Social Anxiety Disorder (SAD) is diagnosed when a person experiences the following symptoms consistently over a six month period:
- Excessive fear or anxiety about one or more social situations involving possible judgment from others
- Concern about being negatively evaluated due to one’s behaviour or anxiety symptoms
- Avoidance of the social situation(s) or endurance of them despite intense fear or anxiety
Some commonly feared situations for individuals with social anxiety disorder include:
- Public speaking or other performance situations
- Parties
- Dates
- Exams
- Phone calls
- Talking to new people
- Voicing controversial opinions
- Potentially inconveniencing others
Some commonly feared consequences for people with social anxiety disorder in relation to these social situations include:
- Others thinking negative thoughts about them
- Others voicing negative feedback
- Being mocked or ridiculed
- Making mistakes and being noticed
- Appearing incompetent, foolish, unattractive or stupid
- Appearing anxious (e.g. blushing, sweating, shaking)
People with social anxiety disorder often use unhelpful coping strategies to manage their anxiety, such as:
- Outright avoidance of feared situations
- Leaving social events early
- Limiting social circles and talking only to ‘safe’ people at social events (e.g. close friends and family members)
- Relying on substances (e.g. alcohol) to reduce anxiety symptoms in social situations
- Preventing others from observing anxiety symptoms (e.g. never picking up a glass so shaking is not visible, wearing dark clothes or excessive amounts of deodorant to prevent sweat from showing, wearing makeup to hide blushing)
Often these strategies are helpful in the short term but, in the long term, they maintain social anxiety disorder and other problems (e.g. loneliness, substance abuse, depressed mood).
How common is SAD?
The one year prevalence of SAD is approximately 5% of the population in Australia. It is equally prevalent in children, adolescents and adults and some studies suggest it is more prevalent in women than men. It usually emerges in childhood or early adolescence. Without treatment, SAD can last for many years or a lifetime.
How is SAD diagnosed?
SAD symptoms usually emerge in childhood or early adolescence. A GP may notice that a person has SAD if they have had anxiety symptoms in social situations for at least six months.
If you believe you may have SAD, it is important to talk to your GP about your symptoms. The GP should conduct a comprehensive medical examination to ensure that another health problem is not causing the symptoms. The doctor may refer you to a mental health specialist, such as a psychologist, for further assessment and treatment.
How is SAD treated?
Cognitive Behavioural Therapy (CBT)
The main treatment used for SAD is CBT with a major exposure therapy component. The focus of CBT is to address the unhelpful and unrealistic thinking patterns that are causing a person’s anxiety, as well as identify and eliminate unhelpful behaviours that maintain negative beliefs and anxiety responses.
The key component of CBT for SAD is exposure therapy, or behavioural experiments. These are activities designed to test the reality and helpfulness of the beliefs and behaviours that maintain SAD. The ultimate goal of exposure is for the client to learn that anxiety is a safe and tolerable response that need not be feared or avoided, particularly as the consequences of avoidance are often more costly than fully experiencing the anxiety and engaging in the feared situation.
Group Therapy
Engaging in group therapy can be particularly useful in terms of having social support available and setting up and engaging in exposure tasks with others.
Medication
For more severe cases, some doctors may prescribe anti-anxiety medications to increase the ease with which the patient can engage in psychological therapy, as some SAD sufferers find it very difficult to overcome their anxiety about attending therapy sessions. Medications reduce their anxiety to a tolerable level so they can begin to engage in psychological treatments.
If you believe that you or someone in your family may have SAD, talk to your GP, and reach out a psychologist for support.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Washington, D.C.: American Psychiatric Association.