Social anxiety

Social anxiety is anxiety (emotional discomfort, fear, apprehension, or worry) about social situations, interactions with others, and being evaluated or scrutinized by other people. The difference between Social Anxiety and normal apprehension of social situations is that social anxiety involves an intense feeling of fear in social situations and especially situations that are unfamiliar or in which you will be watched or evaluated by others. The feeling of fear is so strong that in these types of situations one may be so worried that they feel anxious just thinking about them and will go to great lengths to avoid them.

According to the US National Comorbidity Survey, social anxiety is the number one most common anxiety disorder and is also the third most common mental disorder in the U.S. An estimated 19.2 million Americans suffer from social anxiety disorder and it can occur at any time but most often it surfaces in adolescence, early adulthood, or even early childhood. Statistically it is also more common in women than in men.

It occurs for different reasons. Developmental social anxiety occurs early in childhood as a normal part of the development of social functioning, and is a stage that most children grow out of, but problem or chronic social anxiety may persist (perhaps unnoticed) until adolescence or may surface in adulthood. People vary in how often they experience social anxiety and in which kinds of situations.

Overcoming social anxiety depends on the person and the situation. In some cases it can be relatively easy—just a matter of time passing for many individuals, and yet for some people social anxiety can become a very difficult, painful and even disabling problem that is chronic in nature. The reasons are unknown. Social anxiety can be related to shyness or anxiety disorders or other emotional or temperamental factors, but its exact nature is still the subject of research and theory and the causes may vary depending on the individual. Recovery from chronic social anxiety is possible in many cases, but usually only with some kind of therapy or sustained self-help or support group work.

A psychopathological (chronic and disabling) form of social anxiety is called social phobia or social anxiety disorder, and is a chronic problem that can result in a reduced quality of life. Standardized rating scales such as Social Phobia Inventory can be used for screening social anxiety disorder and measuring severity of social phobia. Overcoming social anxiety of this type can be very difficult without getting assistance from therapists, psychologists or support groups. Social anxiety can also be self-integrated and persistent for people who suffer from obsessive-compulsive disorder, which can also make the social anxiety harder to overcome, especially if ignored.

Some use the terms social anxiety and social phobia interchangeably.

Child development
Social anxiety first occurs in infancy and is said to be a normal and necessary emotion for effective social functioning and developmental growth. Cognitive advances and increased pressures in late childhood and early adolescence result in repeated social anxiety. Adolescents have identified their most common anxieties as focused on relationships with peers to whom they are attracted, peer rejection, public speaking, blushing, self-consciousness, and past behavior. Most adolescents progress through their fears and meet the developmental demands placed on them. More and more children are being diagnosed with social anxiety and this can lead to problems with education if not closely monitored. Research has shown that some students have such severe cases of social anxiety that they are too afraid to speak or interact with other students or teachers. Part of social anxiety is fear of being criticized by others, and in children social anxiety causes extreme distress over everyday activities such as playing with other kids, reading in class, or speaking to adults. On the other hand some children with social anxiety will act out because of their fear which makes it much harder to diagnose. Some cases have been reported where the social anxiety is so bad that it leads to physical illness. The problem with identifying social anxiety disorder in children is that it can be difficult to determine the difference between social anxiety and basic shyness. Often, children with social phobia (social anxiety) don’t want to go to school because of their anxiety.

Ordinary adult form
It is much easier to spot social anxiety in adults because they tend to shy away from any social situation and keep to themselves. Common adult forms of social anxiety include shyness, performance anxiety, public speaking anxiety, stage fright, timidness, etc. All of these may also assume clinical forms, i.e., become anxiety disorders (see below).

The term social anxiety is also commonly used in reference to experiences such as embarrassment and shame. However some psychologists draw distinctions among various types of social discomfort, with the criterion for anxiety being anticipation. For example, the anticipation of an embarrassment is a form of social anxiety, while embarrassment itself is not.

Criteria that distinguish between clinical and nonclinical forms of social anxiety include the intensity and level of behavioral and psychosomatic disruption (discomfort) in addition to the anticipatory nature of the fear. Social anxieties may also be classified according to the broadness of triggering social situations. For example, fear of eating in public has a very narrow situational scope (eating in public), while shyness may have a wide scope (a person may be shy of doing many things in various circumstances). The clinical (disorder) forms are also divided into general social phobia (i.e., social anxiety disorder) and specific social phobia.

