation in which other people are present. When an individual’s social anxiety is excessive and results in significant distress or impairment, the person may be diagnosed with social anxiety disorder (or social phobia).

Social anxiety disorder is the third most prevalent psychiatric condition in the United States, with a lifetime prevalence rate of approximately 13 percent in the general population. The majority of individuals with excessive social anxiety, or social anxiety disorder, also report co-morbid anxiety, mood, or substance abuse (e.g., alcohol) conditions. Although excessive social anxiety is a relatively common psychological condition, the exact cause of the phenomenon remains unclear. Several researchers have noted the possibility of a genetic predisposition for social anxiety that appears to contribute to familial patterns of the condition. Developmental researchers point to temperamental characteristics in shy, fearful, and behaviorally inhibited children and the increased likelihood that these children will develop excessive social anxiety later in life. Other researchers believe that a predisposition may interact with early learning to reinforce the perception that social interactions are threatening and that estimated costs of social failures outweigh the possible benefits (e.g., intimacy).

As a coping strategy, people with excessive social anxiety often attempt to alter or control negative feelings associated with social evaluative concerns and avoid or escape situations in which these feelings may occur. These efforts may lead to increased apprehension of future social events, increased use of alcohol and other maladaptive coping strategies (e.g., rumination), and social withdrawal and isolation. As a result, excessive social anxiety is related to functional impairment in a variety of domains including school, work, leisure, and physical health. Socially anxious individuals also report a number of interpersonal problems, including fewer friends, less perceived social support, an increased likelihood of being single, and less romantic relationship satisfaction. Thus excessive social anxiety may be what therapists call a “life-limiting” condition in that it interferes with interpersonal functioning and results in fewer positive emotional experiences and events.

Social anxiety may be treated effectively with a variety of psychological and pharmacological interventions. Evidence suggests that both individual and group cognitive-behavioral therapy may be effective in reducing symptoms and distress associated with social anxiety. Cognitive-behavioral therapies tend to target dysfunctional thoughts, beliefs, and behaviors and teach individuals different, more adaptive, ways to manage their behavior and respond effectively in social situations. In addition, several medications, including benzodiazepines and the class of antidepressants called SSRIs (selective serotonin reuptake inhibitors) appear to be effective and well-tolerated.

SEE ALSO Addiction; Anxiety; Neuroticism; Psychology; Psychotherapy; Stages of Development

BIBLIOGRAPHY

Heimberg, Richard G., Michael R. Liebowitz, Debra A. Hope, and Franklin R. Schneier, eds. 1995. Social Phobia: Diagnosis, Assessment, and Treatment. New York: Guilford.

Hofmann, Stefan G., and Patricia Marten DiBartolo, eds. 2001. From Social Anxiety to Social Phobia: Multiple Perspectives. Boston: Allyn and Bacon.

Rapee, R. M., and R. G. Heimberg. 1997. A Cognitive-Behavioral Model of Anxiety in Social Phobia. Behaviour Research and Therapy 35 (8): 741-756.

William E. Breen

Todd B. Kashdan

Social Anxiety Disorder

What Is Social Anxiety Disorder?

What Causes Social Anxiety Disorder?

What Are the Symptoms of Social Anxiety Disorder?

How Are Teenagers Affected?

How Is Social Anxiety Disorder Treated?

Resources

Social anxiety (ang-ZY-e-tee) disorder is an intense, long-lasting fear of social situations in which embarrassment might occur.

KEYWORDS

for searching the Internet and other reference sources

Anxiety

Selective mutism

Shyness

Social phobia

Kim was shy. She did not like to raise her hand in class, but when the English teacher asked her a question, she answered in a soft voice. Angie, on the other hand, was so afraid of being called on that she began skipping English class. Her problem went beyond ordinary shyness. She was suffering from social anxiety disorder.

What Is Social Anxiety Disorder?

Social anxiety disorder, also known as social phobia (FO-bee-a), is an in-tense, long-lasting fear of embarrassment in social situations. It is different from shyness or stage fright, however. Social anxiety disorder involves extreme anxiety, an unpleasant feeling of fear, worry, or nervousness. It may cause people to avoid social situations, or to feel intensely self-conscious or uncomfortable and may lead to problems at home, work, or school.

Some people with social anxiety disorder are afraid of one particular type of situation, such as giving a speech, talking in class, eating in a restaurant, or going to a party. Others, however, have a broad form of the disorder, in which they fear and avoid almost any interaction with other people. In its most extreme form, the disorder can greatly limit people’s lives. It makes it hard for them to go to school or work. It also makes it almost impossible for them to have any friends at all. Some children who have a particular and intense form of social phobia that causes them to be too anxious to speak in certain situations may have another type of disorder, known as selective mutism.

