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  • Writer's pictureJen Ottolino

Five Things That Might Surprise You About Social Anxiety Disorder

Updated: Jan 26, 2023

Social anxiety disorder (SAD) is a potentially disabling disorder that can affect many areas of a person's life. And it's much more common than you may think.

If poisonous snakes make you nervous, you can avoid them. Don’t poke sticks under rocks in the desert. Steer clear of the reptile house when you go to the zoo. But what if what you fear is… people?


SAD goes way beyond simple shyness. It is “an intense, persistent fear of being watched and judged by others,” according to the National Institute of Mental Health. The fear must last longer than six months and interfere in daily activities to qualify for an official diagnosis


SAD, also known as social phobia, is a challenging, potentially disabling condition that can affect many areas of a person’s life, including school, work, friendships, and dating. Some people have generalized SAD, meaning they fear all or most social situations. Others fear more specific situations, such as:


  • Public speaking

  • Going to parties

  • Performing a musical instrument

  • Competing in a sporting event

  • Interacting with strangers, especially authority figures

  • Eating or drinking in public

  • Using a public restroom

  • Any situation where you could be judged, criticized, or rejected


Those with SAD may experience the following symptoms in social situations:


  • Intense panic

  • Rapid heartbeat and breathing

  • Blushing

  • Sweating

  • Tremors

  • Muscle tension

  • Feeling faint or nauseous


Some SAD-sufferers can perform socially but feel extreme self-consciousness when they do so. Others may do anything and everything to avoid social situations. Someone may turn down an amazing job promotion because they fear leading meetings. They may drop out of medical school even though they aced their board exams. In these cases, people with SAD aren’t the only ones who suffer. Societies do, too, because we miss out on the gifts and talents these people have to offer.


Five Surprising SAD Facts


1. It’s one of the most common mental health conditions.


If you have SAD, you are not alone, even though you may feel like it. SAD may be the third most common mental health condition in the world after major depression and alcoholism. Around 4% of people in the world may develop SAD at some point in their lives.


Anyone can have SAD, from your teenage son to your dog walker or dermatologist. But the condition is more common in women and certain groups. For example, a recent article in Psychology & Sexuality reviewed 46 studies and found that those in sexual minority groups (gays, lesbians, bisexuals, et al.) had a higher risk of SAD compared to others.


2. It’s more common in some countries than in others.


SAD appears to be more common in higher-income countries (like the United States) and less common in Africa and the Middle East.[1] This suggests that culture plays a role in SAD onset.


3. We don’t know exactly what causes SAD.


Along with culture, genes, brain structure, and environment may influence SAD. For instance, the condition can run in families. It is more likely among those who are shy or have experienced abuse, bullying, or other trauma in the past.


4. SAD may emerge gradually or come on suddenly.


Some people were timid as children and develop full-blown SAD in adolescence. Others were socially comfortable as children, but then a specific stressful event (for example, having to defend a PhD dissertation or starting a demanding new job) triggered SAD in early adulthood.


5. Many people with SAD improve with treatment.


A wide range of effective treatments are available for SAD. Consult with your physician or mental health care provider to decide which treatment is best for you.


Medications to treat SAD may include antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or selective serotonin-norepinephrine reuptake inhibitors (SNRIs), and antianxiety medications, such as benzodiazepines. Beta blockers may be helpful for those who fear specific situations like musical performances or speeches.


Individual psychotherapy: Cognitive behavioral therapy (CBT) is the gold standard in SAD treatment. CBT helps SAD-sufferers address negative thought and behavior patterns that feed into the disorder. Therapy that involves gradual exposure to a social situation (exposure therapy) can help extinguish the panic response. Newer approaches such as commitment and acceptance therapy can help people cultivate mindfulness and set goals toward recovery.


Support groups: If you have SAD, nothing may be more comforting than being in a room (physical or online) with people who know exactly what you’re going through. Learn more about support groups for SAD in the resource section below.


Lifestyle: Avoid excessively using caffeine, alcohol, and other substances while undergoing treatment for this and any other mental health condition. Exercise and adequate sleep can help you manage stress more effectively and make you more resilient.


 

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