Social Anxiety Disorder is a common form of anxiety illness found in about 7% of the U. S. population. It most commonly starts during the teenage years, but it can be found in children. It is unusual for it to first begin during adulthood.
The basic feature of this condition is marked fear in social situations that is excessive for that situation compared to most people. To be a disorder the fear of social situations must lead to significant emotional distress and/or impair normal functioning, for example, preventing someone from seeking a job.
What lies behind the fear of social situations is the belief that others will judge them negatively so that they will be severely embarrassed or rejected. Examples of feared judgments that are listed in the Diagnostic and Statistical Manual of Mental Disorders, Edition Five (DSM V) are: appearing "anxious, weak, crazy, stupid, boring, intimidating, dirty, or unlikeable." It is understandable that someone with such fears would avoid social situations.
If someone fears social situations because they have a psychiatric or other medical disorder that is obvious such as a severely burned face, they are not considered to have a disorder since the fear of social situations is not unrealistic.
Social Anxiety Disorder in children may show up as having temper tantrums, crying, clinging to parents, holding back, or not talking in front of strangers. These symptoms must be associated with social situations to consider them as possibly due to this disorder. Being fearful of adult strangers is not abnormal for children so those situations do not count toward having the disorder. Also, it is normal for kids to have transient social fears. A diagnosis of Social Anxiety Disorder cannot be made unless the social fears persist for at least 6 months.
What distinguishes this disorder from ordinary shyness? A shy person is socially reticent, which is just a personality trait and is not pathological. That is because it usually does not lead to marked distress and it does not impair normal functioning. A shy person may be reluctant to speak in a social situation in which they don't know many people, but they lack the clear, conscious fear of being judged negatively.
There are many negative consequences of having this disorder. Teenagers may develop a fear of going to school and may even drop out. Adults may be underemployed. Such individuals may be lonely, are less likely to marry or have children, lack assertiveness, underachieve, have decreased well-being, and may have a substance abuse disorder such as alcoholism. This last issue may be a consequence of using alcohol to "self medicate" in order to reduce social anxiety. Interestingly, this disorder is a common cause of the "shy bladder syndrome," in which the person cannot urinate in a public bathroom.
Teenagers with this disorder have extra challenges since this is when peer relationships are very important and such adolescents may not socialize with anyone. Parents should be concerned if their teenager rarely if ever goes out with friends. They may say that parties are boring or too loud. Also, teens have to cope with the psychological and physical changes that occur with puberty.
Treatment is often delayed since people wait as long as 15-20 years before they seek help. Therapy is usually quite helpful and typically involves cognitive and behavioral approaches, which may include "homework assignments." Medication can also help. The Selective Serotonin Reuptake Inhibitors (SSRI) such as fluoxetine (Prozac) are commonly used. Another medication, buspirone (Buspar) can be given along with the SSRI and make it more effective. For patients with severe forms of the disorder the use of another class of medications called MAO inhibitors can be very helpful.
If you or someone you know has symptoms of this disorder, it could make a big difference if an evaluation by a mental health provider is sought.
