May is Mental Health Awareness Month.
For Kristen Rogers, fun was a nightmare.
When I ran into a colleague, my heart would beat so hard it felt like it would jump out of my chest. Her mind went blank. She would stutter as she spoke while sweat pooled under her arms. Even impromptu conversations with close friends or family members caused this intense anxiety.
But the fallout was more severe.
“I would always end those interactions feeling really embarrassed and ashamed, and I would brood for hours or days about how the other person would think I was stupid or incompetent,” Rogers said. “I would get so angry, stressed and physically sick. It was an unfortunate cycle.”
Rogers was a teenager when her symptoms began, and they became more severe as she got older. She didn’t date or make many new friends. She didn’t even dance at concerts because she was afraid that everyone was watching her. I judge her.
Rogers thought he was just an anxious person. But when she started seeing a psychiatrist in 2020, she learned it wasn’t just anxiety, she was suffering from social anxiety disorder.
What is social anxiety disorder?
Social anxiety disorder (SAD) is a persistent, intense fear of social or performance situations in which one expects to be scrutinized, judged, or humiliated. For people with SAD, common everyday activities such as talking to new people, eating in public, or giving presentations at work can cause significant anxiety and fear.
“When you have social anxiety disorder, the fear of being found inadequate or the worry that people will judge you can interfere with how you live your life,” said Ellen Hendriksen, Ph.D., psychologist and author of the book. How to Be Yourself: Quiet Your Inner Critic and Overcome Social Anxiety.
Hendriksen said people with social anxiety experience distress, impairment, or both. In this context, distress means feeling uncomfortable, stressed, anxious, and upset before, during, and/or after social interactions. Disability means that social anxiety prevents you from doing what you want to do. “If you turn down a promotion at work, it’s a setback because you have to go to satellite offices and talk to a lot of strangers,” Hendriksen said.
People with SAD also experience physical reactions such as flushing, rapid heart rate, nausea, tremors, dizziness, and difficulty speaking in social situations.
“You might feel your stomach sinking, your face might turn red, you might start sweating – all of these classic fight-or-flight physical symptoms,” Hendriksen said.
Symptoms of SAD can vary from person to person and can change over time. Although it’s completely normal to feel anxious or anxious from time to time, SAD is a chronic condition that requires treatment.
Sources of Social Unrest
Social anxiety disorder is not caused by a single factor. Instead, a cognitive behavioral therapist and Social Anxiety for Beginners.
As for biology, Johnson said people with SAD may be born with a tendency to be inhibited. “Social anxiety may be linked to hyperactivity in the amygdala, the part of the brain that regulates fear responses.”
Having a family history of SAD may also increase your risk. One study found that people who have a first-degree relative (parent, sibling) with SAD are up to six times more likely to develop the disorder.
And because SAD usually begins in childhood or early teens, negative life events such as abuse, neglect, growing up with a medical condition that causes unwanted attention, and the way your parents raised you can be risk factors for SAD.
“Ways parents can influence the development of social anxiety include modeling anxious behavior and being overly protective or critical,” Johnson said.
Women and social anxiety disorder
SAD affects both men and women, but studies have shown that women are more likely to have SAD, have more severe symptoms, and experience greater social fear than men.
“Many women are subtly (and sometimes not-so-subtly) taught from a young age to be agreeable, likable, and not take up too much space. This can translate into excessive monitoring of how they are treated, second-guessing their own opinions, and holding back conversations, especially in settings like the workplace where men may dominate or interrupt discussions, which can further reinforce self-doubt,” Johnson said.
SAD typically occurs early in life, but major life events, such as moving to a new city or being diagnosed with a disease, may first trigger symptoms in adulthood.
“Middle-aged women with social anxiety disorder have probably had this condition for decades. The important thing to know is that social anxiety disorder is maintained by avoidance, so it’s important to confront your fears and think about where you have built up avoidance in your life,” Hendriksen said.
Social anxiety never goes away, but it can get better
The most common treatments for social anxiety disorder are prescription medications and cognitive behavioral therapy (CBT), which involves identifying and reframing negative or irrational thoughts over time.
“The most effective treatment is cognitive behavioral therapy, especially when it involves exposure,” Johnson said. “This means gradually facing the situations you fear, rather than avoiding them, while also learning how to respond differently to anxiety-provoking thoughts.”
Exposure exercises involve identifying fears and worst-case scenarios in social situations and testing them to see if the outcome is as bad as the person with SAD thinks. “The key is to face your fears. The outcome we fear is almost always worse than what actually happens. Even if the worst-case scenario happens, we have to remind ourselves that we can cope and handle what life throws at us,” Hendriksen said.
For Rogers, CBT made a big difference. “CBT saved my life in many ways,” she said. “I had childhood experiences that instilled perfectionism in me, so part of that required me to undo that and find relationships and people who were much more open-minded to the idea that not everything had to be perfect all the time.”
It’s been six years since Rogers began treatment, and she no longer experiences social anxiety on a daily basis. When she does that, it’s not as intense as it used to be. “I still sometimes find it odd that I take a different route to avoid a conversation or that I always have nothing to say when I meet someone, but I usually try to start a conversation with a stranger or colleague,” she said.
Rogers’ advice for anyone struggling with SAD: Find a good cognitive behavioral therapist. “The process can be painful and difficult, and sometimes you might not want to listen to what your therapist has to say, but it actually gets better.”
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