Social Anxiety Disorder: An Overview

Social Anxiety Disorder, often referred to as SAD, is a disorder in which when the person is placed in a social setting or public event, they experience extreme fear and feelings of apprehension or worry (Wikipedia, 2006). More specifically, those who suffer from SAD have a fear of embarrassment that if extreme enough can have debilitating effects on the persons relationships, both personal and professional (medicine.net, 2006). According to Zamorski and Ward (2000), approximately 13% of the population experience SAD and about one third of them suffer some sort of dysfunction because of it. Twice as many women have Social Anxiety Disorder than men do but men are more likely to seek out help. This is due to the fact that it is more socially acceptable for women to seem shy, when men are that timid and anxious about social settings, it is more deviant from the norm and therefore it is believed that they need treatment (Wikipedia, 2006).

There are two subcategories of SAD, generalized social anxiety and specific social anxiety. Generalized social anxiety should not be confused with Generalized Anxiety Disorder, the main difference being that with generalized social anxiety, the person has difficulty with most or all social settings in fear of being judged, while GAD focuses on anxiety in any and all arenas of ones life (Wikipedia, 2006). When a person suffers from specific social anxiety, they have an intense fear of a specific social setting or event, for example, the most common is public speaking (Feldman & Rivas-Vazquez, 2003).

Although this disorder has been around for many years, it wasn't necessarily classified as Social Anxiety Disorder. The symptoms had been recorded since the time of Hippocrates but it didn't receive it's name until 1960 (Schrof, Shultz, Koerner & Svetcov, 1999). It became a psychological disorder in 1980 and when it's symptoms first appeared in the DSM-III it was originally known as social phobia (Feldman & Rivas-Vazquez, 2003).

Unlike some other conditions, those suffering from Social Anxiety Disorder can't always pinpoint one specific cause for their problem. Those who believe in the biological approach feel that SAD can be caused by an imbalance of the brain chemical serotonin. Others take a more psychological approach and see it as a learned behavior, a previous negative social experience may trigger someone to fear all social settings (Wikipedia, 2006). For example, if someone has a bad experience, such as giving a speech in front of a large group of people, forgets what they were going to say and stumbles over their words, resulting in laughter from the audience, they may develop SAD and generalize their fear to all social settings in which they may get embarrassed. There is also a cognitive model of the causation of SAD, with the basis being a self evaluation of a social performance including thoughts and self statements (Snyder, Smith, Augelli & Ingram, 1985). If one constantly focuses on the negative points of their social interaction they can convince themselves that other people felt the same way and it can become an embarrassing event that they don't want to relive.

Looking at SAD from another point of view, the cause could be the fast changing, technologically advanced society in which we live. The internet is allowing shy people to have less and less face contact with the outside world and in certain occasions, this is taking shyness to social anxiety (Schrof et al, 1999). For the most part the internet has brought a lot of great opportunities for people but nothing is ever perfect, and in this case can cause more damage to someone who is already suffering from a social disorder.

Although anyone can develop Social Anxiety Disorder, adolescents and those in early adulthood are most likely to develop it. It is rare that someone over the age of 25 will develop SAD but that doesn't mean that a past anxiety can't arise later in life (Juan, 2005). An event that happens to someone in their later adult years is not very likely to bring about SAD, a younger person is more susceptible to developing this social disorder. According to the DSM-IV-TR (2000), a person with SAD must have knowledge that their fear is unreasonable and the symptoms must persist for at least 6 months.

There are several symptoms, both somatogenic, bodily, and cognitive, of the mind, which tend to be common amongst the sufferers of Social Anxiety Disorder. Some of these symptoms include a racing heart rate, trembling, increased muscle tension, perspiration, dry mouth, lack of words, cluttered thoughts, and an urge to escape the present situation (Schrof et al, 1999). According to Wikipedia (2006), other symptoms may include blushing, nausea, and in some cases weeping. The major problem with these symptoms is that they create a vicious cycle, when the sufferer realizes that they, for example are blushing, sweating, and are at a lack of words, they think that everyone is staring at them and judging them for all the negative aspects of their performance, which then in turns makes their reaction worse and just increases their levels of anxiety.

