“It is just easier to avoid social situations,” you think to yourself. You avoid people and places because the apprehension churns in your stomach.
Palms become sweaty as the fear of not being understood sticks to your thoughts like pollen to a flower.
According to the Anxiety and Depression Association of America (ADAA), Social Anxiety Disorder, also called social phobia, is an intense fear of being judged, negatively evaluated, or rejected in a social situation.
Symptoms can be so extreme that it can affect the person to the point of disrupting daily life, affecting occupational performance, college completion, and making it difficult to get a job.
Dr. Peggy Skinner, chairperson of the Behavioral Sciences Department and professor of psychology at South Plains College, said that there is also a subtype which specifically relates to performance, such as giving a speech, singing, or acting in front of a group.
“The person might avoid all classes that require participation,” Dr. Skinner explained. “They might avoid parties or social gatherings where they might be talking to others.”
Public speaking is a common fear for young adults, according to Dr. Skinner, and a student might see dropping out of college as a better choice than having to take a speech class.
Amy Morris, behavioral health authority director at StarCare Specialty Health System in Lubbock, said that people might not like going to Walmart, the mall, or eating in front of other people because they are self-conscious.
A fear of eating and drinking in front of people is common with social phobia, as is the fear of using public restrooms, according to the National Institute of Mental Health (NIMH).
“Most of the anxiety is related to the person feeling that others will see them in a negative manner,” Dr. Skinner said, adding that the person is so afraid that it can trigger the fight or flight response or some physical symptoms.
Some of these symptoms may include mind going blank, making little eye contact, or speaking in an overly soft voice.
Other common physical manifestations for social phobia may include sweating, palpitations (where your heart feels like it is beating too hard or fast/skipping a beat), trembling, shaking sensations, chest pain, nausea, faint chills, and fear of losing control/dying, according to Morris.
Morris said those symptoms can lead up to a panic attack if the person does not have appropriate coping skills.
Those who suffer from social phobia can develop major depression and alcohol use, according to ADAA.
“Having social anxiety disorder would be highly distressing,” said Dr. Skinner, “because the person could be very capable and competent and then be too terrified to do things… It is a cycle that then leads to fear of more disapproval and more avoidance.”
Dr. Skinner says that Barbara Streisand stopped performing for years because of anxiety, and Scarlett Johansson avoided performing on Broadway.
According to the ADAA, 15 million American adults are affected by social phobia. It is the second most commonly diagnosed anxiety disorder.
“My Abnormal Psychology textbook states that over 12 percent of the population will suffer from social anxiety disorder at some point in their lives,” said Dr. Skinner, explaining that millions of people will at sometime have this disorder and many others will have symptoms, but the symptoms are not enough to meet the criteria for the disorder.
Symptoms, fear, anxiety, or avoidance, must be going on for at least six months or more, according to the DSM- 5
According to the National Institute of Mental Health (NIMH), social phobia can sometimes run in families. But it is not known why some members have it and others do not.
Underdeveloped social skills are another possible contributor to social anxiety.
Social phobia can be treated by psychotherapy, such as cognitive behavioral therapy (CBT) which teaches different ways of thinking, behaving, and reacting to situations to help one feel less anxious. Support groups may also be helpful to receive unbiased, honest feedback about how others see you. Medication, such as Anti-anxiety medications, antidepressants, and Beta-blockers, can help as well.
Benzos, Ativan, and Xanax are sometimes prescribed as well, but can be addictive, according to Morris.
Dr. Skinner recommended that someone should first try CBT and then use medication if the CBT is not working as expected.
“Seeing a therapist to learn coping skills would definitely be the starting place,” said Morris. “Then, if that is not working and you are still having breakthrough symptoms, then you could see your doctor.”
The toughest part of this disorder may be asking for help, since asking for help is a social action.
“I believe that goes along with any mental health issues,” Morris said. “There is a stigma, and people are embarrassed and afraid other people would not understand.”
Morris added that with social phobia a person might be concerned that if they ask for help, then they are being foolish or insecure.
Asking for help goes along with the fear of people judging you and making an evaluation about you, so that person might just avoid all situations rather than asking for assistance, according to Dr. Skinner.
“If a student feels self-conscious, then going to the Counseling Center could be one more area when the student is afraid to talk to a new person and also fear that others might see them going into that office,” said Dr. Skinner.
Despite the availability of treatments, fewer than 5 percent of people with social phobia seek treatment, according to the ADAA, and more than a third of people say they have had symptoms for 10 or more years before seeking help.
Morris said some ways to self-treat, if one is unable to get professional help, include practicing yoga and meditation.
“There is a lot of things out there, like apps that you can use,” she added.
According to Psychology Today, one of the first steps in self-help is to realize that anxiety is natural. Anxiety is a natural response when perceiving something as dangerous.
The second thing to realize is that anxiety is not reality. Social anxiety comes from thoughts that exaggerate danger.
The third step one should take is relabeling. Instead of saying, “I’m getting anxious,” say “I’m getting excited.”
The fourth step is to breathe deep and slow from the abdomen. Once you alter breathing, shift your focus to the thing you are doing instead of focusing on the fact that your hands are shaking.
Be willing to experience discomfort and try to tolerate uncertainty. Challenge your anxious thoughts by doing the thing that is causing it. Most importantly, reward yourself, and start taking your life back one step at a time.