Disorder
Extreme, persistent and disabling social anxiety may be diagnosed as social anxiety disorder. The experience is commonly described as having physiological components (e.g., sweating, blushing), cognitive/perceptual components (e.g., belief that one may be judged negatively or looking for signs of disapproval), and behavioral components (e.g. avoiding a situation).

The essence of social anxiety has been said to be an irrational or unreasonable expectation of negative evaluation by others. One theory is that social anxiety occurs when there is motivation to make a desired impression along with doubt about having the ability to do so. Although the "official" clinical name for the disorder, as listed in the DSM and ICD, is Social Phobia or Social Anxiety Disorder, support groups for people who have the disorder (whether through clinical diagnosis or self-diagnosis) often refer to it as simply "social anxiety" or even "SA".

Criteria in the DSM and ICD attempt to distinguish clinical versus nonclinical forms of social anxiety, including by intensity and levels of behavioral and psychosomatic disruption: The validity of the "disorder" diagnosis has been challenged, however, on scientific and political grounds; people satisfying DSM social phobia criteria may simply be temperamentally high in social anxiety rather than suffering from a disorder, although such problems in living in society may still deserve attention as a matter of social justice.

Clinicians and researchers continue to struggle with definitional problems regarding the constructs of shyness, social anxiety, and social anxiety disorder. Each shares similarities, yet each has been used to define distinct aspects of psychological life as it relates to interpersonal functioning and how easy or difficult different cases of social anxiety are to overcome. A continuum describes some of the distinctions yet there is no absolute consensus yet as to where one disorder begins and another ends, although it is widely agreed that there are differences.

Social anxiety disorder may sometimes be symptomatic of an underlying medical disorder, such as hyperthyroidism.

Diagnosis
This disorder is very tricky to diagnose because its so easily confused with general shyness or paranoia. But if symptoms of social anxiety disorder are present, the doctor will ask questions about the medical history and patients will have to perform a physical exam. Although there are no laboratory tests to specifically diagnose social anxiety disorder, there are a variety of tests that can prove whether the cause is a physical or mental illness causing the symptoms. If no physical illness is found, patients will be referred to a psychiatrist or psychologist. Psychiatrists and psychologists use specially designed interview questions and assessment tools to evaluate a person for an anxiety disorder. The doctor bases their diagnosis of social anxiety disorder on reports of the intensity and duration of symptoms, including any problems with functioning caused by the symptoms;if the symptoms and degree of dysfunction are above normal it indicates that it is social anxiety disorder.

Causes
The exact causes of social anxiety are still contested. Ongoing research on the genetic roots of physical and mental health suggests that the tendency toward feelings of anxiety, in social situations in particular, has a moderate probability of inheritance. In other words, if one parent has a mental health disorder such as social phobia, the child has a slightly higher chance of having an anxiety disorder.

Another possible cause of social anxiety is the nervous system. Medications that are prescribed to treat social anxiety affect the levels of neurotransmitters, chemical messengers that are responsible for transmitting signals in the brain. However, researchers are still unsure if the differences in these chemicals cause social anxiety. Several studies have found that certain areas of the brain, such as a small, almond-shaped area called the amygdala, can be more active in individuals with social phobia.

Another possible cause of social anxiety is life experiences. Negative experiences in life, and the way one handles and reacts to them, can also lead to the development of social anxiety. If one is consistently put in situations that make him or her feel inferior or fear the judgment of other people, he or she can begin to develop negative beliefs about himself or herself and the world that can cause social anxiety. If negative experiences continue, one may also begin to develop confirmation bias and tend to pay attention only to the actions and events that will reinforce negative beliefs, creating a snowball effect. For example, a public speaker who is worried about his or her presentation being boring may selectively focus on the few people in an audience who appear bored while completely disregarding the majority of others who are watching with great interest. As the confirmation bias strengthens pejorative beliefs, one tends to start exhibiting socially anxious behaviors such as anxious sensations, like blushing, or anxious thoughts. After a while, these beliefs lead one to make negative assumptions and read too much into neutral situations. If one sees another person glance at him or her as he or she walks by, one may automatically assume that such is on account of strange appearance or an odd manner of walking without considering other possibilities such as that the person's outfit attracts attention or that the person looking prefers to make eye contact with anyone he or she passes.

If one believes that most social situations are going to be uncomfortable, he or she is naturally going to try to avoid them. Avoidance allows one to escape feelings of anxiety temporarily by avoiding an uncomfortable situation, but doing so may strengthen beliefs that one cannot handle social situations normally. This causes one to miss the chance to find out that one may be completely wrong about automatic negative assumptions. If one enjoys singing but fears the judgment of others, he or she may never be able to discover the quality of his or her voice due to constant avoidance.

