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Social Anxiety Disorder (SAD), also referred to as social phobia, is a common condition that can often be hard to diagnose and may even be confused with other mental health issues. Individuals with SAD tend to feel extremely nervous or fearful when questioned or when in social settings. They may also exhibit physical signs of anxiety such as trembling, sweating, or blushing. There are several common signs to look for if you suspect that you or a loved one may be dealing with social anxiety.
Steps
Understand Social Anxiety Disorder (SAD)
Learn about the symptoms of SAD. Understanding the common symptoms of SAD will help you identify this disorder. Those affected by SAD often experience overwhelming fear in situations where they are confronted with strangers or when others are watching and evaluating them. These situations include: speaking in front of a crowd, giving a presentation, meeting new people, and engaging in social interactions. People with SAD may react to these situations by:
- feeling intense anxiety
- avoiding the situation
- experiencing physical symptoms of anxiety like blushing, trembling, or nausea
Distinguishing between normal anxiety and social anxiety. Everyone experiences anxiety at times. Unfamiliar situations or scenarios like speaking or interacting in front of a crowd or being observed by others can trigger some anxiety. This kind of anxiety helps you prepare for what's ahead. However, problems arise when these fears and anxieties become overwhelming, irrational, and/or force you to avoid or flee from the situation.
- Signs of normal anxiety include: fear before speaking in front of an audience, giving a presentation, or performing; feeling shy and awkward when meeting strangers; discomfort starting a conversation or engaging socially.
- Social anxiety disorder includes signs such as: extreme fear and dread of failure, physical symptoms like sweating, shaking, and rapid breathing; negative thoughts about self-expression; excessive fear when interacting with strangers; intense worry and the strong desire to avoid the situation at all costs; refusing social invitations out of fear of embarrassment or rejection.
Consider the risk factors for developing SAD. Some people are at a higher risk of developing SAD due to experiences, genetics, and personality traits. Having one or more of these risk factors doesn’t guarantee you’ll develop SAD, but it does increase the likelihood. If you already have SAD, recognizing the risk factors can help you understand what contributed to the disorder.
- Bullying. Childhood humiliation or trauma, such as being bullied, can lead to social anxiety and fear. Additionally, a sense of disconnection from others may contribute to the development of social anxiety.
- Genetic factors. Growing up with parents who exhibit social anxiety traits can increase your risk. When caregivers struggle with social situations, they may create an avoidant environment for their children, limiting the development of social skills and encouraging avoidance behaviors.
- Shyness. Shyness is a personality trait and not a disorder, but many people with social anxiety are also shy. However, it’s crucial to understand that social anxiety disorder is far more severe than normal shyness. Shy individuals do not experience the same level of distress as those with social anxiety disorder.
Understand the connection between SAD and other mental health issues. Several mental health conditions are linked to SAD, and SAD can even cause or worsen other problems. It’s essential to recognize the other issues that may be confused with or associated with SAD.
- SAD and panic disorder. Panic disorder involves physical responses to anxiety that often resemble a heart attack. While SAD differs from panic disorder, the two can occur simultaneously. One reason for confusion is that those with panic disorder often avoid social situations to prevent panic attacks when they feel watched or judged. People with SAD avoid social situations due to fear.
- SAD and depression. Depression is a common co-occurring condition with SAD, as people with SAD often limit social interactions. This isolation can create feelings of loneliness, which may trigger or exacerbate depression.
- SAD and substance abuse. A significant percentage of individuals with SAD also struggle with alcohol or substance abuse. Around 20% of people with SAD also experience alcohol-related issues. This may be due to the anxiety-reducing effects of alcohol and stimulants in social situations.
Identifying SAD in social environments
Pay attention to the fear. Do you feel overwhelmed with fear at the thought of being questioned at a social event? This fear may stem from being asked personal questions in front of others, or even from being invited to any social event. If you have SAD, this fear will consume your thoughts and make you panic.
- For example, if you have SAD, you may feel terrified when a friend asks you something in front of strangers.
Pay attention when you feel socially awkward. A common symptom of SAD is an overwhelming sense of shyness that affects how individuals interact with others. Those with SAD often fear that they will embarrass themselves or be rejected in some way. If you feel incredibly awkward in social situations, or struggle to interact or speak in front of a crowd, you might be experiencing social anxiety disorder (SAD).
- For instance, if you feel like you have nothing valuable to contribute during a discussion about a topic you're passionate about, it's likely a sign of social anxiety. Instead of offering your ideas or perspectives, you're consumed by thoughts that others may not like your appearance or may not perceive you as intelligent.
Think about whether you avoid social environments. A common trait of those with SAD is the tendency to avoid situations that force them to speak or engage in social interactions. If you find yourself going to great lengths to avoid social interaction or speaking in front of others, you may have social anxiety disorder.
