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Social Anxiety Disorder

Question:
What do you call “shyness” when it is severe enough to impair your social life or your career advancement?

Answer:
Social Anxiety Disorder (also called Social Phobia)

Social Anxiety Disorder causes physical and mental symptoms of fear and anxiety when the individual is in a situation in which he could possibly be embarrassed.

Typical situations that would provoke Social Anxiety Symptoms include:
• Public speaking
• Speaking to people you do not know well
• Attending a party
• Making business presentations
• Answering questions in class
• Dating
• Eating out at restaurants
• Introducing yourself to a group
• Using a public restroom
• Speaking on the telephone
• Writing in front of others
• Any other situation in which you are observed by others

Individuals with Social Anxiety Disorder don’t usually suffer in all of these situations, but they are significantly impaired in at least one area of social activity.

In the above situations, the typical symptoms of Social Anxiety Disorder include:

• Extreme fear
• Blushing
• Sweating
• Shaking
• Trembling
• Tense muscles
• Shaky voice
• Dry mouth
• Pounding heart
• Racing heart
• Shortness of breath
• Dizziness
• Stomach discomfort

In addition, the person will have negative self-evaluations about the situation, such as thinking, “I will be humiliated,” “Everyone can see my perspiration,” “I can’t do this,” or “I did a terrible job.”

Not every person with Social Anxiety Disorder will suffer from all the above symptoms, but he will experience several of them, and they will cause him repeatedly to avoid situations that provoke the symptoms.

Avoiding situations that provoke or worsen the Social Anxiety Disorder symptoms can involve:
• Avoiding eye contact during conversations
• Minimizing participation at social events
• Avoiding classes requiring presentations
• Selecting careers with minimal interpersonal interaction
• Refusing to attend social gatherings
• Avoiding eating in restaurants
• Avoiding writing out checks in front of cashiers

Social Anxiety Disorder is very common: one in eight Americans suffers with it. Fortunately, we are learning how to treat it.

What’s Normal Shyness?
Some degree of shyness is considered normal. It’s natural to have some mild feeling of apprehension in social groups of strangers. It’s normal to be a little nervous before giving a speech or business presentation. It’s normal to be nervous when going out on a first date.

In these normal situations, the shyness or nervousness does not become a significant problem and does not become the main focus of attention. In the background, the nervousness is perceptible. However, it is not overwhelming and does not interfere with concentration, social interaction, or performance. The nervousness is certainly not severe enough to cause the person to avoid the situation.

With normal shyness the person has a more realistic self-appraisal. He does not feel that everyone is seeing him as incompetent or foolish. Normal shyness is often a temporary stage of childhood or youth and does not get worse with time.

Social Anxiety Disorder, in contrast, causes the nervousness—mental and physical symptoms as described above—to become the main focus of attention in the provoking situations. The symptoms do interfere with performance, and they are strong enough to cause the person to leave, or to avoid that type of situation in the future. Also, Social Anxiety Disorder tends to be a permanent condition, which may get worse with time.

Complications of Social Anxiety Disorder
Social Anxiety Disorder is a serious condition that causes considerable impairment in its victims. Compared to other Individuals, those with Social Anxiety Disorder are:
• Four times more likely to suffer from Clinical Depression
• Three times more likely to suffer from Alcohol Abuse
• Twice as likely to suffer from Panic Disorder

In addition, individuals with Social Anxiety Disorder are more likely to suffer from:

• Social isolation
• Romantic failure
• Poor career advancement
• Low self-esteem

Many individuals restrict their lives significantly to avoid the anxiety-provoking situations.

Social Anxiety Disorder affects 13% of the US population at some point in their lives, making it one of the most common and most costly of all illnesses.

Social Anxiety Disorder can develop at any age, but most commonly begins before age 20 years. Often adults with Social Anxiety Disorder had symptoms of extreme shyness as an elementary school child. There is evidence that their temperament as infants may have been more nervous in new situations—indicating that the biological predisposition to Social Anxiety Disorder is often inherited.

