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Social Anxiety Disorder: More Than Just Shyness (Part 1)

Are you extremely afraid of being judged by others? Are you very self-conscious in everyday social situations? Do you avoid meeting new people? If you have been feeling this way for at least six months, and these feelings make it hard for you to do everyday tasks — such as talking to people at work or school — you may have a social anxiety disorder.

Social anxiety disorder (also called social phobia) is a mental health condition. It is an intense, persistent fear of being watched and judged by others. This fear can affect work, school and your other day-to-day activities. It can even make it hard to make and keep friends. However, social anxiety disorder doesn't have to stop you from reaching your potential. Treatment can help you overcome your symptoms.

What is it like having social anxiety disorder?

"In school, I was always afraid of being called on, even when I knew the answers. I didn't want people to think I was stupid or boring. My heart would pound, and I would feel dizzy and sick. When I got a job, I hated to meet with my boss or talk in a meeting. I couldn't attend my best friend's wedding reception because I was afraid of having to meet new people. I tried to calm myself by drinking several glasses of wine before an event, and then I started drinking every day to try to face what I had to do."

"I finally talked to my doctor, because I was tired of feeling this way and I was worried that I would lose my job. I now take medicine and meet with a counselor to talk about ways to cope with my fears. I refuse to use alcohol to escape my fears, and I'm on my way to feeling better."

What is social anxiety disorder?

Social anxiety disorder is a common type of anxiety disorder. A person with social anxiety disorder feels symptoms of anxiety or fear in certain or all social situations, such as meeting new people, dating, being on a job interview, answering a question in class or having to talk to a cashier in a store. Doing everyday things in front of people — such as eating or drinking in front of others or using a public restroom — also causes anxiety or fear. The person is afraid that he or she will be humiliated, judged and rejected.

The fear that people with social anxiety disorder have in social situations is so strong that they feel it is beyond their ability to control. As a result, it gets in the way of going to work, attending school or doing everyday things. People with social anxiety disorder may worry about these and other things for weeks before they happen. Sometimes, they end up staying away from places or events where they think they might have to do something that will embarrass them.

Some people with the disorder do not have anxiety in social situations but have performance anxiety instead. They feel physical symptoms of anxiety in situations such as giving a speech, playing a sports game, or dancing or playing a musical instrument onstage.

Social anxiety disorder usually starts during youth in people who are extremely shy. Social anxiety disorder is not uncommon. Without treatment, social anxiety disorder can last for many years or a lifetime and prevent a person from reaching his or her full potential.

What are the signs and symptoms of social anxiety disorder?

When having to perform in front of or be around others, people with social anxiety disorder tend to:

• Blush, sweat, tremble, feel a rapid heart rate or feel their "mind going blank."
• Feel nauseous or sick to their stomach.
• Show a rigid body posture, make little eye contact or speak with an overly soft voice.
• Find it scary and difficult to be with other people, especially those they don't already know, and have a hard time talking to them even though they wish they could.
• Be very self-conscious in front of other people and feel embarrassed and awkward.
• Be very afraid that other people will judge them.
• Stay away from places where there are other people.

What causes social anxiety disorder?

Social anxiety disorder sometimes runs in families, but no one knows for sure why some family members have it while others don't. Researchers have found that several parts of the brain are involved in fear and anxiety. Some researchers think that misreading of others' behavior may play a role in causing or worsening social anxiety. For example, you may think that people are staring or frowning at you when they truly are not. Underdeveloped social skills are another possible contributor to social anxiety. For example, if you have underdeveloped social skills, you may feel discouraged after talking with people and may worry about doing it in the future. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.