Social Anxiety

Imagine you are invited to a party. But before you have even opened the invitation, there is a lingering sense of fear; fear that there might be people you do not know at the party, fear that they might judge the way you interact with others, fear that you might say something wrong, or fear that everyone will start to dislike you by the end of night.

This is what is called Social Anxiety, or Social Phobia. It’s a condition in which a person is hyper alert of their surroundings and thinks that the people around them are watching their every step. It’s the intense fear of criticism, judgment, and embarrassment. Social Anxiety hinders a person’s day-to-day activities and makes them self-conscious.

Symptoms of Social Anxiety

According to Gaba Telepsychiatry, a person may suffer from social anxiety and decide to seek help if they are experiencing the following symptoms:

  • A persistent and excessive fear of one or more social or performance situations where the individual may be exposed to unfamiliar people or possible scrutiny by others. The person fears that they will behave in a way that is embarrassing or humiliating, or that they will exhibit symptoms of anxiety.
  • The feared situation almost always triggers anxiety, which may manifest as a situationally bound or situationally predisposed panic attack.
  • The person recognizes that their fear is unreasonable or excessive.
  • The feared situations are avoided or endured with intense anxiety and distress.
  • The avoidance, anxious anticipation, or distress related to the feared social or performance situations significantly interferes with the person’s normal routine, occupational (or academic) functioning, social activities, or relationships, or causes marked distress about having the phobia.

Some other symptoms of the condition are as follows:

  • Avoiding eye contact and not engaging in conversations
  • Fear of judgment, and as a result, fear of criticism
  • Physical symptoms like sweating, feeling ‘feverish’, heart pounding or trembling
  • All of a sudden feeling overwhelmed and having regular panic attacks
  • Always expecting the worst outcome of any situation

What are the Symptoms of Social Anxiety?

Some of the symptoms of Social Anxiety are stated below:

  • Rapid heartbeat
  • Intense fear of social situations
  • Sweating, trembling
  • Avoiding going to public places
  • Difficulty in speaking up

While these symptoms are found in other mental conditions as well, these are, however, very prominent in a person suffering from Social Anxiety. These symptoms could be categorized into four categories, which are the following:

  • Physical Symptoms
  • Behavioral Symptoms
  • Emotional Symptoms
  • Cognitive Symptoms

Physical Symptoms

People who have Social Anxiety, have often noticed that their bodies’ reactions are triggered by certain situations which they find stressful, tiring, or fear-inducing. These reactions could be counted under the physical symptoms of Social Anxiety. These could be:

  • Sweating profusely– Sweaty palms, underarms, or forehead are some physical symptoms of Social Anxiety.
  • Rapid heartbeat– People with Social Anxiety often feel like their heart is pounding so loud that it might ‘explode’.
  • Feeling ‘feverish’– Social Anxiety could lead people to feel like they are running a fever when in reality, that is not the case.
  • Trembling or Shaking– People with Social Anxiety often find themselves shaking their legs or not being able to sit still. Sometimes, they fiddle with whatever object is in their hands, for instance, a pen.
  • Feeling light-headed/ dizzy– Sometimes Social Anxiety comes along with a feeling of dizziness. A person with Social Anxiety might always think that they are about to faint. This might be due to increased adrenaline or hyperventilation.
  • Feeling short of breath– Taking short breaths, not being able to breath at a normal pace, or experiencing shallow breaths are some signs of Social Anxiety.
  • Experiencing muscle tension– People with Social Anxiety have a stiff posture, tend to experience tightness in muscles, jaw, shoulders, and neck. Sometimes, they also often find themselves cracking their knuckles from time- to- time.
  • Having an upset stomach– Having a feeling of discomfort in the pit of the stomach, feeling queasy, or feeling like there is a knot in the stomach are some of the physical symptoms of Social Anxiety.

Behavioral Symptoms

Behavioral Symptoms of Social Anxiety in a person, surface because of an underlying psychological or physiological condition. These are often observed in a person’s mannerisms, behavior, and overall emotional state. The following are some of them:

  • Avoidance– Social Anxiety causes people to avoid eye- contact, social situations, and overall, situations/ places they perceive as ‘stressful’ or ‘tiring’.
  • Over-preparation– People with Social Anxiety are highly alert to their surroundings and in order to not receive any criticism, prepare things beforehand. For instance, a person with Social Anxiety might always rehearse their order back-to-back whenever they are at a restaurant.
  • Seeking validation/ assurance– Since the fear of judgment and criticism comes along with the condition, people often seek validation and feedback from others to avoid any embarrassment/ criticism they might face in the future.
  • Safety behaviors– Just like over-preparation, people with Social Anxiety create safety behaviors to cope with their anxiety. This could be preparing for things ahead of time, constantly seeking assurance from others, or sometimes, even turning to substance- abuse.
  • Less social interaction– For fear of being judged and criticized, people with Social Anxiety tend to avoid social events like parties, get-togethers, or small gatherings. They may not engage in conversations, partake in group activities, and sideline themselves from any of the above situations.

