Understanding Social Anxiety

          Social anxiety, however common, is one of the most difficult anxiety disorders to treat.  My practice has informed me that it is, also, one of the most misjudged and misunderstood disorders I have ever diagnosed. Essentially, social anxiety is a crippling fear of being embarrassed, evaluated, judged, humiliated, and/or misunderstood. When any of us experience something embarrassing we might say, “Ya, so what if I trip up on my words, or make a mistake...? So what? I’ll get over it.” But, for individuals with social anxiety, the way they behave in public is a way bigger deal than you could ever imagine.

          Socially anxious people treat embarrassing situations like they are legitimate life-or-death scenarios. The manner in which they think about circumstances like, going to new class, speaking in public, or even wearing a new outfit, can be quite catastrophic. If I were to dissect the thoughts of a truly socially anxious person, they’d sound something like this: “Everyone will be staring at me.” “Everyone will be harshly judging me.” “They’ll think I’m stupid.” “I’ll look like an idiot.” Now, at some point, we've all engaged in this form of negative thinking, but when social phobics do it, it legitimately impairs their functioning. They will likely avoid any and all social situations in the hope of reducing the risk of feeling embarrassed. Their anxiety might be manageable when they are visiting a place they know or engaging in an activity they are familiar with, but it is a completely different ball game when they exit their comfort zone. Going somewhere new or doing something different is met with a lot of resistance and a ton of questions, asked in a desperate effort to avoid or control potential embarrassment or scrutiny.  If there is no way to control or avoid judgement, individuals with social anxiety have been known to cancel plans at the last minute, often breaking commitments made with friends and family members. Inevitably, individuals with social phobia gradually keep avoiding many social situations, often resulting in isolation.

          One of the most maddening things to see as a practitioner working with social anxiety is the degree to which this condition is misunderstood. Family and friends of social phobics often get annoyed and frustrated because they believe that the individual with social anxiety is “being ridiculous” in their concerns and preoccupations. Truth is, individuals with social anxiety are having very real, negative physiological reactions and are not joking or lying.  

          No one really knows what causes social anxiety. Outside of the heredity theory, some psychologists maintain that parenting or early caregiving might have something to do with it. Some argue that overprotective parenting/caregiving or critical parenting/caregiving are the culprits. Overprotective parents basically limit what their children are exposed to, thereby poorly nourishing traits like grit, resilience, and self-efficacy in social situations.  Second, critical parenting may cause a sense of guilt, shame, and embarrassment that lasts well into adolescence and adulthood.  These negative experiences and emotions result in the avoidance of social situations over many years, out of the sheer fear of scrutiny and reticule.  

          Of course, individuals with social phobia should seek help but there is a complication that gets in the way almost every time. Given the fact that their phobia is, in fact, social in nature, these individuals have trouble leaving their comfort zone, even when they need to make moves and seek help. They often have trouble looking for a mental health clinic, calling the office, talking to the receptionist or practitioner, and making the appointment. In every single one of these steps, there is potential for embarrassment, making the option of doing nothing more alluring to an individual with social anxiety.

           If help is not sought and found, individuals with social anxiety may turn to substance use to subdue their symptoms and to cope with the perceived danger and complexity of social situations, raising the risk of substance dependency. Moreover, perpetual  avoidance and isolation can increase the risk of depression and suicide rates among these individuals.

          Therefore, when an individual with social anxiety is ready to get help, my recommendation is for a friend or family member to become aware of the nature of social phobia. This will enhance compassion and decrease judgment and misunderstanding of the disorder itself. Afterwards, it would be important that this friend or family member help search for an appropriate treatment facility and the type of therapy social anxiety clients need is, surely, exposure therapy.  Exposing socially anxious clients to "strange" social situation enables the therapist to accompany the client as they face their fears and reduce their anxiety right in the belly of the beast.

          In sum, social anxiety is a very real clinical disorder and is often misunderstood. The best thing you can do for a socially anxious person in your life is to begin understanding the nature of this condition, increase your empathy about it, and help them get the treatment they need as soon as possible.