Speaking Up

The most common form of social anxiety disorder is fear of public speaking. Many people have a less extreme form of this fear. Toastmasters International is a group with more than 8,000 clubs and more than 170,000 members worldwide. The aim of this group is to help people become more comfortable with and skilled at speaking in public. Some of the group’s tips for successful public speaking include:

• Know the material that you will present. Practice your speech, and change it if necessary.
• Imagine yourself giving the speech successfully. Imagine your voice as loud, clear, and confident.
• Realize that people do not want you to fail. They want you to be interesting and fun to listen to.
• Do not apologize for nervousness or glitches. This just calls attention to any problems you have.
• Think about what you are saying, not how you are saying it. Focus on getting your message across.

What Causes Social Anxiety Disorder?

There are probably several causes for social anxiety disorder. People may learn their fear in part from watching how other people behave and what results from their behavior. Research also suggests that some people may inherit a tendency for anxiety. Research points to the possible role of the amygdala (a-MIG-da-la), a small structure inside the brain that is believed to be the seat of fear responses, whether learned or inherited. In addition, some studies have looked at the role of various hormones*, which have an effect on how the body responds to stress. Scientists are exploring the idea that certain hormones may influence some people to overreact to criticism shown by others.

* hormones

are chemicals that are produced by different glands in the body. A hormone is like the body’s ambassador. It is created in one place but is sent through the body to have specific effects on other parts of the body.

What Are the Symptoms of Social Anxiety Disorder?

Children with social anxiety disorder may cry, throw tantrums, freeze, shy away from others, or avoid or refuse to participate or perform in certain situations without really understanding what the problem is. Teenagers and adults, on the other hand, realize the source of their fears. While they know their fears can be extreme, unreasonable, or out of proportion they feel they cannot control them. Instead, they avoid the feared situation, or they face it with great distress. People with social anxiety disorder commonly fear situations including:

• giving a speech
• performing on stage
• eating in a restaurant
• using a public restroom
• talking in class
• talking to a teacher
• going on dates
• going to parties
• meeting someone new
• talking on the phone

About 4 percent of adults in the United States show symptoms of social anxiety disorder in any given year. The problem typically starts in childhood or the early teen years. It occurs twice as often in women as men, but a higher percentage of men who have social anxiety disorder seek treatment for it.

How Are Teenagers Affected?

Most teenagers feel self-conscious at times, but those who are gripped by social anxiety disorder may be so overcome by self-doubt and worry that they find it hard to join in social activities. Instead, they may withdraw to the point where they have trouble making and keeping friends or participating in class. Their constant fear of being judged harshly or criticized may lead them to fret too much about their health and appearance. Some teenagers may try to escape the anxiety by drinking alcohol or using drugs. Others may try to mask fear by acting like class clowns. Still others may stop going to school or taking part in after-school activities and may avoid opportunities to socialize with friends. As a result, their grades may fall, and their self-esteem may decline.

How Is Social Anxiety Disorder Treated?

Medications

Four out of five people with social anxiety disorder feel better when treated with medications, psychotherapy, or both. Several kinds of medications have been shown to help people with the disorder. Though they cannot cure social anxiety, certain medications, called selective serotonin* reuptake inhibitors, can decrease the intensity of anxiety, allowing people to learn and practice new ways to feel comfortable in social situations. These medications work to correct imbalances in neurotransmitters* (like serotonin), which play a part in mood conditions such as anxiety and depression. Other medications that are sometimes used include benzodiazepines (BEN-zo-dy-AZ-a-peenz), fast-acting agents that help people relax and decrease physical symptoms of anxiety like sweating, trembling, and a pounding heart.

* serotonin

(ser-a-TOE-nin) is a chemical in the brain that is associated with feelings of well-being.

* neurotransmitters

(NUR-otranz-mit-erz) are chemical messengers that let brain cells communicate with each other and therefore allow the brain to function properly.

Psychotherapy

In psychotherapy (sy-ko-THER-a-pee), people talk about their feelings with a mental health professional, who can help them change the thoughts, behaviors, or relationships that play a part in their problems. With social anxiety, certain approaches to therapy can be especially helpful. Exposure (ex-PO-zhur) therapy is the name of a technique in which people are gradually introduced, in a relaxed and supportive environment, to situations that frighten them, until they begin to feel more and more comfortable. Anxiety management training refers to various techniques, such as deep breathing, that people can be taught to use to help control their distress. Cognitive techniques help people learn to identify their beliefs that might not be reasonable (for example, “I will die if I have to give this talk”) and replace them with more realistic ideas about the likelihood of danger in social situations (for example, “It might be uncomfortable, but I know the material, and I will be okay.”).

See also

Anxiety and Anxiety Disorders

Phobias

School Avoidance

Selective Mutism

Self-Esteem

Therapy

Resources

Organizations

Anxiety Disorders Association of America, 11900 Parklawn Drive, Suite 100, Rockville, MD 20852. This group sponsors a public education program on social anxiety disorder. Telephone 301-231-9350 http://www.adaa.org

Anxiety Disorders Education Program, U.S. National Institute of Mental Health, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. This government program provides reliable information about social anxiety and other anxiety disorders. Telephone 888-8ANXIETY http://www.nimh.nih.gov/anxiety