Avoiding more and more situations for fear of others' judgments will strengthen negative beliefs and prevent one from going into situations where he or she might actually enjoy himself or herself. As this pattern starts to interfere with overall functioning, the warning signs of social anxiety can become more apparent.

Treatment
It is very difficult to treat social anxiety and the treatment needed varies case to case. It is claimed that the most effective treatment available is Cognitive behavioral therapy (CBT), improving symptoms in up to 75 percent of people with social anxiety disorder according to the Mayo Clinic website. The goal of CBT is to guide the patients's thoughts in a more rational direction when faced with anxiety; it helps the person to stop avoiding situations that once caused anxiety, it teaches people to react differently to the situations that trigger their anxiety. Cognitive-behavior therapy may include systematic desensitization or controlled exposure to the feared situation. With systematic desensitization, the person imagines the anxious social situation and works through their fears in a safe and controlled environment. This desensitization gradually exposes the person to the situation but with the support of the therapist, this allows them to become better skilled at coping with these anxious situations and to develop the confidence to face them alone. CBT may also include role-playing to practice social skills and gain the comfort and confidence in order to relate to others. Relaxation or stress management techniques may be included in a treatment plan.

For some patients medication might be used along with CBT. There are several different types of medications used to treat social anxiety disorder, such as antidepressants like Paxil or tranquilizers such as Xanax, Librium, Valium, and Ativan. Beta-blockers, which are often used to treat heart conditions, may be used to mitigate some of the physical symptoms of social anxiety, such as reducing heart rate or blood pressure.

Another more time-consuming approach is psychoanalytic therapy. This can be helpful in identifying the sources of anxiety in childhood, and may also be combined with medication.

In addition to seeking medical help, there are some things that people suffering from social anxiety can do on their own to handle situations likely to trigger social anxiety. Making a deliberate effort to return eye contact when walking past someone or to give someone a compliment will help to build coping skills in social situations even though it may initially be difficult or painful. Changing one's diet may also be of benefit; drinking less caffeine may help reduce some of the symptoms, because caffeine is a stimulant which increases the heart rate.

Communication Apprehension
Social Anxiety causes something called Communication Apprehension, this can be thought of as an‘‘internally experienced feeling of discomfort’’ that causes ineffective communication when in a social or public situation. “Communication apprehension is the level of fear or anxiety associated with either real or anticipated communication with another person”. Early communication researchers described physiological sensations experienced while giving a public speech as "profound discomfort", patients with social anxiety typically experience embarrassment, distressing panic attacks, and self consciousness impairing their speech. According to a study done by Robin and Mills children experiencing social anxiety show issues in social perspective-taking ability, fewer successful problem solving skills, and use less interpersonal problem solutions. This brings up a problem with people who experience social anxiety getting help for their problems. The feelings of embarrassment, inferiority, and shame that social anxiety causes inhibits the ability to seek help. Basically, avoiding social situations because of their fear eliminates the opportunities for social growth which reinforces their fears which will of course lead to more avoiding, creating a pattern that is hard to break. Social anxiety can bring about several problems in the process of language learning because it can hinder the students from mastering the language. An anxious learner will tend to avoid answering questions and being involved in class. Victim feels if he/she would answer they might say the wrong thing in the wrong way and make a fool out of themselves.

Sometimes what can help people with communication apprehension is to imagine the interactions that could happen. Imagined Interactions(II) refer to the cognitive process of individuals indirectly experiencing themselves in anticipated future communication interactions with others through the process of imagination. II's have their theoretical roots in symbolic interactions. The functions of II's is to put into practice the phrase "practice makes perfect". When using II's you can try to anticipate what is going to happen, and by doing this people with low communication skills can try and account for what is going to happen in the upcoming interaction. According to the article "Communication Apprehension and Imagined Interactions", people who practiced II's were less likely to have nonverbal displays of apprehension. e.g. fewer silent pauses, shorter speech on set latencies, and fewer object adapters. II's are said to increase the readiness to communicate and decrease the apprehension associated with a communication episode.

One thing that increase communication apprehension is if the partner is unknown. Some things that can reduce communication apprehension is if someone is extroverted, good self control, high levels of self esteem, and has high willingness to disclose information. These are all things that contribute to helping reduce communication apprehension.