Social Anxiety Disorder

Social anxiety disorder, also known as social phobia, is a common anxiety disorder that affects many people. People with social anxiety have excessive and unreasonable fears before and during different social situations. With a social anxiety disorder, normal, everyday interactions may cause feelings of anxiety, nervousness, self-consciousness and embarrassment. Individuals who suffer from social phobia may avoid certain social situations because of the overwhelming fear and anxiety that these situations may cause. The anxiety and emotional discomfort caused by a social anxiety disorder may interfere with daily routines, relationships, school or employment.

Symptoms of Social Anxiety Disorder

Symptoms of social anxiety disorder may begin in childhood and can affect people both emotionally and physically. One common early sign is difficulty with separation and, for instance, leaving one's caregivers to head off to school. This continues later in life when one is invited to a 'play date,' tries to play a sport, and subsequently wishes to leave home for college. Any of these development milestones may arouse a great deal of anxiety and one way to feel better is to avoid participating in each of these activities. People with social anxiety disorders feel very nervous and anxious when they are around other people and may find it difficult to hold a conversation. They may worry for days or weeks in advance about events that they may have to interact with other people (for more information on this point refer to my article on narcissistic vulnerabilities by clicking here). Individuals suffering from social anxiety may also have an emotional fear of being judged, watched or embarrassed, which may lead to additional symptoms such as:

  • Profuse sweating
  • Blushing
  • Shaking
  • Confusion
  • Nausea/upset stomach
  • Diarrhea
  • Ulcers

Causes of Social Anxiety Disorder

Like other mental health conditions, the cause of social anxiety disorder is believed to be a result of a combination of environmental and psychological factors. Social anxiety disorders may run in families; however, it is also believed that the link may not only be genetic, but possibly learned behavior passed on from a parent to a child. Not only is it passed on, I must add from my experience with these people, it is induced. In other words, it is not uncommon that people with a social anxiety disorder have learned from an early age that leaving home, separating, is both frowned upon, discouraged, and negatively reinforced. This typically happens because a significant caregiver (like a parent) has unresolved issues around and cannot tolerate the child's developing independence and autonomy.

Disparaging separation can result in the child feeling a heightened sense of responsibility to meet the caregiver's emotional needs. I have found that beliefs develop - oftentimes out of awareness - that they are responsible for other people's feelings, and that their own needs and desires should be subordinated to those of others. As they grow older, these individuals may become excessively self-critical and anxious about the possibility of negative evaluation from others, as they fear that any misstep may lead to abandonment or rejection. In essence, social anxiety can be seen as an attempt to manage the underlying fear of loss and separation from significant others.

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Social Anxiety Disorder Treatment

I have found that psychodynamic psychotherapy is the most effective treatment for social anxiety because it helps people better understand what is actually making one anxious. This allows individuals to have more rational and reasonable thoughts about social situations. Individuals with social anxiety may get short term relief and some benefit from practicing relaxation techniques on their own as well as keeping a journal to track their thoughts and feelings. It is helpful when they can bring these thoughts into session so we can closely examine where they are coming from, what they mean, and how they get so distorted.

In my work with these individuals, the focus is on helping them to explore and work through the underlying causes of their anxiety. This often involves examining the individual's relationship history, including any difficulties they may have had with separation and loss in early childhood. I may help the person to identify patterns of thought and behavior that may be contributing to their social anxiety, and work with them to develop more adaptive ways of coping with their fears. In particular, I may help the person to develop new, more positive ways of relating to others. This may involve developing greater self-acceptance and self-compassion, as well as learning to assert their needs and boundaries in relationships while simultaneously working on being present and appropriately assertive. By developing a more secure sense of self, the individual can begin to feel less anxious in social situations, and more able to connect with others in a meaningful and genuine way. Overall, the psychodynamic treatment approach can be a powerful tool for helping individuals to overcome their anxiety and develop a stronger sense of self and connection to others.

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