Life is a constant cycle of experiencing fear, apprehension, avoidance, pain, and every other emotion a person can feel. Sometimes people feel anxious of something they said. They fear that they said something wrong and inappropriate. They worry about other people’s disapproval about something. Some are afraid of rejection, of not fitting in. Sometimes people feel anxious about joining a conversation because they think they have nothing interesting to say and people will find them boring. If these are the things someone constantly feels, then he or she may be undergoing the daily, chronic trouble of living with this mental disorder called social anxiety disorder which is also known as social phobia. But what is it really like to live with this disorder? How much does it affect a person’s way of living? Social anxiety disorder should not be simply shunned away and be treated as just another “phase”. Like other mental disorders, social anxiety is greatly unrecognized for it is commonly mistaken for extreme shyness. Through this research, it could help people know more about this disorder.
Social anxiety disorder is a paralyzing fear of social situations and of being judged or humiliated by others. This severe social phobia can leave one feeling ashamed and alone.It involves intense fear of certain social situations—especially situations that are unfamiliar or in which one would feel watched or evaluated by others. Underlying social anxiety disorder or social phobia is the fear of being scrutinized, judged, or embarrassed in public. A person may be afraid that people will think badly of them or that he or she won’t measure up in comparison to others. And even though one probably realizes that their fears of being judged are at least somewhat irrational and overblown, one still can’t help feeling anxious.
Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of environment and genes. Social anxiety disorder seems to run in families. It is unclear how much of the hereditary component is related to genetics or to anxious behavior learned from her environment, including other family members. There may be specific susceptibility genes that play a role in the development of anxiety disorders. Additionally, environmental and social experiences can shape the progression of social anxiety disorder. For example, people who have consistently been involved in situations that provoke anxiety or feelings of inferiority may cause a greater likeliness that social anxiety disorder can develop. Other possible contributing factors include low self-esteem, depression, rejection, and/or overprotection. Overall, it is likely that social anxiety is not the direct cause of one factor, but rather, the result of a combination of factors.
Natural chemicals in the body may also play a role in social anxiety disorder. For instance, an imbalance in the brain chemical serotonin could be a factor. Serotonin is a neurotransmitter that helps to regulate mood and emotions, among other things. A person with social anxiety disorder may be extra-sensitive to the effects of serotonin. It is also possible that a structure in the brain called the amygdala, which is involved in emotions of fear and aggression, may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.
Recent epidemiologic studies report that social phobia has a lifetime prevalence rate of 13.3% and a one-year prevalence rate of 7.9% in community samples, making it the third most prevalent psychiatric disorder, following substance abuse and depression. In community samples, circumscribed fears of public speaking or performing are most prevalent. In clinical samples, generalized fears of many social interactions predominate, perhaps because of the greater likelihood of disability, and consequent help-seeking, in generalized social phobia.
Onset of social phobia typically occurs between 11 and 19 years of age. Onset after age 25 is rare, although it is not uncommon for an existing social phobia to remain unprovoked for years until some new social or occupational demand forces these persons into social encounters that trigger the syndrome. Slightly more females than males have social phobia. In one study, about one half of the patients reported that their phobia began in response to a specific embarrassing experience; the others reported that it had been with them for as long as they could remember.
Approximately 85% of patients with the disorder experience academic and occupational difficulties caused by their inability to meet the social demands of securing and maintaining employment or relationships. In one epidemiologic sample, nearly one half of those with social phobia were unable to complete high school; 70% were in the lowest two quartiles of socioeconomic status; and approximately 22% were on welfare.
Situations that are often stressful for people with social anxiety disorder include meeting new people, being the center of attention, being watched while doing something, making small talk, public speaking, being teased or criticized, talking with “important” people or authority figures, being called on in class, making phone calls, using public bathrooms, taking exams, eating or drinking in public, speaking up in a meeting, and attending parties or other social gatherings.Emotional symptoms of social anxiety disorder comprise of excessive self-consciousness and anxiety in everyday social situations; intense worry for days, weeks, or even months before an upcoming social situation; extreme fear of being watched or judged by others, especially people you don’t know; fear that you’ll act in ways that that will embarrass or humiliate yourself; fear that others will notice that you’re nervous.