- For example, if you're invited to a party but decline because you're overly anxious about interacting with others, this could be a sign of social anxiety disorder.
Notice if you often remain silent during discussions. Individuals with SAD often withdraw during conversations because they are afraid to express their thoughts. They worry that what they say will upset others or lead to ridicule. If you frequently find yourself silent in conversations out of fear, it could be a sign of SAD.
- For instance, when engaged in discussions, do you notice that your voice fades over time and you avoid eye contact with others?
Recognizing SAD in school or the workplace
Monitor when you begin to worry about an upcoming event. People with SAD often start worrying about a speech they have to give or a social event they will attend, even weeks before it actually happens. This anxiety can cause digestive issues, such as loss of appetite, and sleep disturbances. While feeling anxious the day before or in the morning before a presentation is completely normal, starting to feel anxious weeks in advance is typically a sign of SAD.
- For example, if you have a presentation two weeks away and you’ve already prepared your speech, you might feel relatively calm. However, someone with SAD might lie awake at night, stressing about the presentation weeks in advance.
Reflect on your involvement in class or meetings. A common sign of social anxiety disorder (SAD) is the reluctance to participate in class or meetings. This can show up as avoiding raising your hand to ask or answer questions or choosing solo projects over group work. People with SAD tend to shy away from group work because they fear judgment from other members.
- For example, if you avoid raising your hand in class even when you don’t understand the material, it could be a sign of social anxiety disorder.
Pay attention to physical symptoms of anxiety. Those with SAD often exhibit both mental and physical signs of anxiety. These physical symptoms can include blushing, sweating, trembling, shortness of breath, and numbness.
- For instance, if you’re called on in class and you know the answer, but instead of answering you start blushing, sweating, and struggling to breathe, it might indicate social anxiety disorder.
Think about whether you ever change your opinion to avoid sharing your thoughts. People with SAD often change their opinions to avoid having to defend their thoughts. They try to escape the discomfort of feeling isolated or being questioned.
- For example, imagine you’re working on a group project, and someone suggests an idea that’s not as good as yours. You might choose to follow their less effective idea simply because you don’t want to be questioned or have to explain your own idea.
Reflect on how you feel about public speaking. Those with SAD will go to great lengths to avoid speaking in public, giving speeches, or any situation where all eyes are on them. Think about how you feel about speaking in front of others and how often you go out of your way to avoid it.
- In such situations, you might think: What if I forget what I’ve prepared? What if I freeze up in the middle? What if my mind goes blank during the presentation? What will people think? Will they laugh at me? I’ll look foolish.
Identifying SAD in children
Understand that children can develop SAD. While SAD commonly manifests during adolescence, it can also appear in younger children. Just like adults with social anxiety disorder, children with SAD fear judgment or criticism to such an extent that they may try to avoid certain social situations altogether. It’s not just a "phase" or bad behavior.
- Children with SAD may express their fears through phrases like, "What if I look silly? What if I say something wrong? What if I mess everything up?"
Distinguish between SAD and shyness in children. Just like in teens and adults, childhood SAD is not simply shyness. It’s normal for a child to feel anxious in unfamiliar situations, and after exposure to the situation with the support of parents and friends, they can often overcome it. However, SAD inhibits a child's ability to interact socially. Children with SAD might avoid school, refuse to speak in class, and shy away from parties, among other things.
- Children with SAD are terrified of criticism from both peers and adults. This anxiety often interferes with daily activities as they avoid stressful situations. Some children may cry, scream, hide, or act out in other ways to escape these situations. Physical reactions like trembling, sweating, and rapid breathing may also occur. If these symptoms last more than six months, it's considered SAD.
- Shy children might sometimes avoid certain activities or show mild anxiety in specific situations, but this nervousness isn't as overwhelming or prolonged as in children with SAD. Shyness doesn't hinder a child’s enjoyment like SAD does.
- For example, presenting an analysis in class may be difficult for a shy child, but they can still do it when needed. However, a child with SAD may refuse the task due to extreme fear or even skip school to avoid it. This behavior can be misunderstood as misbehavior, but the root cause is fear.
Observe how children interact with others. SAD often causes children to feel extremely uncomfortable or even terrified when interacting with adults and other children. Even simple conversations with relatives or playmates can cause them to cry, throw tantrums, or withdraw.
- Children may express fear of strangers, refuse to meet new friends, or avoid places where strangers are present.
- They might also refuse or try to avoid attending events with other people, especially in crowded places like field trips, playdates, or extracurricular activities.
- In severe cases, children may experience panic even in seemingly simple social interactions, such as asking a friend for a pencil or responding to someone at a store. They could exhibit symptoms like a racing heart, sweating, chest tightness, trembling, nausea, rapid breathing, and dizziness.