These anxiety reaction symptoms arise in many different situations, as reported by Juan (2006) some of those circumstances may include: being teased or criticized by either someone you already know or a stranger, being the center of attention in a group of people, being put in a situation to meet new people, interacting with an authority figure, interacting with someone of the opposite sex, or most commonly, any kind of public performance, mainly eating, writing or speaking in public. Although these are some of the most common situations in which someone with SAD may have an anxiety attack, each person is different. Someone who had a horrible experience as a child, in a park for example, may do everything in their realm of possibilities to avoid a park in fear of evoke an anxiety attack.

People who suffer from SAD have been known to use a self-handicapping strategy in order to provide an excuse for possible failure (Snyder et al, 1985). Someone may precede their performance with a statement on how they aren't prepared or something of that nature so if they mess up, it was already expected but if they do well, it looks as though they executed their public performance better than was expected of them. It is believed that people are likely to do this as a self protective function, they avoid threatening evaluative situations and to control judgment concerning their performance (Snyder et al, 1985).

There are two categories of treatment for those who suffer from Social Anxiety Disorder, psychotropic medications and psychotherapy, sometimes used separately but more effective when combined. Psychiatrists who prescribe psychotropic medications do so because they feel their patients SAD is the result of an imbalance of the brain chemical serotonin. These medicines include antidepressants and Selective Serotonin Re-uptake Inhibitors such as Paxil, Fluoxetine, Sertraline, Fluvoxamine, and Citalopram (Wikipedia, 2006). Psychotherapy is also used, primarily cognitive behavioral therapy who's goal is help people change their thinking patterns that are stopping them from overcoming their fears, by doing so they use anxiety management training to change peoples reaction to situations which may cause them to suffer an anxiety attack (Wikipedia, 2006).

Social Anxiety Disorder is anxiety taken to the extreme. People experience anxiety in their everyday lives and there are some habits which they can avoid in order to keep their anxiety at a healthy level which won't lead to SAD. Bryson (2005) said that some of these every day routines include limiting the intake of caffeine and nicotine as well as other illegal drugs which can trigger an anxiety attack, reduce the use of medications especially cold medicines, and avoid alcohol which can cause sleep problems which can lead to depression and anxiety. For those people who are already experiencing slight amounts of anxiety, there are some simple methods to reduce the anxious feelings they may associate with life. Some of these ideas include slow deep breaths such as meditation or relaxed breathing, warm baths, soothing music, take a long walk or exercise to get your blood flowing and feel refreshed, or drink a warm nonalcoholic non-caffeinated drink to relax your body (Bryson, 2005).

Social Anxiety Disorder, SAD, an extreme fear, worry or apprehension of embarrassment and judgment in any or all social situations is a very common problem in the world today. It affects those ranging in age from adolescence to early adulthood, more often women than men but surprisingly men seek out treatment more often. In order to be diagnosed with SAD the person must meet certain criteria including knowing that their fear is unreasonable and their symptoms must last for at least 6 months. There are two types of treatment, to be most effective, both are used - psychotropic medications as well as psychotherapy.
References

American Psychiatric Association (2005). Diagnostic and statistical manual of mental disorders. Forth Edition-Text Revision.

Bryson, S.J. (June 13, 2005). Reducing anxiety. Retrieved March 2006, from http://www.questdiagnostics.com.

Feldman, L.B., & Rivas-Vazquez, R.A. (2003). Assessment and treatment of social anxiety disorder. Professional Psychological Research and Practice, 34(4), 396- 405.

Juan, J. (2005). Social anxiety disorder. Retrieved March 2006, from http://www.aurorahealthcare.org.

Schrof, J.M., Shultz, S., Koerner, B.I.& Svetcov, D. (1999). Social anxiety: For millions of Americans, every day is a struggle with debilitating shyness. U.S. News & World Report, 126(24), 50-57.

Snyder, C.R. (1985). On the self-serving function of social anxiety: Shyness as a self-handicapping strategy. Journal of Personality and Social Psychology, 48(4).

Social Anxiety (February 1, 2006). Retrieved March 2006, from http://en.wikipedia.org/wiki/Social_phobia.

Swinson, R.P. (2005). Social anxiety disorder. The Canadian Journal of Psychiatry, 50(6), 305-306.

Zamorski, M.A., & Ward, R.K. (2000). Social anxiety disorder: common, disabling, and treatable. Journal of the American Board of Family Practice, 13(4).