Social anxiety disorder is also known as social phobia because it is a form of anxiety disorder that induces feelings of extreme fear in social settings. Patients who have social anxiety disorder struggle to talk to people, to make new friends, and to attend social events and gatherings.
There is an irrational (but deep-rooted) fear of being judged, mocked, or otherwise scrutinized. Even if patients understand that their concerns are unreasonable and not grounded, they remain helpless to overcome them.
Social anxiety disorder is not shyness, which is much more common and benign. Shyness tends to be short term, nondisruptive, and can be overcome with encouragement and effort. Social anxiety disorder is chronic, debilitating, and persistent. Patients who suffer from social anxiety disorder will likely not be able to work, go to school, or develop relationships with people outside their immediate family.
Social anxiety disorder is very common. The Anxiety and Depression Association of America estimates that around 15 million adults have this condition, with many people developing the first symptoms as young as 13 years old.
The symptoms of social anxiety disorder show how this can be a very serious condition.
Patients will often obsess over social interactions, intensely worrying about their safety and well-being in the weeks leading up to an event. At its worst, patients will go out of their way to avoid social situations. If they attend, they will do their utmost to go unnoticed.
The fear behind social anxiety is rooted in a fear of embarrassment (on a much deeper level than simple stage fright). Social anxiety disorder often feeds on itself. Patients will worry that others might notice that they are anxious or stressed, which often causes even more anxiety. Some patients turn to alcohol or drugs to work up the courage to attend an event, or to use the behavioral changes that come from substance consumption to overcome the anxiety.
A certain level of anxiety in social situations is normal and might even be healthy. But social phobia pushes the anxiety to extreme levels, leaving patients with a pathological fear of being judged and humiliated in front of the world. When social anxiety reaches these levels, patients might even forego important situations and events, like job interviews, grocery shopping, using public restrooms, eating at restaurants, or going on dates.
What makes social anxiety disorder additionally difficult to live with (and diagnose) is that its symptoms may not appear in all situations. A patient may have limited or selective anxiety, such as being fine when talking to strangers but experiencing crippling symptoms when having to go on a date or eat at a restaurant. The patient cannot choose when and how the symptoms appear, or for which form of interactions they present.
Only patients who have the most extreme form of social anxiety disorder will experience symptoms in all social settings.
Mayo Clinic explains that, like any number of other mental health illnesses, social anxiety disorder stems from a complex intersection of risk factors in the patient’s biology and their environment.
Such factors might include:
Further risks can cover children who have been severely teased, bullied, rejected, humiliated, ridiculed, or otherwise abused. They may be prone to developing social anxiety disorder in adulthood. Other kinds of trauma, like family conflict or forms of sexual or physical abuse, can make children very scared of social interactions.
Individuals who have physical or mental health conditions that draw attention might also be at risk. The Indian Journal of Plastic Surgery writes that patients with facial disfigurements, who have tremors (as with Parkinson’s disease), or who have a stutter might be so self-conscious as a result of their condition that they may also develop social anxiety disorder.
There is usually a connection between social anxiety and substance abuse, although the formulations and combinations of the respective conditions are unique to every individual. Social phobia and alcohol addiction, for instance, are very common co-occurring conditions. Having said that, substance abuse can cause drug-induced social anxiety, while some people who are often addicted to drugs or alcohol might develop social anxiety disorder first.
Research published in Psychiatric Times suggests that having an anxiety disorder can increase the chances of a patient developing a substance use disorder, which can complicate treatment of both the anxiety disorder and the substance abuse itself.
Some drugs cause an immediate (or almost immediate) anxiety response. Other drugs, based on their chemistry, can cause a delayed effect. Stimulants, marijuana, and hallucinogens usually induce anxiety while the drugs are still active in the patient’s system.
Alcohol, opioids, and sedatives are depressants, so they do not directly cause anxiety attacks; however, withdrawing from those substances can usually include anxiety-like responses as part of the process. If left untreated, the responses can lead to the development of a full-blown anxiety disorder. With the right combination of other risk factors, this can result in social anxiety disorder.
Any drug that has the side effect of increasing anxiety generally intensifies the symptoms of the form of anxiety disorder that the patient is experiencing. Individuals who use drugs or alcohol to self-medicate their social phobia symptoms tend to use those substances when they are alone, often to boost their nerve before they have to engage in a social activity. Thus, they might engage in the activity when they are experiencing the chemical effects of those substances. If the effects wear off during the act of socializing, this can induce an onset of anxiety that is even stronger — both as a result of the comedown and the shock of being in a social situation.
Embarrassing behavior is one of the hallmarks of alcohol consumption, and for people with social anxiety disorder, suffering humiliation while under the influence can be enormously psychologically devastating. Anything of the kind can push the social phobia into extreme levels, which might in turn compel more substance abuse.