Emotional Symptoms

Emotional Symptoms of Social Anxiety refer to a person’s inner emotions/ experiences (often distressing) that arise in any social situation or a situation they are uncomfortable in. Following are some emotional symptoms of Social Anxiety:

  • Embarrassment/ Humiliation– Individuals with Social Anxiety tend to avoid social situations for fear of being embarrassed, humiliated, or judged negatively. They are concerned about making mistakes and think people will judge them if they slip up.
  • Guilt/ Shame– Social Anxiety makes people feel guilty over things/ situations they have no control over. Individuals with Social Anxiety monitor their every single move and later, beat themselves up for a minor mistake/ inconvenience. They associate feelings of guilt and shame with their mistakes and think they have to appear ‘perfect’ in front of everyone or else they will be criticized.
  • Depression/ Feeling lonely– Since people with Social Anxiety isolate themselves, they feel alienated, which more often than not, leads them to depression. Since they do not converse with other people/ are unable to form connections, they have no one to talk to and hence, feel like they are alone and isolated.
  • Hypervigilance– Many individuals with Social Anxiety have a distorted perception of social interactions and so, they are hypervigilant of any social cues or their surroundings. They often scan signs of rejection or criticism.
  • Extreme self-criticism– Oftentimes, people with Social Anxiety talk down to themselves and beat themselves up for the smallest of problems. This, in turn, perpetuates a feeling of inadequacy, which could lead to a loss of self-confidence.

Cognitive Symptoms

Symptoms that hinder a person’s mental processes and force them to think the same thought patterns, which further leads to anxiety, are known as Cognitive Symptoms of Social Anxiety. Following are some cognitive symptoms:

  • Extreme fear/ worry– Individuals with Social Anxiety may constantly think of worst-case scenarios of any situation and ruminate about them throughout the day, which could hinder their thinking capacity, and as a result, they are unable to concentrate on the task at hand.
  • Negative self-talk– Negative self-talk arises from the fear of criticism and judgment and as a result, people lose confidence in themselves and question their every decision. This is a result of a sense of inadequacy that a person feels when they are faced with something they find intimidating.
  • Rumination– Individuals with Social Anxiety constantly replay the social situations they were a part of and try to analyze their performance. They try to think back to observe everyone’s reactions to the things they said at the event. This often leads to feelings of distress and intense anxiety.
  • Perceive things/ situations– People may try to read others’ minds (often in a negative manner) and come up with conclusions that may be far from the truth. They may try to gauge what other people are thinking about them, and end up perceiving things/ situations in a negative light.
  • Perfectionism– Some individuals with Social Anxiety may try to appear ‘perfect’ in front of everyone, which leads them to set high standards for themselves that are unrealistic. They have a fear of coming off as ’imperfect’ and hence, constantly try to perfect their every move. They therefore undermine their self-confidence.

Symptoms of Social Anxiety in Childhood

While the symptoms of Social Anxiety are the same in childhood, it would be beneficial if these were recognized in their early stages, so that timely intervention could facilitate easy access to support and mitigate some of the symptoms. However, some of these symptoms may differ from some seen in adults. Following are some symptoms of Social Anxiety observed in childhood:

  • Avoiding joining groups– Children often display signs of Social Anxiety by not joining class groups, not conversing with fellow students, or avoiding participating in group activities. This symptom persists in adulthood if left unrecognized.
  • Selective mutism– As the name suggests, selective mutism is a symptom of social anxiety that restricts a child from speaking to certain people or in certain places. The inhibition of speaking in a child plays a role in this symptom and hinders their speech development. For instance, a child may only talk to their family members and close group of friends, or speak only in their own house and not in someone else’s.
  • Avoiding class participation– Children who show early signs of Social Anxiety tend to avoid participating in class discussions, group discussions, or taking part in group/ class activities altogether. This symptom stems from the fear of public speaking, judgment, and criticism. They even try to avoid engaging in conversations with their teachers lest they be scolded for not actively participating in the classes.
  • Fear of Evaluation– Due to the fear of public speaking, criticism, and judgment from teachers and fellow peers, children with social anxiety fear evaluation; be it academic, non-academic, or even daily- life simple conversations. They fear that they will not be ‘good enough’ for anything and let down those around them.
  • Experiencing physical symptoms– It is often suggested to parents that they do not dismiss their children’s complaints of stomachache, headache, or nausea as mere excuses for not attending school. These could be early signs of Social Anxiety in a child. Just like in adulthood, these physical symptoms are seen and could be identified in early childhood.
  • Difficulty in making friends– The fear of rejection and criticism comes into play when children suffering from Social Anxiety, try to make new friends. They fear approaching other children of their age, maintaining friendships, and participating in group play/ activities.

What Causes Social Anxiety

According to a study conducted by WHO, as of 2019, 301 million people in the world live with an anxiety disorder, including 58 million children and adolescents. Since, there are many factors that could contribute to the onset of Social Anxiety in a person, the exact cause of the condition is unknown. Following are some causes of Social Anxiety:

  • Family history– It is believed that Social Anxiety disorder is hereditary, but whether it is related to genetics or a traumatic/ chaotic family past is unknown. It could also stem from a child learning the behavior themselves.
  • Past experiences– Social Anxiety could be developed if a person has been bullied, harassed, or faced extreme embarrassment or humiliation in the past.
  • Childhood behavior– Children who are extremely shy, rarely converse with those around them, or hardly make friends, are prone to develop Social Anxiety Disorder.
  • Brain structure– It has been observed that people with a hyperactive amygdala are at a risk of developing Social Anxiety Disorder as the amygdala is responsible for controlling the fight-or-flight response and therefore, heightens the fear response. This causes the person to be highly anxious.
  • Personality traits– While many people with personality traits like avoidance behavior, introversion, or extreme shyness may not have Social Anxiety, it has been observed that people with Social Anxiety do show these personality traits.

Risk Factors of Social Anxiety Disorder

Risk factors are conditions/ factors that increase the likelihood of developing Social Anxiety. Following are some risk factors of the condition:

  • Depression– A person suffering from depression may unknowingly, also suffer from Social Anxiety. Since depression restricts a person from socializing, conversing with others, or going out, the person may develop avoidance habits and start to isolate themselves, which are some signs of Social Anxiety.
  • Genetics– Genetics or family history could also be a risk factor for Social Anxiety. A traumatic family history or a parent/ family member with the same condition could lead a person to develop Social Anxiety.
  • New connections– While it may sound unusual, meeting new people or talking to a stranger could trigger Social Anxiety in a person, and they could develop the condition without ever experiencing it before.
  • Substance abuse– Substance could lead to Social Anxiety as it increases dependency, social isolation, and avoidance behaviors. Steering away from substance abuse could curb the condition.

Difference Between Shyness and Social Anxiety

People often confuse shyness with Social Anxiety; however, there is a huge difference between the two.

Shyness:

  • Shyness is a characteristic/ personality trait that goes away with time.
  • Most of the time, this personality trait is not a hindrance in a person’s day-to-day life.
  • It is a mere feeling of discomfort that could go away once a person starts socializing.
  • It usually persists if a person feels they are the center of attention; however, this feeling subsides with time.

Social Anxiety:

  • Social Anxiety is a disorder/ condition that does not go away with time; it requires timely intervention.
  • Most of the time, it restricts a person from performing to the best of their ability.
  • It is a persistent fear of socialization, criticism, judgment, and humiliation that a person cannot get over easily.
  • It gives rise to avoidance behavior, where people try to avoid social situations that put them in distress.

How Social Anxiety Affects Daily Life

It is not easy to live with Social Anxiety, to say the least. Living in constant fear of rejection, humiliation, embarrassment, and criticism, it is tiring for people with the condition to live their lives without worrying about these things. A 30-year-old African American shared about her struggle with Social Anxiety on the internet.

She starts her story by telling us how she started developing Social Anxiety when she was 11 years old because she was a victim of bullying in her junior year of school. She was constantly bullied by her peers which led her to avoid social interactions and isolate herself from everyone.

Fortunately, she sought help in time and joined a Cognitive Behavioral Therapy (CBT) group. She goes on to tell us how an exercise called Cognitive restructuring worksheets (CRW) benefitted her greatly in her journey of combating Social Anxiety. She explained how it worked for her; she wrote down whatever negative thoughts, behaviors, or situations she thought of, or that generated discomfort and then, focused on turning those ‘negatives’ into ‘positives’; she thought of positive ways that could counteract those negative thoughts and looked for positivity in every aspect of her life.

