About Overcoming Anxiety, Panic Attacks, Social Phobia, and GAD

Social Anxiety | Social Phobia |Social Anxiety Disorder

Social Anxiety | Social Phobia |Social Anxiety Disorder (All Are The Same)

Social Anxiety

Social Anxiety is a problem where a person is fearful of being around others who are not familiar to them. They are afraid of being scrutinized by others and this causes intense anxiety. People with social anxiety are usually aware of their distress. However, social anxiety disorder is a “silent illness” in that many of these patient never end up being hospitalized as is the case at those with panic attacks. One of the most frustrating things for those suffering from social anxiety is they usually know their fear is unreasonable…but they continue to worry. The more they worry, the more they avoid the feared situation, and this cycle continues. Social anxiety can occur in only one type of situation (public speaking, having to read in class,eating with others) or it can be generalized and the fear can happen in any situation with others.

What happens in social anxiety that is so disturbing? The main problem is the fear of being judged by others. It could also be the fear of doing something embarrassing. Some people worry about the symptoms starting and others people with notice them (such as trembling hands). When one begins to worry about what (symptoms) might happen, this is called anticipatory anxiety. They may feel nauseated, can’t talk from feeling “choked up,” begin sweating, or having hand tremors. When the anxiety starts, the person may experience a full blown panic attack. Contrary to what some people say panic attacks can happen in with social anxiety and it does not mean you have a separate panic disorder.

The cost of social anxiety to the individual is great. Those with social phobia may not advance in their careers because the turn down opportunities that require working with others or having presentation skills. They may miss out on close relationships because of the fear of being around others. If things get really bad, they may not be able to work at all or even be able to get out of the home.

Social Anxiety : What You Need To Be Concerned About

Social Anxiety Consistently Turns Into Major Depression
Risk of Suicide is higher in Social Anxiety
Lower pay and Lower level employment from avoidance
Risk of Alcoholism (treating the anxiety) and sedative addiction
Social Isolation

Social Anxiety : How Many People Have It

The number of people with Social Anxiety at some time in their lives varies with the study used. To keep it simple, 5% of people will have enough symptoms to be considered having a social anxiety disorder. Other Statistics:

Social Anxiety affects about 15 million Americans
Almost all those with social anxiety disorder have excessive fear of public speaking.
Half of those with social anxiety disorder cannot be around stranger without significant problems.
Women Have Social Anxiety twice as often as men
If someone in your family has it, you are more likely to have it
It usually begins in the childhood and teen years and tends to be lifelong.
If you don’t have it by the age of 25 you are unlikely to get it.
Few people usually seek treatment for social phobia unless they are seeking help for another problem (depression)

Despite the statistics indicating social anxiety disorder is life long, I firmly believe one can improve if one is willing to work at it. The easiest thing for someone to learn are the various ways to relax. Some people use progressive muscle relaxation. Others use hypnosis or biofeedback. Slowly exposing oneself to the feared situations has to happen, but it can be done in a way this is not traumatic. Someone can be there to support you. There is also “cognitive restructuring” that needs to be done. That is, changing the way you look at a situation so it is not so fearful.

One other component of getting better that is important for social anxiety in particular, is social skills training. Learning how to get out and mingle with others and make friends. After years of avoiding people and situation, the can be challenging for many. There are self-help audio programs that are very good for this. A good therapist can be invaluable.

Social Anxiety : What Causes It

Genetics: Those with relatives that have it have a have a 2-3 fold risk of getting it
Learning: We observe our parents and other important figures growing up. If they had an anxiety disorder, we will learn their same behaviors and coping mechanisms as being normal. Later in life we may realize these coping mechanisms where not so normal
Sensitivity: Some people may be more sensitive to criticism (genetic) than others.
Biological: The Amygdala in the brain is part of a circuit in the brain that is involved in reinforcement of fear and anxiety. Medications act on these systems to calm them. Therapy and cognitive restructuring can also calm the circuit without medications.
Unfortunate Events: A series of bad experiences that resulted in humiliation and/or embarrassment could trigger social phobia. The fear and avoidance starts and then continues. This might be similar to Post Traumatic Stress Disorder. This could be related to a person’s lack of social skills and/or shyness and inability to negotiate difficult social situations.
Parenting: Shaming as a form of parenting and an emphasis on other people’s opinions in American culture.
Our Beliefs: Thinking we need to be perfect, thinking we cannot show our anxiety to others, believing all others are judgmental or scrutinizing others always. Fear of rejection by others. Wanting to succeed but fearing the consequences of success. Thinking you need to be perfect.
Our Actions: People remain stuck in experiencing the anxiety, judgmental thoughts, and have not had the skills to work through these feeling. Instead, they avoid the situations.

Social Anxiety | Do I Have It

Here is a list of well know symptoms for social anxiety.

Fear of humiliating or embarrassing oneself while being around others (peers) or when in a performance situation.
This situation produces anxiety and perhaps a panic attack
The person knows the anxiety is unreasonable
The person avoids these types of situations
The anxiety and avoiding of these situation results in problems for the person
Drugs, medical/psychiatric problems are not causing the problem
It may be on type of situation or generalized to many situations

A person with social anxiety may do quite well in areas of their life where they do not fear being scrutinized.

Fear of speaking, stage fright, or being shy are only considered to be social phobia if they significantly impair the person as these three symptoms are common in the population. There has to be problems caused by the above. Just having them is not enough.

The exact DSM-IV-TR Criteria for Social Anxiety Disorder also provides the criteria for Social Phobia in children.

Things That Can Cause or Mimic Social Anxiety Disorder

The main things to look for they may look like social anxiety disorder are other mental illness diagnoses.

Panic Disorder With or Without Agoraphobia
Separation Anxiety Disorder-Children
Body Dysmorphic Disorder
Pervasive Developmental Disorder
Schizoid Personality Disorder
Avoidant Personality Disorder
Depression
Dysthymia

When I see a patient, it is prudent to do a basic laboratory workup. With the exception of a substance disorder, the other medical problems that are related to panic attacks do not really apply to social anxiety disorder. However, because social anxiety is related to depression and alcohol, screening for medical problems related to and accompanying depression or alcoholism should be done.