Social Anxiety Disorder and What It Feels Like
By: Brian Murray, LMHC, NCC
Social Anxiety Disorder is a diagnosable mental health condition where the person suffering from it has a strong fear of other people and social interactions. Those with the disorder during social interactions, such as those at work, home and among friends, can be severe enough to cause job performance loss, avoidance of gatherings and isolation. Even doing simple everyday tasks such as going to the grocery store can create a strong anxiety or panic reaction.
The underlying fear of social anxiety is the perception of scrutiny by others. This same behavior is also seen in those with low self-esteem often remaining silent in social situations. Low self-esteem is a major contributor to social anxiety disorder. Internal psychological pressure occurs when they feel like they are being observed by others. They literally fear what others might possibly be thinking about them in a negative manner. This can happen when eating, speaking in front of others, at work, around family or any environment where they are being observed.
Symptoms of social anxiety include excess fear of situations in which one may be judged, worry about embarrassment or humiliation, or concern about offending someone. Physical symptoms beyond and co-existing disorders can include depression, panic disorder, shakiness, sweating and heart palpitations. These symptoms can vary anywhere from just a couple to all of them and have a range in severity. Typically, severity is measured on a Likert Scale such as one to ten with ten being most severe as indicated by client self-report.
Social anxiety is different from shyness and introversion which confuses some people thinking it’s the same thing. Characteristics of shyness is someone slow to engage socially and considered a personality type. Introversion is someone who may not fear social interactions at all, yet they can feel overwhelmed in social gatherings after some time. Social anxiety is different because it is fear based and creates a fight or flight response in the body. Social anxiety used to be called social phobia, or fear-based socialness. The flight response is the avoidance a person experiences as a result which occurs naturally when we feel threatened. All creatures will usually flee if given the chance and people are no different.
Some people with the disorder have a variation in social situations that involve performance. They feel physical symptoms of anxiety in situations such as giving a speech, playing sports, dancing, or playing a musical instrument on stage. However, the same underlying fear is present which is concern over how they are being observed by others.
There are many ways that social anxiety can be treated. Usually, psychotherapy is the primary method. Techniques for treatment such as systematic desensitization is very effective. This method slowly introduces the person to the feared situation where they learn how to manage their anxiety each step of the way. The feared exposure is eventually managed to an acceptable level that permits the person to engage socially.
Other methods that are highly useful involve some form of Cognitive Behavioral Therapy also known as CBT. This method follows a formula that thoughts lead to emotions (anxiety) which leads to behaviors. For example, if the thought is one where a person believes others are judging them in social gatherings, then feelings of anxiety are produced followed by the behavior which is avoidance. The idea is to introduce a new replacement thought that will change the feeling which ultimately changes the behavior. This technique takes practice and some time to learn how to be used effectively. A well-trained therapist in this method can be very effective in treating the disorder.
While social anxiety can feel debilitating, it is highly treatable and often without medication. At some point the person with the disorder may temporarily be prescribed anxiety medication, but usually only for extreme cases such as when panic attacks cannot be managed very well. Medication along with psychotherapy has shown to be effective however learning effective management techniques should reduce the need for medication over time.
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