We all get jaded from time to time, longing for alone time and dreading big groups of people. And most of us get nervous before that big presentation at work or the first date with a stranger.
But if you're someone who experiences intense stress over presentations or speeches, is anxiety-ridden in social settings, has a phobia of interacting with new people, or feels judged by others — to the point where it impacts your day to day life — you may be suffering from social anxiety disorder.
But it's not as scary as it sounds, and it doesn't have to disrupt your life. There are great resources out there and ways to get help so that it doesn't continue to impact your life negatively, or cause you to avoid social settings. Read on to find out all about social anxiety disorder, if you have it, and how you can treat it.
What Is Social Anxiety Disorder?
"Social anxiety is basically a phobia of social situations, or a significant fear or heightened worry of a situation where someone might be scrutinized by someone else," explains psychiatrist Jessi Gold M.D., MS., an assistant professor in the department of psychiatry at Washington University in St. Louis.
Patients may say something along the lines of, "'Every time I go into a room I feel like people are watching me, judging me, thinking about me,'" Dr. Gold says. Oftentimes they'll add that they logically know that's not true, but they feel 'paranoid', she says.
James Shamlin, LCSW, a Pittsburgh-based psychotherapist agrees, adding that social anxiety disorder can most simply be defined as the "consistent and persistent fear of being criticized by others" — whether that's a peer, romantic interest, or authority figure.
The disorder can also cause "anticipatory anxiety" when someone thinks about an event that will happen in the future, Shamlin says. For those who suffer from social anxiety disorder, if you do follow through with said event, "you endure it with intense fear or anxiety, or ideally, you really actively try to avoid doing it at all," Dr. Gold adds.
Avoidance can then snowball into a cycle that will only make your anxiety worse, says Pittsburgh-based psychotherapist Terrie L. Means, LCSW. "It is like the scary, hairy monster under your bed that you are afraid of looking at, but I often ask, what happens if you do look?"
What Does Social Anxiety Disorder Look Like?
The majority of us experience anxiety or social anxiety, to a degree. Most of us get nervous about presentations or speeches, and we can all feel a little awkward in a large group of new people, for example. But that doesn't necessarily mean you're suffering from social anxiety.
So how do you distinguish between normal amounts of anxiety and a disorder? "Like all mental health disorders, [the social anxiety] has to cause distress that interferes with your day-to-day life or your functioning in some aspect of your life — socially, at work, or in your relationships," Dr. Gold explains. She adds that on top of the social anxiety being all-encompassing, it has to last for six or months to qualify as a true disorder.
Dr. Gold adds that typically, the level of anxiety you feel is "grossly out of proportion to the situation," and will typically happen every time someone encounters that situation. For example, symptoms can interfere with activities like ordering food, returning items at a store, or speaking on the phone, says Means.
She adds that it can even affect your "ability to eat or drink in front of others, write on a blackboard if you're a student, use a public restroom, or speak publicly." (Speaking publicly is actually the number one form of social anxiety, Means says.)
Another sign of the disorder, according to Shamlin, is being very focused internally on yourself, often overthinking situations and trying to figure out if you did or said something "stupid." Other telltale symptoms are physical and include "sweating, blushing, shaking, racing heart, nausea, difficulty with concentration, muscle tension, rapid speech or soft and low voice, and limited eye contact," according to Means.
If you experience these symptoms on a normal basis, you could be suffering from social anxiety disorder. But it's also important not to diagnose yourself — seek professional treatment and advice if this is the case.
What Causes Social Anxiety?
Like a lot of mental illnesses, this disorder is typically the result of several factors, but can mainly be attributed to the chemical makeup in your brain or genetics.
"There is actually brain scan evidence for its existence, and it runs in families so there is a genetic basis too," says Dr. Gold. But "nurture" can also work in tandem with "nature." For example, traumatic social situations that are embarrassing or where someone felt judged can also trigger the onset of social anxiety disorder, especially if it happened when they were younger, she explains.
According to the ADAA (Anxiety Disorders and Depression Association of America), the average onset of Social Anxiety Disorder is 13 years old, although it can start even younger, Means explains.
With the Covid-19 lockdown, Means says that patients with the disorder were initially relieved being able to avoid large gatherings and social settings. But re-entering social settings is proving to be a triggering thing for a lot of individuals who already suffer from social anxiety disorder. "People with social anxiety are also finding that their self-esteem or confidence has been negatively affected," Means says.
What Treatments Can Help Social Anxiety Disorder?
If you do believe you are suffering from social anxiety disorder, it's important to seek help, so you can find ways to cope with the disorder and prevent it from impacting your life.
Shamlin says the most common way to treat the disorder is through Cognitive behavioral therapy (CBT), which "helps individuals to look at their thoughts about their feared social situations and aids in changing thinking patterns."
While it can be intimidating, exposure therapy is also an effective form of treatment that can help patients disassociate the fears of a negative outcome with the specific action, James says. One example of this that Means gives her patients is making eye contact with a stranger, making a point to notice their eye color. "The purpose of exposure therapy is to help people in gradually learning that the negative feared outcome does not cause the negative result that they will often expect," says James.
Another very effective method of treatment is group therapy. Dr. Gold says, because it allows patients to be exposed to a group setting in a safe space. Oftentimes, patients are given a seemingly ridiculous task to perform, like buying things in all pennies — and tolerating the anxiety of it. "Then, when you go to do something simple like saying hi to someone you don't know, it feels so simple and boring," she says.
In some circumstances, it may be beneficial to treat your social anxiety with both therapy and medication, says Dr. Gold. "Medication can absolutely be helpful to better tolerate the physical sensations and interact in your day-to-day life," she adds. "It shouldn't be used instead of therapy, but in addition."
If you are struggling with social anxiety or any other mental illness, contact the SAMHSA National Helpline at 1-800-662-HELP (4357).