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Social Anxiety Disorder

Social Anxiety Disorder

In this blog we will be revisiting the topic of Social Anxiety, including a couple of updates from the new DSM 5, or the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

Social Anxiety Disorder, which was formerly called Social Phobia, is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations. Anxiety (intense nervousness) and self-consciousness arise from a fear of being closely watched, judged, and criticized by others.

A person with Social Anxiety Disorder basically feels fearful that he or she will make mistakes, look bad, and be embarrassed or humiliated in front of others. The anxiety can be severe enough to build into a panic attack. As a result of the fear, the person either tries their best to endure certain social situations even though they are in extreme distress, or may avoid them altogether. To receive a diagnosis of Social Anxiety Disorder, the anxiety must be “out of proportion” to the actual threat or danger the situation poses. Symptoms may include blushing, sweating, heart palpitations, trembling, dizziness, and nausea.

People with Social Anxiety Disorder often suffer “anticipatory” anxiety — the fear of a situation before it even happens — for days or weeks before the event. Most of us may feel nervous before a job interview or a public presentation. For the person with Social Anxiety Disorder, the way they feel is far beyond a simple case of nervousness. It can be crippling, and can prevent the person from fully participating in their own lives.

In many cases, adults tend to be aware that the fear is unreasonable, but they are unable to overcome it on their own. Children may not have the maturity yet to recognize that their anxiety is extreme.

People with Social Anxiety Disorder may be afraid of a specific situation, such as speaking in public. However, most people with Social Anxiety Disorder experience fear more than one social situation. Other situations that commonly provoke anxiety include:

  • Eating or drinking in front of others.
  • Writing or working in front of others.
  • Being the center of attention.
  • Interacting with people, including dating or going to parties.
  • Asking questions or giving reports in groups.

Although worries about some of these situations are common, people with Social Anxiety Disorder worry excessively about them before, during and after the event. They fear that they will do or say something that they think will be humiliating or embarrassing, or that those around them are judgmental or critical.

Social Anxiety Disorder can have a negative impact on a person’s functioning, disrupting normal life, interfering with social relationships and quality of life and impairing performance at work or school. People with Social Anxiety Disorder may misuse alcohol or drugs to try to reduce their anxiety, and in some cases, alleviate depression which can co-occur with anxiety.

Social Anxiety Disorder can sometimes be linked to other disorders, such as Panic Disorder, Obsessive Compulsive Disorder, and depression. Without treatment, Social Anxiety Disorder can negatively interfere with the person’s normal daily routine, including school, work, social activities, and relationships.

Treatment for Social Anxiety Disorder

As with most mental health disorders, there is no one answer for the best way to treat each individual case. Nor is every person with Social Anxiety Disorder the same. That said, I will do my best to give you an overview of the most common thinking about the disorder, and some links below where you can investigate and learn more.

People with Social Anxiety Disorder are thought to suffer from distorted thinking, including false beliefs about social situations and the negative opinions of others. I can give you a couple of examples to help this make sense. A faulty thought which can contribute to anxiety looks like “If I speak up in this meeting and ask my question, I will look like a fool.” Or “I am no good with making conversation. People at this party are going to hate me.”

That leads me to one of the most widely accepted therapies for Social Anxiety, which is Cognitive Behavioral Therapy. If we can work with you to help clear up any distortions in your thought patterns, improve your self-concept, and develop a realistic perception of the likelihood that others are evaluating you in a negative way, it can help develop new ways of thinking that are more realistic and healthy.

We also sometimes include assertiveness and social skills training in helping people overcome Social Anxiety. There may be a genuine sense of not knowing what to say or do in social or work situations. Speaking up or meeting someone new can be stressful if you aren’t sure how to do it.

Relaxation training can be an enormous help in dealing with any type of anxiety. We work with clients to help them recognize the signs that they are becoming anxious, and then set up steps to relax and calm any fears.

Finally, there is medication available to help with anxiety, usually in conjunction with the therapies I have already mentioned. My suggestion in most cases is to try therapy first, and if we don’t see improvement within an agreed-upon period of time, we will discuss a referral to a physician who can prescribe medication.

As I mention often, I want to know what my client with anxiety is eating or drinking. If you feel anxious, and you are drinking coffee or soda with caffeine every day, your symptoms are likely to be worse. I would say the same for a diet with lots of sugar and processed food. There does seem to be a correlation between diet and mental health – be kind to your body, feed it nutritious food, and chances are your mental health will benefit as well.

Thank you for reading, and feel free to add your comments below about Social Anxiety Disorder.

Video on this topic: http://youtu.be/Wma-UXKVfNg

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