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Social phobia, also known as Social Anxiety Disorder (SAD), is not simply extreme shyness.
Many people experience some shyness and discomfort, especially in new situations or with unfamiliar people. However, it’s generally tolerable once you warm up and relax after a while. Unlike shyness, such conditions are intolerable for SAD sufferers who find it nearly impossible to relax in social or performance settings.
The Myth
In fact, the belief that people with SAD typically retreat into the background, are often silent, tend to be socially unsophisticated, and generally isolate themselves is a myth. Of course there are social anxiety sufferers with such characteristics. However, many patients I’ve treated with debilitating SAD are quite competent socially, and some of the adolescents are even popular kids or star athletes at school.
Features of SAD
How are these socially competent, popular individuals diagnosed with SAD? The often misunderstood component is the “performance” condition.
Social anxiety sufferers intensely fear being rejected, criticized, judged, or simply perceived unfavorably when having to perform. Although these presumed negative consequences can occur in “social” situations, not all social environments require you to “perform.”
Thus, an individual with SAD can be socially sophisticated until he or she imagines the possibility of being disapproved of while having to perform (e.g., giving a speech, playing piano at a recital, kicking a goal at a soccer competition). As such, social phobia does not equal mere shyness.
Reverse Narcissism
Individuals with SAD experience what I call “reverse narcissism.” While those with narcissism have an inflated sense of self and direct the spotlight onto themselves, people with social anxiety have a deflated sense of self and avoid this illusory spotlight.
Because SAD sufferers believe all attention is focused on them with ready criticism toward any mistake made (real or imagined), they often exert much effort to avoid social/performance situations at all costs. If unavoidable, they may become overwhelmed with intense anxiety that can lead to physiological reactions, such as a racing heart, hyperventilation, sweating, nausea, dizziness, headache, and stomachache—and result in a panic attack.
Consequences of SAD
The most important distinction between SAD and shyness is that social anxiety disorder debilitates one’s functioning, and not just socially. In adults, social anxiety can impair one’s work functioning and cause conflicts in family life. In children, social anxiety can interfere with academic achievement, school attendance, social hobbies, and making friends. Furthermore, the lack of self-confidence of social anxiety sufferers tends to result in poor assertiveness skills, and often leads to other psychiatric conditions, such as depression, anxiety disorders, and substance abuse.
Effective Treatment
The most important precursor to any successful treatment is psychoeducation. Once the sufferer and involved family members or significant partners understand the vicious avoidance-reinforcement cycle of the disorder, Cognitive Behavior Therapy (CBT) is the evidence-based treatment for SAD.
CBT teaches patients what causes them to feel anxious and provides tools to control anxiety. Patients learn effective skills through relaxation and mindfulness training, role-playing, and social skills training. Systematic exposures increase sufferers’ ability to face their fears, while cognitive restructuring teaches them to identify negative thinking patterns that contribute to anxiety.
Conclusion
Although SAD is the third most common mental health disorder affecting as many as 10 million Americans, there is effective help. Social anxiety doesn’t have to result in debilitating impairments.
If you suffer from SAD or know of someone who does, there is no time like the present to get the relief and freedom to live an engaging life. Why let social anxiety get in the way of all life's possibilities?
