The Truth Behind Social Anxiety Disorder
Virtually everybody has experienced some symptoms of a social anxiety disorder (SAD) before. It is normal to feel nervous before a job interview — Or embarrassed because you made an offensive joke at your work party, causing everyone to glare at you judgingly — even though the joke sounded way funnier in your head. This article is for people that suspect themselves or a friend of having SAD or are just interested in learning more about social anxiety in general.
What are the Causes?
Your risk of developing social anxiety disorder (SAD) is strongly influenced by genetic and environmental factors.Living circumstances and other health conditions can affect your individual chances of having social anxiety. SAD often results from several different factors.
Alike to other anxiety disorders, social anxiety stems from poor experiences — in this case with people. For instance, many people experience OCD related symptoms towards cleanliness, after getting a contamination related infection. On the other hand, social anxiety could stem from growing up with an overly critical parent.
Genetics and Family History
Genetics plays a large role in developing SAD. The serotonin transporter gene “SLC6A4” is strongly correlated with SAD and obsessive-compulsive disorder (OCD). This is interesting because the comorbidity rates between OCD and SAD have been reported at 11%.
Serotonin is a neurotransmitter, which sends signals to your brain that help regulate your mood. Issues with neurotransmitter releases can contribute to anxiety, depression and other mood disorders.
An AI institute of Human Genetics affiliated study used a single-marker analysis to genotyped 321 patients with SAD, and 804 controls without any type of social phobia. Then they genotyped both workers using single-marker analyses quantitative association analyses.
Study results provided evidence for “SLC6A4” being correlated with social anxiety. There appears to be a polymorphism (genetic mutation) that occurs in SLC6A4 which is correlated to social anxiety.
There was another study done by the Norwegian Institute of Public Health (NIPH), to determine the relation between genetics and SAD. They sampled approximately 3000 Norwegian twins, in their 20s, and then again in their thirties.
When the twins were examined in their 20s, four percent were diagnosed with SAD and nine percent had SAD related symptoms but weren’t diagnosable. Ten years later five percent of the same group had SAD, and about nine percent had related symptoms.
Surprisingly, about two-thirds(66%) of people that had social anxiety in their twenties, no longer met the diagnostic criteria when they were interviewed in their thirties. People with SAD should be relieved at this information since the disorder has been proven to be so unstable —Not last as long.
The researchers claim that genetics doesn’t exactly cause SAD. Instead, genetics leads to personality traits that put you at high risk for the disorder such as, introversion and low emotional stability.
Fortunately, NIPH claims that the environment causes a short-term impact on social anxiety. Meaning that the effects of being bullied, or losing a job may last for a limited duration.
Because some could argue that negative events could lead to an indefinite spiral in the wrong direction, this is a controversial claim. For instance, being verbally abused could lead to negative-self talk that can follow you indefinitely, without the help of a medical professional
While on the other hand, NIPH claims that genetic factors can determine the risks of having social anxiety in the long-term. Novik (NIPH) says “Although the genetic risk is long-lasting, it does not mean that you have to live with the symptoms. There are good treatments for SAD. The treatment involves exposure to feared situations and acknowledging your anxiety.”.
Abusive parenting is one of the root causes of developing SAD. It is much more likely for you to thrive in social situations, when being raised in a safe and supportive environment.
If you grew up in a verbally abusive household or raised by narcissists, then you are at a greater risk of having SAD. Many old-school parenting techniques follow the old trope “sticks and stones may break your bones, but words shall never hurt you”, but verbal abuse can lead to life-long invisible scars.
Victim of verbal abuse can find themselves feeling confused and lonely because the severity of verbal assaults is often downplayed. You experienced verbal abuse if you’ve been criticized or insulted in a hostile manner.
Verbal abuse in children leads to adults that are overly self-critical of themselves according to Florida State University study. This is because the negative self-thoughts are taught to the child by the abuser (e.g. you are stupid). People who were verbally abused experience 1.6 times as many anxiety and depression symptoms.
Examples of verbal abuse include:
- Constant criticism
- Silent-treatment or stonewalling
- Threatening, even if they don’t follow through
- Being Manipulative
Emotional Neglect and Abuse
A history of emotional abuse or neglect are what links many people to SAD. Journal of Anxiety Disorders report over 50% of people with SAD experienced emotional abuse in their childhoods. 39% of those with SAD experienced a childhood of emotional neglect.
They also report that someone with a history of childhood emotional abuse had a stronger relation is more likely to be diagnosed with SAD, compared to physical or sexual abuse.
Many people see parenting as a figurative field of landmines that are filled with things you should refrain from, in order to avoid being an abusive parent. Emotional neglect occurs when a parent fails to tend to, act upon, or notice your feelings as a child.
Examples of emotional neglect include:
- Not feeling listened to
- Parents fail to notice when you’re sad, angry, anxious
- Not giving enough attention
- Lack of questions about your wants, needs or preferences
Emotional abuse is a tool used to chip away at your self-esteem. The abuse is harsh and overly critical.
