Living with
Social Anxiety Disorder

What is social anxiety disorder?

In social situations that are unfamiliar or when having to perform in front of others, many people tend to feel concerned or apprehensive. Concerns usually involve fears of saying or doing something that will result in embarrassment or humiliation.
However, for some, the concern and apprehension are often very intense and severe and have a marked influence on most aspects of their daily functioning. These individuals may be suffering from social anxiety disorder, also known as social phobia.

Social anxiety disorder is by far the most common of all anxiety disorders and its onset is usually during adolescence or early adulthood.

How do you know you have social anxiety disorder?

Social anxiety disorder is characterised by a marked and constant fear of social or performance or public situations, such as:

• Eating or drinking in front of others
• Writing, signing or working in front of others
• Being the centre of attention
• Going to parties or dating
• Using a public restroom
• Speaking in public.

In the face of such social situations, a person with social anxiety disorder may experience intense anxiety that may include a full-blown panic attack . They may also experience marked anticipatory anxiety prior to the social situation.

Common symptoms that people with social anxiety disorder experience include:

Cognitive symptoms:

• Dysfunctional thought patterns (for example, self-doubt or negative thoughts)
• Discounting of positive encounters and magnifying the social abilities of others
• Believing strongly that you are inadequate in social situations.

Physical symptoms:

• Blushing
• Sweating
• Trembling voice
• Dry mouth
• Racing heart
• Shortness of breath.

Behavioural symptoms:

• Avoidance of situations that bring about anxiety
• Abusing drugs, alcohol or medication to reduce the anxiety.

Is there a link between social anxiety disorder and being shy?

When shyness becomes so severe that it has a detrimental effect on functioning, it is no longer seen as normal and may warrant a diagnosis of social anxiety disorder.
Individuals with social anxiety disorder are typically shy and tend to be withdrawn in unfamiliar situations.
However, unlike persons who are shy and have mild anxiety, persons with social anxiety may experience the following:

• Excessive doubt, worry and fear when anticipating a social or performance event.
• No reduction of anxiety during the event.
• Anxiety that is disabling to such an extent that it limits their interactions and can result in a negative outcome in the social or performance situation they are facing.

What causes social anxiety disorder?

According to the South Africa Journal of Psychiatry, social anxiety disorder ranges in prevalence from 3 to 16 % of the general population.

This condition may be attributed to genetic, neurobiological, and environmental factors:

• Genetic factors: First degree relatives of someone with social anxiety disorder are 2 to 3 times more likely to develop the disorder than the general popualtion. Heritability of the disorder has been estimated at around 30 to 40 %.
• Neurobiological factors: Functional neuroimaging studies point to an increased activity in the amygdala and insula in patients with social anxiety disorder. The amygdala is thought to play a very important role in the fear response and its activation during response to emotions seems to correlate with the severity of social anxiety disorder symptoms.
• Environmental factors: Several environmental factors may influence the risk of developing social anxiety disorder. These include but are not limited to:
  • Having an overly critical or controlling or protective parent
  • Being bullied or teased as a child
  • Family conflict
  • Sexual abuse
  • A shy, timid or withdrawn temperament as a child.

How is social anxiety disorder diagnosed?

If you think you are worrying excessively and feel your worry and anxiety interferes with your daily life, or depend on alcohol or other substances to reduce your feelings of worry, then contact your doctor or a mental health professional for help as you may have social anxiety disorder.
The earlier you get help, the easier social anxiety disorder is to treat and manage, so be open and honest with your doctor or mental health professional.

Your doctor may diagnose you with social anxiety disorder through one or more of the following ways:

• Physical examination and history taking: Your doctor can look for physical signs of underlying medical conditions that can cause you to feel overly anxious, such as signs of thyroid disease, or they may look for physical symptoms of social anxiety disorder such as sweating or trembling. While talking and interacting with a patient, a doctor can also observe their behaviour and general mood and ask questions about their general daily-life experience.
• Laboratory tests (blood tests): Your doctor can check for hormone and vitamin levels in the blood. This can show if you have thyroid disease or vitamin B or D deficiencies, for example.
• Psychiatric exam: A psychiatrist or psychologist will talk with you about your thoughts, feelings and mood. They may use a questionnaire to help them. They will also determine whether you have any other mental health condition, like depression or post-traumatic stress disorder, that are associated with social anxiety disorder. They may also want to talk to your family or people you live with to determine your everyday functioning.
• DSM-5: Your doctor or mental health professional may use the criteria for social anxiety disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (these are the symptoms listed earlier).

Living and managing

• Keep a journal: This is a useful way to identify the stressors in your life and can be beneficial to your therapy. Identifying what may be making you anxious can help you feel better.
• Set up schedules and prioritise tasks in your life: This may help to manage your time and energy more efficiently and to help you focus when you feel anxious.
• Avoid unhealthy substance use: Keep alcohol consumption in moderation and avoid drug use. Drinking alcohol and using tobacco products make you more anxious, and quitting can reduce this impact. Speak to your doctor or mental health professional about ways to quit smoking or drinking alcohol if you think you are addicted.
• See your doctor or find a support group: Get more resources to help you cope and to reduce any negative feelings or stigma you may feel about having social anxiety disorder.
  Find out more about anxiety on Let’s Talk. You can find resources that you may find useful in helping to manage stress and stay positive. You can also find out about where to get help if you are struggling to cope and need someone to talk to.

What treatment is available for social anxiety disorder?

Optimal treatment for social anxiety disorder requires individualised interventions.
The most important step is to consult a professional person for an accurate diagnosis.
The combination of medication and psychotherapy has been shown to be a particularly powerful approach in managing social anxiety disorder.

Cognitive behavioural therapy (CBT), whether it be in a group or an individual setting, is usually the first line of therapeutic treatment.

Certain medications are effective such as selective serotonin reuptake inhibitors (SSRI’s), monoamine oxidase inhibitors (MAOI’s) and serotonin-noradrenaline reuptake inhibitors (SNRI’s). Consult your doctor about these.