What is Social Anxiety?

The third largest psychological problem in the United States affecting 15 million Americans, “social anxiety” or “social phobia” is a persistent, irrational fear of social situations and more specifically, a fear of failure and embarrassment as a result of social interaction.

With social anxiety, the sufferer is so impeded by fears of scrutiny, being watched and harshly evaluation, or even just interacting with people, they can worry for days or even weeks about a dreaded event. They may even struggle to function with “normal” day to day activities, such as at work or interacting in close personal relationships. People with the condition are in a chronic state of hyper-alertness and suffer from overwhelming self-conscious.

While they realize their worries don’t make “head sense” and their fears are unfounded or excessive, they struggle to apply and internalize this information in order to overcome these fears on their own.

While the social anxiety is largely experienced as a mental, emotional health issue, the disorder, like any other mental, emotional health condition, is rooted in the physical. With the social anxiety disorder (SAD) there is commonly an imbalance of the neurotransmitters norepinephrine and serotonin. To better understand the physiology, or the way anxiety occurs and affects the body, please read my blog “Emotional Stress and Physical Health”.

Social Anxiety Triggers

With social anxiety, sufferers are dealing with baseline of generalized anxiety which is increased by certain social “triggers”.  For some, this is limited to just one or two social situations. For others, their anxiety level is heightened whenever they are around other people. Common social anxiety triggers include:
  • Going to parties or large social gatherings
  • Eating in front of others
  • Drinking in front of others
  • Writing in front of others
  • Meeting  or being introduced to new people
  • Public speaking
  • Using public restrooms
  • Teasing or criticism
  • Being the center of attention
  • Being watched
  • Meeting or speaking to authority figures
  • Having to make “small talk”
  • Making eye contact
  • Going to public places
  • Making telephone calls
  • Taking turns speaking in a circle.

Social Anxiety Risk Factors

Social anxiety is believed to be caused by a combination of both genetic and environmental factors, with the majority of the weight being on environmental or by social (parental, peer, familial, authoritative…) influence throughout life. A traumatic social event may also correspond to the condition in some cases. Risk factors for social anxiety include:
  • Being female.
  • Having a family member with social anxiety disorder.
  • Being raised by overly anxious or protective parents.
  • Being raised by overly controlling, critical or rejecting parents.
  • Peer bullying and rejection throughout childhood.
  • A naturally shy, timid or restrained temperament.
  • Facing new social or work demands.
  • Having a condition, behavior or appearance which draws attention such as stuttering or facial disfigurement.

Shyness Vs. Social Anxiety

For people that are not familiar with the disorder, it is easy to confuse social anxiety with shyness. However, while they do share a lot of commonalities, social anxiety is considered much more severe.
And official SAD (social anxiety disorder) diagnosis according to the DSM-IV requires:
  • Significant and persistent fear or social or performance situation in which embarrassment, rejection or scrutiny are possible,
  • Physical symptoms of anxiety are almost always experienced when in the feared social situation(s).  Physical symptoms including:
    • Blushing
    • Difficulty talking
    • Nausea
    • Excessive Sweating
    • Trembling
    • Dry mouth and/or throat
    • Difficulty swallowing
    • Muscle twitches
    • Rapid heart rate and elevated blood pressure.
  • Though fear is recognized as unreasonable, the patient is unable to do anything about it,
  • The feared situations are either avoided or endured under intense anxiety and distress,
  • Fear is not due to the direct physiological effects of a substance (eg. Drugs, medication…) or another medical condition AND…
  • The avoidance or distress significantly interferes with a person’s ability to function normally.
If you think you or someone you know may be suffering from social anxiety, there are a variety of treatment options available.  Please check out my blog “Anxiety Treatments Review” for my review of the most popular prescription and natural medicines used for social anxiety.

Stay Healthy,
Dr. Jeff M.D.


PubMed Health: Social Phobia 

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