She went on to receive her Bachelor of Science degree and is currently pursuing her childhood dream of becoming a fashion model.

While there are many struggles that come along with Social Anxiety, it is always good to remember one thing; where there is a will, there is a way. Coming up with ways to curb the symptoms of the condition, or seeking professional help is always advisable as every person deserves to live a life free of worries and concerns.

Treatment for Social Anxiety Disorder

While it is important to timely intervene and get Social Anxiety diagnosed on time, it is equally important to consult a professional and seek treatment options. Following are some treatment for Social Anxiety:

  • Cognitive-Behavioral Therapy (CBT)– CBT helps a patient work with their doctor in changing a problem/ negative situation. They start by identifying the problem, then use some relaxation techniques, and learn coping skills and strategies to handle the situation at hand, thereby reducing the patient’s anxieties and fears.
  • Support groups– Support groups include people with similar experiences and problems. A person with Social Anxiety could find solace in a support group as the people share their experiences with one another and provide support and sympathy to each member of the group.
  • Lifestyle changes– A sedentary lifestyle could often lead to various mental as well as physical illnesses, including Social Anxiety. Exercising regularly, maintaining sleep hygiene, limiting caffeine intake, and following a healthy diet are some ways to curb the symptoms of Social Anxiety.
  • Exposure therapy– Exposure therapy involves exposing a person with Social Anxiety to situations they fear. The end goal of this therapy is to expose the person to situations they fear time- and- time again and desensitize them to these distressing situations to reduce their anxiety-fueled responses.
  • Medication– Medication could help control the emotional as well as physical symptoms of the condition. Beta-blockers are prescribed to help with the physical symptoms. Some of the medications professionals prescribe are:

          SSRIs (selective serotonin reuptake inhibitors)

          -SNRIs (serotonin-norepinephrine reuptake inhibitors)

          -Benzodiazepines

          -Propranolol or Metoprolol (for physical symptoms)

Social Anxiety and Career

Studies show that people with Social Anxiety tend to take different career paths from people who do not have it. This showcases the negative effects of the condition and further proves that Social Anxiety hinders a person’s career choices.

Will shared his experience on the Internet about his struggles with Social Anxiety. Will is an engineer who wants to take up various projects and become a manager. However, his Social Anxiety comes in the way of his work and he is unable to give any project ideas, updates about ongoing projects, and build connections in the industry. He thinks that his colleagues will find him incompetent and doubt his work decisions.

Another individual Ali, shared about his experience with the condition as an Accountant. He states how he eats lunch alone because he does not want to engage in small talk, agrees with everyone’s opinions because he wants to avoid any conflicts, and is often burdened with multiple tasks because he cannot say ‘no’ and set boundaries. Due to this, Ali often feels extremely overwhelmed and burned out.

This goes to show how Social Anxiety if left untreated, does not let a person succeed in their chosen career path and could be a huge hindrance in their life.

Social Anxiety and Friendships

People with Social Anxiety find it difficult to maintain friendships. Scared of being judged, they isolate themselves and do not engage in conversations with anyone. This leads to loneliness, and avoidant tendencies, which could affect the friendships in their lives.

Linda shared her experience about how she had no friends growing up. People tell her that she is the ‘life of the party’ when in reality, all she thinks about is going home and not talking to anyone. She is sixty- two now and tells the readers about her teenage years. She does not have anyone in her life whom she could call, ask out on a coffee date, go on a shopping spree with, or most importantly, call a ‘true friend’.

Sophia shared her story as well. She told the readers how due to her Social Anxiety, she often cancels plans last minute, which puts a strain on her friendships with others as they often get frustrated with her last-minute decisions. Most of the time, she finds herself sitting alone at parties and gatherings, observing others. As a result, she feels lonely and blames herself for not initiating conversations and reaching out to people.

Social Anxiety could ruin friendships and relationships in a person’s life and make them vulnerable to criticism and judgment, further pushing them into a spiral of negative thoughts about themselves.

Social Anxiety sounds like a terrifying condition but could be treated easily with utmost care and sensitivity. It is important to remind yourself that there is help available and that you are not alone.

To learn more about our services and seek help, visit www.gabapsychiatrist.com.

References

Virtual Psychiatrist
Fact Checked by
- Dr. Gundu Reddy
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