Once it develops, Social Anxiety Disorder is usually a long-term illness, even lifelong. Untreated, it is likely to get worse with age, and many of the complications described above are likely to develop over time.

Causes of Social Anxiety Disorder
Social Anxiety Disorder seems to be primarily a biological, genetic illness. Anxiety disorders of all types run in families. Parents with Anxiety Disorder are three times more likely to have children with Social Anxiety Disorder.

The biological trait that is inherited is probably over-sensitivity to normal mental tension. This over-sensitivity is probably due to an imbalance in the brain’s level of serotonin and norepinephrine. As a result, the “fight or flight” reaction (normal in the face of real danger) is triggered too easily, with just normal stress. The fight-or-flight reaction increases levels of adrenalin, increases heart rate, and increases anxiety and vigilance. It is helpful when we must fight or flee in the face of physical danger.

In social anxiety disorder, however, the fight-or-flight reaction is triggered when it is not helpful—in situations of normal tension. The rapid heart rate, anxiety, and high levels of adrenalin then interfere with our thinking and performance. We find this extremely unpleasant, and we will start avoiding situations in which this reaction has occurred.

Early signs of Social Anxiety Disorder can often be seen in infancy, when the child is more fearful of new people and new situations. As the child grows older, this trait develops into severe shyness, at least in certain “performance” situations.

Less commonly, Social Anxiety Disorder can develop later in life, often related to excessive stress.

Treatment of Social Anxiety Disorder
New medication treatments for Social Anxiety Disorder have been developed. These medications improve the “fight or flight” trigger so that the person doesn’t experience severe nervousness provoked by normal situations.

The medications work by increasing the levels of serotonin, and of norepinephrine, in the brain. These brain biochemicals are important for the normal functioning of the brain’s “emotional circuits.” The serotonin-increasing medications work well to reduce the symptoms of Social Anxiety Disorder. Though these medications are called “antidepressants” they are used to treat many types of disorders, including Social Anxiety Disorder. They are safe and are non-addictive. They are usually not even stopped during pregnancy.

Within a few weeks of starting a SSRI medication, you should notice that you feel much more normally calm in social situations. Public speaking, attending parties, talking in small groups, introducing yourself to strangers, eating in restaurants, writing checks in stores—all these activities become much less stressful. As time passes, you become more and more free to engage in all forms of social activities. If depression has been a problem, this improves, too.

Getting Help for Social Anxiety Disorder
If you or a loved-one suffer from symptoms of “shyness” or nervousness that restrict your functioning, you should get an evaluation from a specialist. Untreated Social Anxiety Disorder is unlikely to improve; in fact it is likely to get worse with age. With treatment good results are usually achieved. You can enjoy your career and social life much more. You need not live a restricted life.

A good start toward improvement is to complete the Free Symptom Analysis on this web site. After I review it, I’ll e-mail you (via ZixMail secure e-mail service) my impression of how I can help you; and there’s no cost or obligation.

I specialize in treating anxiety disorders, including Social Anxiety Disorder. I can provide quick, accurate diagnosis and treatment. Click here to read more about my training and qualifications.

At Tate Healthcare Specialists we emphasize fast appointments, and great client service and satisfaction. We work to ensure that your experience with us is enjoyable and that treatment achieves the results you want. We also emphasize cost-efficient care. We strive to get you the maximum improvement at the minimum expense. Click here to read more about our clinic’s philosophy of care and client service.

By the way, an independent audit showed that the total cost of treatment at Tate Healthcare Specialists is 35% less than the Arkansas statewide average. I believe this is because we are more accurate in our evaluation and diagnosis and we use state-of-the-art treatment.

For more information about Tate Healthcare Specialists, or to make an appointment click here or call 800-889-4319.

I’m looking forward to helping you and your loved-ones! Thank you!

Jeffrey L. Tate, MD


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