A diagnosis of Social Anxiety Disorder is not made for the normal feelings of shyness, embarrassment, or performance fears that most people experience at one time or another. It is made when highly excessive shyness coupled with a fear of criticism in social situations becomes impairing. Children and adults can be diagnosed with this condition. Sometimes worries about eating and drinking in front of parents can be an early sign of social anxiety.
Individuals meeting criteria for Social Anxiety Disorder have an intense, persistent fear of embarrassing themselves in public, receiving negative feedback, or being judged negatively by others. Typically, they spend a lot of time feeling apprehensive about upcoming social events, and worrying about the impression they will make, whether people will think positively of them, or if they will do something embarrassing. The person may even feel nervous doing basic things in public, or about laughing and showing their emotions. They may also fear that others will notice signs of anxiety, such as blushing, shaky or sweaty hands, or sweating. Often, when the discomfort becomes too much to bear, they begin to avoid social situations.
While some individuals with Social Anxiety Disorder fear only one or two social situations (e.g., public speaking, dating), many individuals meet criteria for the Generalized subtype of Social Anxiety Disorder in that they fear and avoid a wide range of places, people or social situations. Social Anxiety Disorder can be a very frustrating condition, because while the affected person recognizes his or her fears are irrational, they still find them extremely daunting to challenge.
Higher rates of Social Anxiety Disorder are found in females than males; this gender difference is most often during adolescence and young adulthood. It is estimated that Social Anxiety Disorder affects approximately 7% in the U.S., but since so many people suffer in silence, the true statistics are likely to be much higher. Symptoms most often start during teenage years, with 75% of individuals with Social Anxiety reporting their first symptoms occurring between ages 8-15.
The onset of Social Anxiety Disorder may follow a stressful or humiliating experience, such as vomiting during a public event, or it may develop slowly over time. In adults, it may occur after life changes that require new social roles. Like any other psychological condition, Social Anxiety is considered to need intervention when it dominates one’s time and thought process (or that of parents in the case of a child), causes high levels of distress, and interferes with daily life functions, and trying to change it on one’s own isn’t working.
Social Anxiety Disorder can be effectively treated with Cognitive Behavioral Therapy (CBT). The CBT research base indicates that people with Social Anxiety Disorder often interpret situations differently than those without Social Anxiety. For instance, they may be especially sensitive to social cues, such as other people’s facial expressions, but they are more likely to misinterpret these social cues. They may also anticipate negative outcomes in social situations, even though they have no real evidence to justify this belief. Cognitive Behavioral Therapy for Social Anxiety teaches people how to identify and challenge, as well as “accept,” the anxiety-provoking thoughts that contribute to their social fears, and face feared situations and places via the use of behavioral exposures. Often CBT is combined with medication to achieve the best treatment outcomes, but this must be considered case-by-case.
The basic goal of treatment for Social Anxiety problems is for the individual to gain the freedom to engage in social activities of any kind and be able to enjoy them, not letting fear of embarrassment hold them back from achieving their goals.