“His palms are sweaty, knees weak, arms are heavy. There’s vomit on his sweater already, mom’s spaghetti.” Recognise the lyrics from multi-award winning musician, Eminem? These words sum up the emotions and feelings associated with social anxiety disorder.
While Eminem was describing how he felt as he took the stage to perform in front of a live audience, social anxiety can happen in many other social situations. What exactly is social anxiety disorder? Can it be treated?
What is social anxiety disorder?
It’s normal to feel a little anxious in some social situations, for example performing in front of other people or going on a date. However, if you have an excessive and unreasonable fear of social situations, you may have social anxiety disorder.
Also known as social phobia, social anxiety disorder is one of the common types of anxiety disorders that people face.
Here are some common triggers among people with social anxiety:
- Speaking in public
- Eating in front of others
- Being watched while doing something
- Interacting with people
- Being at the centre of attention
- Asking questions or stating own opinion in a group setting
While feeling slightly uncomfortable in such situations may mean that you are introverted, experiencing extreme discomfort, such as fear, anxiety and avoidance, in these situations may be a sign of social anxiety disorder.
Feeling intense nervousness, self consciousness and paralysing fear are some of the characteristics of an episode of social anxiety.
The disorder stems from the thought of being judged, observed or criticised by others. People who suffer from social anxiety disorder usually try to avoid social situations at all costs. Since the opportunities to socialise is greatly reduced, people suffering from social anxiety disorder will find it difficult to make friends and maintain relationships.
Anticipatory anxiety is a symptom commonly found in social anxiety disorder. This happens when you develop an unreasonable fear of a social situation or event before it happens, which can start days or weeks prior to the event. To deal with the fear, the sufferer may spend the time leading up to the event coming up with excuses and reasons to forgo the situation completely.
What are the physical symptoms of social anxiety disorder?
Here are some of the physical symptoms that they may experience, in addition to the psychological signs described earlier:
- Blushing and turning red in the face
- Stammering when speaking
- Excessive sweating
- Pounding heart
- Muscle tension
- Uncontrollable shaking or shivering
- Nausea and vomiting
- Upset stomach or unexplained abdominal pain
- Trouble catching breath
- Dizziness or lightheadedness
- Feeling that the mind has gone blank
If you experience these symptoms persistently when faced with social situations, you may have social anxiety disorder.
What causes social anxiety disorder?
The exact cause of social anxiety disorder is unknown. However, current research supports the idea that it likely arises from a complex interaction of biological and environmental factors. Let’s take a look at some of these possible causes.
Social anxiety disorder tends to run in families. You’re two to six times more likely to develop social anxiety if you have a first-degree relative suffering from it. However, it isn’t entirely clear how much of this may be due to genetics and how much is due to learned behaviour.
Physical abnormalities such as serotonin imbalance or overactive amygdala may contribute to this disorder. Serotonin is a chemical in the brain that helps regulate mood while amygdala, a structure in the brain, controls fear response and feelings or thoughts of anxiety.
Past trauma and negative experiences, such as bullying, family conflict and abuse, may contribute to this disorder. The traumatic event may have left deep emotional and psychological scars that affect how you react and behave in social settings.
Your upbringing may also affect the likelihood that you will develop the disorder. For instance, if you grew up with parents who were rejecting, controlling, critical or overprotective, you’re more likely to develop social anxiety disorder.
How to differentiate between social anxiety and shyness in children
For adults, it’s easier to tell the difference between shyness and social anxiety. However, the difference is much less obvious in children. How do you differentiate between the two? How to know if you should intervene?
With shyness, the anxiety is less intense. A shy kid will eventually warm up to others. Given enough time, the child will be able to interact and perform in a social situation. In addition, this kind of initial shyness should not impede his or her development. In fact, shyness can be considered normal and shouldn’t disrupt the child’s life significantly.
In the case of social anxiety, however, the fear is very intense. It lasts much longer, and may not even go away. The intensity of the fear in children with social anxiety can be so bad that they wouldn’t be able to function normally in these social situations. For instance, they might throw tantrums or not be able to speak during such circumstances.
Here’s a table to summarise the differences between shyness and social anxiety in children:
|Level of anxiety||Low|
Will warm up to people eventually
May not warm up to people
|Does it disrupt development?||No|
Can interact and perform in social situations
Cannot function normally in social situations
How can social anxiety disorder be treated?
If you or your loved one is suffering from social anxiety disorder, keep in mind that it doesn’t need to be a lifelong condition. Social anxiety disorder can be treated.
With professional help, you can overcome the debilitating fear of social situations and interactions. The disorder can be treated through psychotherapy or medication, or a combination of both.
Psychotherapy can help to treat social anxiety by introducing behavioural changes in your life. This approach may or may not involve prescribed medication.
Psychotherapy techniques include:
- Cognitive behavioural therapy
- Exposure and response prevention therapy
In cognitive behaviour therapy, the therapist will first help you to recognise and control your fears. It aims to modify any misperceptions so that you’re better able to deal with social situations.
Another option to treat social anxiety is through exposure and response prevention therapy. It’s done by gradually exposing you to social situations that you usually avoid, with the presence of a therapist. For instance, if you’re scared of public speaking, the therapy can start with having you give a speech for a small group of people, and work your way up before eventually joining Toastmasters.
Generally, medication does not address the root cause of social anxiety. Instead, it aims to relieve the physiological symptoms of anxiety. The type of medication you can expect will include antidepressants, anti-anxiety drugs and beta-blockers.
Do take note that anxiety can’t be fully ‘cured’ by medication. While it can reduce the symptoms to help you face an upcoming social situation, other treatment options like therapy should also be considered.
Other useful strategies to help you cope with social anxiety
Besides medication and psychotherapy, you can try doing some meditation or relaxation techniques to help you cope with anxiety and improve your overall well-being. This can help you enter a state of relaxation and calmness, especially when faced with social situations.
Another strategy is to exercise regularly. Doing so helps to activate the frontal region of the brain and control the amygdala, helping you become less anxious about social situations.
Living with social anxiety isn’t easy, especially if it disrupts your everyday life. However, the good news is that it can be overcome, and you don’t have to live with it throughout your life.