Ask teachers about your child’s behaviors at school. Children with SAD may have difficulty focusing and participating in class because they fear judgment or poor grades. Activities that require interaction or performance, such as giving presentations or speaking in front of the class, may seem "impossible" for these children.
- Sometimes SAD co-occurs with other disorders, such as attention deficit hyperactivity disorder (ADHD) or learning disabilities. It is important for the child to be evaluated by a mental health professional to accurately identify the issue and determine the best approach for treatment.
Understand the challenges of diagnosing SAD in children. Identifying SAD in children can be difficult because they often struggle to express their feelings and may act out in response to fear. Children with SAD might exhibit behavioral issues or skip school as a way of coping with their anxiety. In some cases, the fear associated with SAD may even manifest as tantrums or crying.
Check if your child is being bullied. Bullying can be a trigger or exacerbating factor for social anxiety in children. It is a major risk factor in the development of social anxiety disorder, so it's very likely that your child may be dealing with some form of bullying. You should talk to your child’s teacher or supervisor when they are among other children to find out if bullying is taking place and plan an intervention.
Managing SAD
Practice deep breathing. When you're stressed, you may notice your heart racing, sweating, muscles tensing, and shallow breathing. Deep breathing helps reduce these negative symptoms by calming your nervous system.
- Start by placing one hand on your chest and the other on your stomach.
- Breathe in deeply through your nose, counting to 7 as you inhale.
- Then exhale through your mouth, counting to 7 while tightening your abdominal muscles to push all the air out.
- Repeat this process 5 times, each breath taking about 10 seconds.
Stop negative thinking. Negative thoughts can worsen social anxiety, so it’s important to stop yourself when these thoughts arise. The next time negative thoughts come up, don’t just wait for them to pass. Take a few minutes to analyze and try to spot where they’re flawed.
- For example, a negative thought might be, “I’m going to look like a fool in front of everyone when I present this.” When you notice yourself thinking this way, ask yourself, “Is it really true that I’m going to make a fool of myself?” and “If I mess up, does that mean people will think I’m stupid?”
- The answers to these questions are likely to be “No” and “No” because you can’t know for sure what people will think or do. The more likely outcome is that you’ll do well and no one will think you’re a fool.
Take care of yourself. Taking good care of yourself can help you cope with social anxiety. Eating healthy, getting enough sleep, and exercising regularly will help you feel better both physically and mentally. It’s important to maintain a balanced diet, get adequate sleep, and stay active to be in the best physical and mental shape.
- Follow a balanced diet with plenty of fresh fruits and vegetables, whole grains, and lean protein.
- Sleep 7-9 hours each night.
- Exercise 3 times a week for 30 minutes each session.
- Limit your intake of caffeine and alcoholic beverages.
Consider seeking help from a mental health professional. You might find it extremely challenging to overcome severe anxiety on your own. If you or a loved one is struggling with SAD, it may be worth seeking assistance from a licensed mental health professional. They can help identify the root causes of your social anxiety and address them.
- You might also want to explore joining a behavioral therapy group specifically for people with social anxiety. These groups can help you build confidence and learn cognitive-behavioral techniques to better manage difficult situations.
Consult your doctor about medication options. While medication alone cannot cure social anxiety disorder, it can be helpful in some cases. Some medications may be more effective than others depending on your specific situation, so it is crucial to discuss your symptoms and treatment options with your doctor.
- Common medications for treating SAD include: benzodiazepines like Xanax; beta-blockers such as Inderal or Tenormin; monoamine oxidase inhibitors (MAOIs) like Nardia; selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Luvox, Zoloft, Paxil, Lexapro; and serotonin-norepinephrine reuptake inhibitors (SNRIs) like Effexor, Effexor XR, and Cymbalta.
Managing SAD in Children
Understand that early treatment is crucial. The average age for the onset of SAD is 13, but it can also occur in younger children. This disorder is associated with the development of depression and substance abuse in adolescents. Therefore, it is extremely important to seek advice from a doctor if you suspect your child may have SAD.
Take your child to a therapist. A therapist can be extremely helpful in identifying the sources of your child's anxiety and helping you manage these triggers. They can also guide your child through exposure therapy, which gradually helps them confront their fears in controlled settings.
- The therapist can provide you with advice on how to support your child.
- Another common approach is cognitive-behavioral therapy (CBT), which helps children recognize and manage negative and unhelpful thought patterns.
- Therapists might also recommend group therapy. This can be beneficial because it helps your child understand that they are not alone in their fears and that others are going through similar struggles.
- Family therapy can help you offer support to your child and work together to manage their anxiety. This form of therapy is particularly useful when the child’s anxiety is affecting the entire family.