People with social anxiety disorder have a 20 percent chance of also having alcohol problems because of the temporary relief intoxication provides from anxiety. However, the short-lived nature of reduced inhibitions leads to a spread of problems that might be merely embarrassing for most people. People with social phobia can become paralyzed by the memory of acting uncharacteristically while under the influence.
In a kind of boomerang effect, anxiety can also be increased as the effects of the alcohol consumption wear off. This is the result of fluctuations in the chemistry of the brain, according to Women’s Health.
Research has found significant connections between marijuana and various anxiety disorders. Like alcohol, cannabis can induce a temporary calming of anxiety or simply make it less distressing. Many users report feeling a dissociative effect, where they feel “disconnected” from their usual anxiety or the situations that trigger it.
However, at higher doses, cannabis can induce anxiety and paranoia, which has the obvious effect of immediately and significantly intensifying any underlying symptoms of social anxiety disorder that a patient has been trying to repress with cannabis consumption. As with alcohol, cannabis can also induce higher levels of anxiety between individual periods of use.
In the Depression and Anxiety journal, for instance, researchers reported that a study of 107 marijuana users found that 26 percent of participants had social anxiety disorders that presented in concurrence with marijuana use problems. Patients experienced an increase in their cognitive and behavioral problems because of how both conditions presented themselves. Other studies have shown that people who have social anxiety disorder have a greater degree of problems relating to their use of cannabis. They are more likely to continue using cannabis even when they expect that their continued use will make their symptoms worse.
Stimulants derive their effectiveness by way of jumpstarting the sympathetic nervous system. This is what activates the release of adrenaline and the flight-or-fight response, which is connected to how people experience anxiety. Environmental stimuli often causes this response, but stimulant substances usually make the anxiety response last for much longer.
Additionally, some research has found that social anxiety disorder induced by stimulant drugs can be further explained by how stimulant abuse affects the production and transmission of dopamine in the brain
Social anxiety disorder can be successfully and effectively managed without the use of drugs or alcohol.Psychology Today provides some starting points on how to control the phobia of being out in public or with other people.
Accept that anxiety is a normal, even a healthy, response to stress. Without anxiety and adrenaline, our bodies and minds cannot be put into a state of readiness to overcome adversity. Similarly, human beings evolved as a social species, so it is natural to be concerned about what others think about us. We need the approval of others to survive.
But nature and nurture can inflate these perfectly healthy feelings to overwhelming and disruptive proportions. One of the keys to managing anxiety is not to banish it altogether, but to use therapy and counseling to learn how to control it and make the best use of it.
Another point is that social anxiety disorder distorts the reality of the environment, setting, and situation that the patient is in. The phobia exaggerates any sense of danger or consequence and attributes negative judgment far beyond scope. To a degree, this is a habit that can be changed. In the same way that thoughts that produce social anxiety are always distorted and exaggerated, those same thoughts can be identified, recognized, and changed.
However, this is not easy to do. Some people might have a severe form of social anxiety disorder that cannot simply be “thought” around. This is again where therapy and counseling can be vital. A psychologist will work with a patient to teach them how they can control their anxious thoughts and see through them to the reality of the situation they are actually in, and not what the anxiety wants them to see. More often than not, while there might be some element of stress in the environment, it is never as bad as the anxiety makes it seem.
One way to do this is by relabeling. In many ways, anxiety and excitement are two sides of the same coin, and they have many symptoms in common. The surge of adrenaline is usually associated with anxiety, but practice and training can change that train of thought from, “I’m getting anxious,” to “I’m getting excited.” A quick relabeling like that can make a person feel ready and capable.
Breathing exercises might be one of the cornerstones of healthy ways to cope with social anxiety disorder. Most people feel that when their anxiety starts to kick in, it will uncontrollably spiral. However, practicing diaphragmatic breathing — slow and deep breaths from the abdomen — is medically and clinically proven to ease anxiety. Intentional breathing techniques are part of any treatment program for most kinds of anxiety, and social anxiety is no exception. It can be done while sitting down, lying down, or standing, and it can easily be part of a daily routine.
With practice, breathing to control anxiety will become natural and even easy. Part of the process is being aware of your breathing when you feel an anxiety attack coming on, and then implementing the intentional breathing techniques to get the anxiety under control. For people with social anxiety disorder, the breathing can be done before they leave the house or before they enter into a public place.
Other methods of managing social anxiety disorder include shifting mental focus (thinking less about the symptoms of the anxiety and more about anything else: the task at hand or neutral factors, to nip the phobia in the bud) and stretching the boundaries of discomfort. This is a mechanism of acceptance and commitment therapy, which posits that certain experiences are worth the anxiety. Patients are encouraged to endure distressing feelings in order to continue making the most of their lives.