Behavioral symptoms of social anxiety disorder include avoiding social situations to a degree that limits your activities or disrupts your life; staying quiet or hiding in the background in order to escape notice and embarrassment; a need to always bring a buddy along with you wherever you go; drinking before social situations in order to soothe your nerves.Physical symptoms of social anxiety disorder include red face or blushing, shortness of breath, upset stomach, nausea, trembling or shaking, racing heart or tightness in chest, sweating or hot flashes, and feeling dizzy or faint.
Literary descriptions of shyness can be traced back to the days of Hippocrates around 400 B.C. Hippocrates described someone who "through bashfulness, suspicion, and timorousness, will not be seen abroad; loves darkness as life and cannot endure the light or to sit in lightsome places; his hat still in his eyes, he will neither see, nor be seen by his good will. He dare not come in company for fear he should be misused, disgraced, overshoot himself in gesture or speeches, or be sick; he thinks every man observes him."
The first mention of the psychiatric term social phobia (phobie des situations sociales), was made in the early 1900s. Psychologists used the term "social neurosis" to describe extremely shy patients in the 1930s. After extensive work by Joseph Wolpe on systematic desensitization, research on phobias and their treatment grew. The idea that social phobia was a separate entity from other phobias came from the British psychiatrist Isaac Marks, in the 1960s. This was accepted by the American Psychiatric Association and was first officially included in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The definition of the phobia was revised in 1989 to allow comorbidity with avoidant personality disorder, and introduced generalized social phobia. Social phobia had been largely ignored prior to 1985.
After a call to action by psychiatrist Michael Liebowitz and clinical psychologist Richard Heimberg, there was an increase in attention to and research on the disorder. The DSM-IV gave social phobia the alternative name social anxiety disorder. Research on the psychology and sociology of everyday social anxiety continued. Cognitive Behavioral models and therapies were developed for social anxiety disorder. In the 1990s, paroxetine became the first prescription drug in the U.S. approved to treat social anxiety disorder, with others following.
There are already several cases of social anxiety disorder being reported around the world. John is a 35 year-old seminarian who is in his first year of theology. Prior to entering the seminary he was a special education teacher in a Catholic high school. He enjoyed working with smaller groups of students even though he was always anxious about whether or not he was doing a good job. Since coming to the seminary, John spends most of his free time studying. When the other seminarians invite him to go out, he usually begs off saying that he has a paper due or is studying for a test. At times John seems to enjoy it when a small group of the seminarians convince him to go with them to a movie.
The other seminarians have noticed that John seems to be quite anxious most of the time and is usually very uptight when he has an upcoming class presentation. He either stays up late to prepare or if he does go to bed, he often has trouble sleeping. Although John manages to "get through" these times, he usually perspires profusely and at times his hands shake. When a few of the seminarians teased him about "the shakes," he became highly embarrassed and feared that they were judging him. Although John is a good student and has a real desire to be of service to others, the Rector is concerned about John's continual worrying about how well he is doing, about his avoidance of public presentations, and his increasing withdrawal from interaction with his classmates. When the Rector spoke with John about his anxiety, John said "I know I am more fearful than I need to be and I'm not sure why or what to do about it."
There has also been a case about someone wherein social anxiety has gravely affected his career. Many people know Ricky Williams as the Heisman Trophy-winning running back who had it all — fame, money, and talent. Selected as the fifth NFL draft pick out of college, he became a celebrity overnight. With a successful career underway, who would believe that this football sensation who played for crowds of 100,000 dreaded the thought of going to the grocery store or meeting a fan on the street?
"I was 23, a millionaire and had everything, yet I was never unhappy in my life," Williams said. "I felt extremely isolated from my friends and family because I couldn't explain to them what I was feeling. I had no idea what was wrong with me."
