Social Anxiety Disorder - By Dr. Peter Norton

Depending on which survey you look at, Social Anxiety Disorder is among the top five most common of all psychological diagnoses. Nearly 15% of the populations will, at some point I their lives, experience enough anxiety and distress over social
interactions that they could be diagnosed with Social Anxiety Disorder.

Although mental health specialists have long since recognized that some people have social fears that are severe enough to cause a significant distress and interference in a person's life, it wasn't until the 1970's and 1980's that researchers began studying it closely. When they did, they quickly found that people with these social fears were so similar that the condition warranted its own diagnosis: Social Phobia.

The core of this disorder seemed to be an intense fear of negative evaluation. In other words, people with Social Phobia feared being embarrassed, humiliated, rejected, or judged by others as stupid or incompetent. This is very different from being a loner or preferring not to interact with others. Social Phobia is about wanting to be accepted by people, but
being intensely afraid that other people will think poorly of them and reject them. As one organization put it, it is
like being allergic to people.

The change in name from Social Phobia to Social Anxiety Disorder came about in the early 1990s when a group of preeminent clinicians and researchers recognized that phobia seemed to imply a fear of a very circumscribed thing, much like someone with a spider phobia specifically fears spiders. The fears of people with Social Anxiety Disorder tend to be much
broader. Like John, people with Social Anxiety Disorder usually fear a number of social situations. Most commonly, people with Social Anxiety Disorder fear public performances (e.g., public speaking, being observed doing something, etc.), interactions (e.g., initiating or maintaining conversations, mall talk, etc.), tests, dating, or even just being out in public places.

It may be hard for loved ones or others to truly understand Social Anxiety Disorder because, in most cases, people don't laugh at you when you misspeak. People usually do not stand up, call you a "moron," and walk out when you are giving a
presentation. But the mind of a person with Social Anxiety Disorder seems to evaluate his/her social performances
differently. A series of interesting research studies have clearly shown that people with Social Anxiety Disorder are much
more likely than others to find evidence that they messed up. They will notice the one person who is yawning in an audience of hundreds, and will interpret that as clear evidence that they were boring. They internally judge their own performance poorly, even though others thought that they did just as well as someone without Social Anxiety disorder. They tend to remember what didn't go well and forget about, or discount, social interactions that did go well.

Because of this intense fear, Social Anxiety Disorder often has a very severe impact on a person's life. Social Anxiety Disorder can, and often does, impact a person's work, school, social, and romantic life. In my own work, I have seen students drop or fail college courses because they cannot give a class presentation. I have seen a gentleman with an MBA working as a night janitor because he couldn't tolerate the day-to-day terror he felt when being around his former coworkers at an accounting firm. As we see in John's story, as a younger he hid himself in his room and didn't make friends. His school suffered. He lost his job, and couldn't begin applying for a new one. Social Anxiety Disorder can have a debilitating impact on a sufferer's life.

Social Anxiety Disorder can also lead to a number of other problems. They may isolate themselves and mentally "beat themselves up" so badly that they develop Major Depressive Disorder. Many people will also try to cope with their anxiety by using alcohol or drugs, which may lead to drug or alcohol abuse. John's story highlights this clearly. He started to use alcohol to calm himself, but even that wasn't enough to allow John to lead the life he wanted.

Despite this foreboding picture, many extremely helpful treatments exist for Social Anxiety Disorder. John is a testament to the fact that people can beat Social Anxiety Disorder. John's treatment involved two approaches: a psychological treatment that is clearly most effective (and the one used by John) is called Cognitive Behavioral Therapy-or CBT for short. CBT usually involves learning to recognize their anxious thoughts, and challenging how realistic the thoughts actually are. Clients then practice engaging in social interactions, starting with easier situations first, to test whether or not their thoughts were correct and to slowly get themselves used to feeling comfortable in social situations.

From a medication standpoint, many drugs are also extremely helpful. In particular, medications that affect levels of a brain chemical known as serotonin are typically very effective. Although scientists aren't exactly sure how raising serotonin levels helps, these same medications also seem to be helpful in treating other anxiety disorders, depression, and a variety of other emotional disorders.

The decision to get CBT, medications, or both should be made by the individual with the advice of his or her psychologist, physician, or therapist as there are advantages and disadvantages of both. Medications tend to work faster and are a lot
easier, but they may sometimes have unpleasant side-effects and many people relapse when they stop taking their medicine. On the other hand, CBT takes a bit longer and requires a lot more hard work, as John has testified, but the effects tend to be much more permanent and have no real side effect.

The jury is still out on whether combining CBT and medicine works any better than either alone, although a few recent studies seem to show that both work slightly better than either alone. Again, this is a question that should be discussed with your mental health provider. Still, with these effective treatments, most people with Social Anxiety Disorder overcome their fears and go on to lead happy and social lives.