Hỗ trợ trẻ. Nếu lo ngại con mình bị SAD, bạn hãy tìm sự giúp đỡ chuyên môn để hỗ trợ trẻ. Tránh ép trẻ chữa tính nhút nhát bằng cách buộc trẻ lên trình diễn hoặc đẩy trẻ vào những tình huống xã hội gây căng thẳng cho trẻ. Làm mọi việc có thể để giúp trẻ cảm thấy thoải mái hơn trong những tình huống xã hội.
- Đảm bảo thấu hiểu cảm giác của trẻ.
- Làm gương về sự tự tin cho trẻ, chẳng hạn như tỏ ra thư giãn trong các tình huống xã hội.
- Giúp trẻ học những kỹ năng giao tiếp xã hội như kết bạn, bắt tay, than phiền, v.v…
Giúp trẻ đối phó với sự lo âu. Nếu con bạn mắc chứng SAD, việc giúp trẻ đối phó với lo âu là điều quan trọng. Có nhiều cách để bạn có thể giúp trẻ ứng phó và phần nào vượt qua chứng lo âu xã hội, trong đó bao gồm việc dạy trẻ các bài tập thở, giúp trẻ điều chỉnh những suy nghĩ tiêu cực, cung cấp tín hiệu giúp trẻ an lòng, và dịu dàng khích lệ trẻ.
- Dạy trẻ bình tâm lại bằng cách thở sâu và chậm. Dạy trẻ bài tập thở sâu và hướng dẫn trẻ dùng kỹ thuật này bất cứ khi nào trẻ cảm thấy hồi hộp.
- Giúp trẻ điều chỉnh những suy nghĩ tiêu cực. Ví dụ, nếu con bạn nói những câu như, “Con sẽ làm hỏng bài phân tích tác phẩm ngày mai!”, bạn hãy đáp lại, “Nếu con luyện tập kỹ, con sẽ có ý tưởng hay để trình bày, và con sẽ làm tốt”.
- Đưa cho trẻ một tấm ảnh để làm tín hiệu giúp trẻ an tâm. Ví dụ, nếu con bạn lo lắng hồi hộp về bài phân tích tác phẩm, bạn có thể đưa cho trẻ một bức ảnh nhỏ của bạn để gắn vào đầu trang giấy. Như thế, con bạn có thể giả vờ như đang đọc bài phân tích tác phẩm cho bạn nghe.
- Dịu dàng khuyến khích thay vì ép buộc trẻ tham gia vào các hoạt động khiến trẻ lo sợ. Ví dụ, nếu con bạn không thấy thoải mái khi chơi trò chơi với những trẻ khác, bạn đừng thúc ép trẻ tham gia. Nhưng nếu con bạn quyết định chơi, bạn hãy kín đáo khen ngợi trẻ, và khen trẻ thật nhiệt liệt khi không có mặt những người khác.
Không xử lý chỉ bằng cách tránh những tình huống căng thẳng. Mặc dù bạn dễ có xu hướng bảo vệ con mình khỏi những tình huống có thể gây lo âu cho trẻ, nhưng điều này thực ra lại khiến chứng lo âu của trẻ trầm trọng thêm. Việc hỗ trợ trẻ học cách kiểm soát phản ứng đối với những tình huống căng thẳng trong cuộc sống hàng ngày sẽ có lợi hơn cho trẻ.
- Thay vào đó, bạn hãy nhắc con rằng trẻ đã từng vượt qua được những tình huống căng thẳng, và trẻ có thể tiếp tục thành công.
Hỏi bác sĩ về việc dùng thuốc. Nếu chứng lo âu của trẻ là nghiêm trọng hoặc không cải thiện, bạn nên hỏi bác sĩ về các loại thuốc có thể dùng để điều trị. Đối với một số trẻ em, thuốc ức chế tái hấp thu chọn lọc trên serotonin (SSRI’s) có thể đem lại hiệu quả giảm lo âu do SAD gây ra.
- Các loại thuốc kê toa cho trẻ em phổ biến gồm có citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), và paroxetine (Paxil).
- Venlafaxine HCI (Effexor) là một loại thuốc thông dụng khác để điều trị trầm cảm, nhưng đó là thuốc ức chế tái hấp thu serotonin-norepinephrine (SNRIS).
Lời khuyên
- Individuals with SAD may feel uncomfortable eating in front of others, worried that people will judge their food choices or eating habits.
- People with SAD may also struggle with speaking on the phone or leaving voicemail messages because they fear their words might sound foolish or trivial.
Warning
- SAD is a serious mental health condition. If you suspect you have social anxiety, it’s important to consult with a therapist or doctor for support.
