Social anxiety disorder (SAD) involves a fear of social and performance situations in which others may judge you negatively. Most people with the disorder are extremely self-conscious, and may have physical symptoms such as nausea, shaking, or feeling faint when around people or performing.
Types of Social Anxiety Disorders
The current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) differentiates between generalized versus specific SAD by adding the specifier “performance only” in the case that a person diagnosed with the disorder only experiences anxiety in performance situations.
Generalized Social Anxiety
Persons with generalized social anxiety are described as having fears about most social and performance situations, including the following:
- speaking to authority figures
- going on dates
- starting conversations
- or giving speeches
People with generalized social anxiety are thought to be uncomfortable around anyone but their closest family members or friends. Generalized SAD is considered to be more severe than performance only SAD and is usually accompanied by greater impairment in day-to-day functioning.
Performance-only Social Anxiety
On the other hand, a person with “performance only” SAD will have anxiety and fear linked to performance situations only. For instance, a person could have a fear of public speaking but experience no anxiety in casual social gatherings. This form of social anxiety can still be extremely harmful, as it may limit you from career advancement or other performance-related achievements. However, people who only fear performance situations tend to be different from those with more generalized SAD, in terms of how old they are when they first experience anxiety, what physical symptoms of anxiety they experience, and how they respond to treatment.
Symptoms and Diagnosis of Social Anxiety Disorder
The symptoms of social anxiety disorder fall into three categories: physical (e.g., blushing, sweating, and shaking), cognitive (e.g., negative thoughts and beliefs), and behavioral (e.g., avoidance and safety behaviors). A diagnosis of social anxiety disorder requires that a number of specific criteria are met in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Causes of Social Anxiety Disorder
The causes of social anxiety disorder are believed to be a combination of genetic factors, environmental factors (e.g., observational learning), societal factors (e.g., cultural influences), and brain structure/biological factors. While these factors may involve risk for developing the disorder, not everyone who has one or more risk factors will be diagnosed with SAD.
Treatments for Social Anxiety Disorder
Regardless of whether you have generalized or performance-related symptoms, effective treatment is available for social anxiety disorder. Cognitive-behavioral therapy (CBT), a form of psychotherapy that addresses current problems and reframes negative thinking, can be very helpful.
Through CBT, you will learn strategies and techniques to help you cope with different situations. After completing cognitive behavioral therapy, many people with anxiety say that it changed their lives and opened doors for them; they can do things they never thought they could, like travel or perform in front of others.
In some cases, particularly for those with more severe generalized social anxiety disorder, your doctor may recommend that you try medication. This can help to calm your mind and suppress negative self-talk, allowing you to focus on therapy and begin to make progress.
Look for a therapist who specializes in anxiety disorders. Without a background in these conditions, your therapist may not fully understand your symptoms or may minimize or too easily dismiss what you are feeling. A healthcare provider who understands social anxiety disorder and cognitive behavioral therapy will work with you to develop effective strategies to manage the disorder.
Self-Help Strategies for Social Anxiety Disorder
Self-help strategies for social anxiety disorder include social coping strategies such as learning to be assertive, emotional coping strategies such as learning to calm panic when it starts, and day-to-day coping strategies such as asking for accommodations at work. Self-help strategies are best used for mild to moderate social anxiety.
Social Anxiety Disorder in Children and Teenagers
Social anxiety disorder in children and teens may appear differently than in adults. Young children with the disorder may cling to a parent, have a tantrum when forced into a social situation, refuse to play with other kids, cry, or complain of an upset stomach or other physical problem. In some cases, children may even be too frightened to speak in certain situations. In contrast, adolescents with SAD may avoid group gatherings altogether or show little interest in having friends.
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