Updated: Jul 12, 2022
Social anxiety disorder can create challenges for people in a lot of different ways, but especially because it often causes them to feel lonely, isolated, and avoidant of situations that make them feel anxious. Since we are all social creatures, avoiding social situations can be a terrible burden and cause a person to lose control of their life. I hope to explain some of the symptoms, causes, and treatments for social anxiety disorder in this article.
What is social anxiety?
Social anxiety disorder (social phobia) is a persistent fear of social situations which causes a person to experience fear, anxiety, and avoidance which cause disruptions to their relationships and ability to participate in life. It can cause a person to avoid friends or family members, to be absent from school or work, and can also even impact the ability of a person to take care of routine responsibilities like going to the store, checking their mail, or taking their dog for a walk outside. I have seen social anxiety completely dominate some client's lives and to make them feel miserable, worthless, and alone. Social anxiety disorder will also keep a person stuck and unable to overcome the obstacles in life, and it can be a significant barrier to reaching out for help in therapy as well because the person may be afraid of this new social situation or that the therapist will judge them negatively. To anyone reading this who identifies with that idea, please know that therapists are deeply caring toward their clients, especially the vulnerable ones, and we are not going to judge you. In fact, we will be proud of you for having the courage to ask for help.
Symptoms of Social Anxiety Disorder: Just to note, these are some symptoms that I have noticed are particularly relevant in my clinical experience. These are not official DSM-5 criteria for Social Anxiety Disorder. If you want to find the criteria, check here: https://www.theravive.com/therapedia/social-anxiety-disorder-(social-phobia)-dsm--5-300.23-(f40.10)
Fear of entering social situations where they might be judged negatively: Sensitivity to criticism and a belief that they will be criticized by those they encounter in public.
Enhanced feelings embarrassment or humiliation: Embarrassment also seems to have a tendency to stick with the client for a very long time. Memories of embarrassing situations can continue to hurt for months, years, or a whole lifetime.
Fear of encountering and interacting with strangers: Strangers are often viewed as hostile and potentially even physically violent threats.
Fear that their anxiety will be obvious to others: Anxiety about their "shyness", blushing, lack of eye contact, trembling, etc. will reveal their vulnerability to others.
Avoidance of attention: Being the center of attention is particularly terrifying, so they prefer to float under the radar and avoid attention. Even praise or awards in a work setting would be very distressing if it made them feel exposed.
Negative attribution to social situations: Emphasis on the risk of situations as opposed to the potential positive side. Also focuses on the negative parts of their interactions and fail to give themselves credit for their successes.
Fear is exaggerated: The severity of the fear is not in line with the actual threat that the situation presents. For example, attending a child's birthday party may be terrifying even though there are few actual threats.
Avoidance or enduring suffering: Social events that evoke the above symptoms are either avoided entirely or they are endured with intense suffering.
Symptoms must last six months.
Prevalence of social anxiety disorder
According to the National Institute for Mental Health (NIMH), 7.1% of adults are regularly experiencing at least mild symptoms of social anxiety disorder, and women are more likely than men to experience these symptoms, though it is relatively common for all adults. It is estimated that 12.1% of adults will experience social anxiety disorder at some point in their lives. For children and adolescents, it is estimated that somewhere between 3% to 9% of children aged 1-17 have been diagnosed with social anxiety disorder and that it becomes more prevalent as a child grows into adolescence. These studies were conducted in 2009 and it is possible that the prevalence has increased as a result of the COVID-19 pandemic and the associated isolation and concerns about infection with COVID-19 that occurred during that time period.
Causes of social anxiety disorder
Like many other mental health disorders, It is clear that there is a genetic component and an environmental component to social anxiety disorder. It is believed that traumatic experiences in childhood can create social anxiety disorder such as abuse, neglect, or abandonment. Teasing, bullying, rejection from peers, or humiliation that occurred, especially when a person is school-aged, also seems to be a common cause of social anxiety disorder. If a person has some aspect of their appearance or characteristics that they believe make them feel like they stand out in a negative way, they are also more likely to develop symptoms of social anxiety. There are also factors involving a child's temperament that may be a factor in that children who are shy and avoidant are likely to continue to have this general attitude as they grow older.
Social Anxiety Treatment
As stated above, social anxiety disorder can be caused by genetic factors, trauma or abuse, disruptions to attachment such as rejection or abandonment, or social factors such as a pattern of bullying, humiliation, and teasing from peers. A person also may have temperamental issues of just being shy, or they may have some characteristics or traits that they evaluate negatively that can cause them to feel anxious about standing out in social environments. It is important for any individual who is experiencing any type of anxiety to check in with their medical doctor to determine if there are any physical health problems that may be contributing to the problem such as changes in hormones or an underlying illness. At Arise Counseling Services, I provide treatment for the other factors described above. I help people to explore the underlying causes of their social anxiety such as attachment disruptions, trauma, peer rejection, low self-esteem, or other dissatisfaction with life. There are many different ways that I can help once these causes are identified, and I will list some of them below.
Treating Social Anxiety
Cognitive Behavioral Therapy (CBT): We will work together to analyze your thoughts, feelings, and behaviors to examine how these impact one another and cause your symptoms to be worse. Then we will work to change how you think about issues in your life and what you believe about yourself and the world.
Exposure: When you are feeling confident, we will begin the process of gently exposing yourself to situations which you know are safe, but yet feel dangerous due to social anxiety disorder. Working together, we will teach you to relax yourself and to address negative thoughts that you have so that you can begin to feel comfortable even in these situations.
Treating trauma: When you feel safe and comfortable, we will examine any traumatic experiences that you have had related to loss of attachment relationships or changes to how you view yourself so that you can stop having the effects of trauma intrude upon your daily life.
Building self-esteem: When a person has been abandoned by a parent, rejected or humiliated by peers, or has otherwise experienced abuse, they often have a tendency to develop a really negative attitude about themselves. I think that this is particularly relevant with social anxiety disorder because I believe that the person is afraid that others will judge them just as harshly as they judge themselves. I think that the fear that these people have of being attacked is due to their own desire to attack themselves for the flaws that they have been exaggerating with their thoughts for their entire lives. I want to help people to reverse the course and begin to see their strengths. I want to cultivate the strengths that each person has and help them to see themselves more positively.
Narrative therapy: I encourage clients to examine their personal characteristics and life journey and to rewrite their story so that they can change the way that they look at themselves and the trajectory of their lives.
For more information
If you would like to learn more about any of the treatments above, please contact me and I would be happy to help. If you would like some professional help dealing with your social anxiety, feel free to schedule an appointment with me today or reach out to discuss your options. You should also subscribe to my blog and continue to follow because I intend to write more specific posts about the treatments that I use in the future.