Williams' fears escalated at the start of his professional football career for the New Orleans Saints. With high expectations to perform, Williams was thrust into the limelight. Often portrayed by the media as aloof or even weird, he was known for conducting interviews with his helmet on and shying away from fans. He could barely interact with his young daughter or leave his house to do errands. What most didn't realize is that by simply talking to a reporter, a fan, a member of the community, or even his own family, Williams was struggling with the very root of his problem.
Williams later learned he was among the more than 15 million Americans who suffer from social anxiety disorder, also called social phobia. Fortunately for Williams, a good friend suggested that he see a therapist. "When I first met Williams, he could hardly look me in the eye," said Janey Barnes, the therapist who diagnosed him and started his treatment program. "Like most people with this condition, Williams thought he was just shy or strange, but it was clear to me that his anxiety was debilitating, which is very different than shyness. Luckily, social anxiety disorder is highly treatable."
After his first therapy session, Williams began his road to recovery. "After I was diagnosed with social anxiety disorder, I felt immense relief because it meant that there was a name for my suffering. I wasn't crazy or weird, like I thought for so many years," said Williams. "As part of my treatment program, my physician prescribed an antidepressant, in combination with therapy. Soon thereafter I was able to start acting like the real Ricky Williams."
Williams made dramatic improvements once he was diagnosed and started treatment. "I understand that a lot of people, especially men, look up to me because of my profession, so I have a chance to reach out to people and let them know what I've been through and how treatment has made my life so much better," he said. "If my story can help even one person to seek help, it will feel as though I've scored the game-winning touchdown."
Social phobia is generally treated with psychotherapy, medication, or both. First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that an unrelated physical problem isn’t causing the symptoms. The doctor may refer you to a mental health specialist.
A type of psychotherapy called cognitive behavioral therapy is especially useful for treating social phobia. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and fearful. It can also help people learn and practice social skills.
Doctors also may prescribe medication to help treat social phobia. The most commonly prescribed medications for social phobia are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.
Antidepressants are used to treat depression, but they are also helpful for social phobia. They are probably more commonly prescribed for social phobia than anti-anxiety medications. Antidepressants may take several weeks to start working. Some may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.
A type of antidepressant called monoamine oxidase inhibitors (MAOIs) is especially effective in treating social phobia. However, they are rarely used as a first line of treatment because when MAOIs are combined with certain foods or other medicines, dangerous side effects can occur.
It’s important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens, and young adults. A “black box”—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment.
Another type of medication called beta-blockers can help control some of the physical symptoms of social phobia such as excessive sweating, shaking, or a racing heart. They are most commonly prescribed when the symptoms of social phobia occur in specific situations, such as “stage fright.”
Some people do better with CBT, while others do better with medication. Still, others do best with a combination of the two. Talk with your doctor about the best treatment for you.
For people with social anxiety disorder, common and everyday social situations cause so much anxiety, fear and self-consciousness that isolation seems like a relief. Normal social situations can be exhausting for them too. They may go to great lengths and come up with many excuses to avoid public events or giving presentations. They may not even be able to eat with friends or make purchases at the grocery store, let alone go to a party and be surrounded by strangers. This can lead to feelings isolation and disconnectedness. Social anxiety disorder can also cause someone to fear that he or she will embarrass or humiliate him or herself. The intensity of these feelings for someone with this disorder differs markedly from the normal feelings of nervousness and awkwardness most feel in some social situations. An increasing withdrawal into social isolation will adversely affect relationships in every sphere of a person’s life, including family, school, and work. One’s silence due to this disorder makes other people think that he or she is rude, which consequently affects his relationship towards others. Several opportunities are also lost for those who suffer from this disorder because they are always hindered by their deafening thoughts. Their self-esteem is lowered as well because of how their anxiety affects their way of thinking towards themselves and the people around them. These are some of the reasons why people should not just simply take someone’s shyness as a part of his or her personality. There is so much more to a person than just their silence. Living with social anxiety is like being trapped inside a cage they created for themselves. It ruins their lives.
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