It is estimated that around three per cent of the Australian population experience social phobia in any one year. Up to 13 per cent of the population may develop social phobia during their lifetime. Men and women are equally affected, though a higher number of men seek treatment.

In many cases, social phobia begins with shyness in childhood and progresses during adolescence. The onset of social phobia generally occurs around ages 11 to 15. Social phobia is also known as social anxiety disorder.

Social anxiety is the fear of being judged and evaluated negatively by other people, leading to feelings of inadequacy, inferiority, embarrassment, humiliation, depression and avoidance.

If you usually become (irrationally) anxious in social situations, but seem better when you are alone, then "social anxiety" may be the problem.

It's perfectly normal to feel nervous in social situations where we might come under the attention of others, whether they're strangers or people we know. Attending a formal function, giving a speech at a wedding, doing a presentation to work colleagues are likely to cause nervousness and anxiety, both in the lead-up and during the event.

People with social anxiety disorder usually experience significant emotional distress in the following situations:

• Being introduced to other people

• Being teased or criticized

• Being the center of attention

• Being watched while doing something

• Meeting people in authority ("important people")

• Most social encounters, especially with strangers

• Going around the room (or table) in a circle and having to say something

• Interpersonal relationships, whether friendships or romantic.

Emotional Symptoms:

The feelings that accompany social anxiety include:

• Anxiety

• High levels of fear

• Nervousness

• Automatic negative emotional cycles

• Racing heart

• Blushing

• Excessive sweating

• Dry throat and mouth

• Trembling

• Muscle twitches.

In severe situations, people can develop a dysmorphia concerning part of their body (usually the face) in which they perceive themselves irrationally and negatively. Constant, intense anxiety (fear) is the most common symptom.

The physical symptoms that can be particularly distressing for people with social phobia include:

• excessive perspiration

• trembling

• blushing or stammering when trying to speak

• nausea or diarrhoea

• feeling as if you have nothing to say

• accelerated heart rate

• shallow, fast breathing

• sweaty palms

• nausea

• tense muscles

• dry throat

• stomach pain

• feeling faint or light-headed

• feelings of self-doubt and uncertainty

• negative thoughts such as ‘I’m making a fool of myself’

• difficulty concentrating on anything other than physical sensations of anxiety, negative feedback from others and negative thoughts

• an overwhelming urge to flee the situation

• the realisation that these feelings are irrational and out of proportion.

These physical symptoms often cause further anxiety as the person fears others will notice – even though these signs are usually barely noticeable to those around them.

People with social anxiety typically know that their anxiety is irrational, is not based on fact, and does not make rational sense.  Nevertheless, thoughts and feelings of anxiety persist and are chronic (i.e., show no signs of going away).  Appropriate active, structured, cognitive-behavioral therapy is the only solution to this problem.  Decades of research have concluded that this type of therapy is the only way to change the neural pathways in the brain permanently.  This means that a permanent change is possible for everyone.      

For a diagnosis of social anxiety disorder the person needs to report clinically significant disruption in their ability to function socially, or in terms of work or study, or some important area in their life.

Causes:

• Genetics and temperament

Anxiety disorders, including Social Anxiety Disorder, tend to run in families. It is unclear how much is due to genetics and how much is due to learning from observing other family members. Children who are born with a shy and timid personality style or temperament appear to be more likely to develop Social Anxiety Disorder.

• Parental factors

Parents who have Social Anxiety Disorder themselves are more likely to have children who develop this disorder, through their child observing their parents’ anxiety in social situations, and learning from it. Parenting styles that are controlling and overprotective have been linked to Social Anxiety Disorder in their children.

• Thinking (cognitive) style

Certain styles of thinking have been linked with social anxiety disorder. A “looming” cognitive (or thinking) style is a tendency to think about and pay attention to thoughts about upcoming dangers and risks. This thinking style has been linked with Social Anxiety Disorder. People with Social Anxiety Disorder also tend to interpret social information, such as others’ responses to them, in negative ways, and frequently think about what others think of them.

• Learning experiences and negative life events

Children who experience bullying and rejection by other children their age are at more risk of developing Social Anxiety Disorder. Sometimes social anxiety disorder will develop in adolescents after a particularly embarrassing event.

Treatment

• Psychological therapies

People with anxiety disorders, including Social Anxiety Disorder, should be offered psychological therapies first, before medication. Cognitive behaviour therapy (CBT) has been developed to treat anxiety disorders, including Social Anxiety Disorder. CBT is a practical treatment, and involves teaching practical skills to deal with anxiety symptoms. CBT focuses on understanding the thoughts, feelings, and behaviours that keep anxiety going, and strategies to gain more control over symptoms. Often people with Social Anxiety Disorder will avoid situations they fear, or do things when in those situations to try to reduce their anxiety, such as trying to make sure they don’t say anything embarrassing. However, these strategies often lead to increased anxiety and “social mistakes”, making the anxiety worse. CBT helps people to begin to change these behaviours, and reduce their anxiety.

With love,

Jacqui Zdravkovski