Examples of emotional abuse include:
- Playing down accomplishments
- Making fun of your appearance
- Constantly monitoring your whereabouts, also known as “helicopter parenting”
- Making important decisions for you
- Treating you like a child
- Denying abuse, also known as gaslighting.
How Does Social Anxiety Affect your Life?
The thoughts and feelings that come with SAD affect many people’s ability to live a functional life. You may isolate yourself, due to an intense fear of social situations, or activities involving social interactions. Watching other people navigate social situations with ease might leave you in awe. Especially when your anxiety causes you to hold back on telling a joke, or give a personal opinion due to fear of embarrassment.
How social anxiety disorder can affect your life:
- Low self-worth
- Negative thoughts
- Hypersensitivity to criticism
- Poor social skills
Everybody has experienced being anxious in social situations before. You might be nervous when being introduced to your significant other parents, or when your boss introduces you to a prized client. Most people don’t avoid situations like these but usually move past them.
Anxiety becomes an issue when it is irrational, also when you avoid situations that are important to you (interviews, school, health checkups, etc.). Thus, it prevents you from living a happy and fulfilling lifestyle.
Having SAD can make the stress and fear of these situations overwhelming. You may avoid social contact completely because you struggle with daily life things that most “normal” people can do, making eye contact and small-talk. This could not only affect your social life but physical health, romantic relationships, career goals, etc.
When Does it Start?
SAD develops at a relatively young age, usually around the age of 13. SAD is linked to abuse, bullying, and teasing, which is more common during the formative years. Children that are shy, or have overbearing parents, are more likely to develop SAD into adulthood.
Situations that may trigger your social anxiety:
- Public speaking
- Eye contact
- Entering a room when everyone is seated
- Entering a room full of strangers
- Eating in front of others
- School or workplace
- Parties or concerts
- Public Restrooms
Not being triggered by some of these situations is still normal if you have social anxiety. For instance, many people with SAD are excellent public speakers but are terrified of parties. Others are triggered by a crowded classroom but thrive in one-on-one conversations.
For instance, many stand-up comedians are socially anxious and are awkward off stage. Award-winning comedian Bill Burr confidently performs in front of thousands of people but admitted that when he would go to parties with his wife, he’d often find himself sitting in a corner: not talking to anybody.
People with social anxiety share different reasons for dreading certain situations.
Generally speaking, SAD is an overwhelming fear of:
- Being negatively judged
- Having all eyes on them
- Fear of public embarrassment or humiliation — And it being obvious by sweating, shaking, stuttering, blushing
- Offending someone by accident
- Being the focus of attention
How Does it Feel?
Having SAD is a different experience based on the individual
Here are some physical signs and symptoms of SAD:
- Stomach aches
- Trouble controlling worry
- The overwhelming need to escape
- Shortness of breath
- Rapid heart-rate
- Sweaty Palms
Anxiety symptoms may flare up right before a social event, or in the days leading up to it. After the event passes, you may spend mental energy contemplating on how you acted. Many people contemplate about past-events right before going to bed, which negatively affects their sleep. You can check out this article on dealing with anxiety when trying to fall-asleep(here)
Can it be Treated?
SAD is a highly treatable condition. Many people with SAD are able to completely overcome their fear and anxiety once they find a treatment plan that works for them. The treatment you receive is based on your ability to function in everyday life. The two common types of treatment include psychotherapy(talk therapy), medications, or both.
Psychotherapy can improve the symptoms of most people who have SAD. Therapy helps you deal with negative thoughts of yourself, and work on needed skills to improve confidence in social situations.
Cognitive Behavioral Therapy(CBT) is known as the most effective type of psychotherapy for social anxiety. It can be done one-on-one or in group sessions. For exposure-based CBT, you face situations that may cause anxiety, and work up to being able to deal with situations that cause the most fear.
There are several types of medications available for those suffering from social anxiety. Some of these medications are simply short-term solutions to anxiety and not one-stop cures.
Antidepressants: The first drug that is usually prescribed for social anxiety patients is a serotonin reuptake inhibitor (SSRI), also known as an antidepressant. Common SSRIs are Zoloft and Paxil.
Antidepressants are given in low doses. Intake is gradually increased, to lower the risk of side effects. It may take several weeks to months to notice the improvement of your social anxiety symptoms.
There are many different types of antidepressants, some work better, and have fewer side effects based on the user.
Anti-Anxiety Medications: Benzodiazepines are fast-acting drugs that may reduce anxiety symptoms. These drugs are easily habit-forming, leaving risk for addiction. They are usually prescribed as a short-term solution, common names for these medications are “Xanax” or “Valium.
Beta-blockers: These work by blocking the effects of adrenaline when you’re in an anxious situation: rapid heart rate, pounding heart, shaky voice, trembling. Therefore, beta-blockers are used infrequently to deal with specific situations, like before a public speech. Beta-blockers aren’t recommended for the general treatment of SAD.