Medical Edge Newspaper Column

Social Anxiety Disorder Goes Beyond Occasional Nervousness

April 13, 2012
Dear Mayo Clinic:
I am often nervous around people and sometimes avoid social situations. How can I tell if I'm just shy or if what I'm experiencing is actually social anxiety disorder?

Answer:
It's natural to feel some nervousness in certain social situations, such as talking in front of others, confronting a problem with someone or being among strangers. But social anxiety disorder goes beyond this, causing an excessive anxiety or fear of activities and situations in which you believe that others are watching you or judging you. In addition, you may fear that you'll embarrass or humiliate yourself. This may lead to:

• Intense fears of being in situations in which you don't know people. This can make it hard to interact with strangers or initiate a conversation.
• Anxiety to the level that it interferes with day-to-day living. This can make it difficult to use a public restroom, return an item to a store or order food in a restaurant.
• Avoiding speaking to people out of fear of embarrassment.
• Avoiding situations where you might be the center of attention.
• Worry about reacting in ways that you know are out of proportion to the situation, or being afraid that others will notice that you look anxious.

The anxiety you feel may cause physical signs and symptoms of nervousness and fear. These may include blushing, sweating, trembling, nausea, stomach upset, confusion, heart palpitations, diarrhea and cold, clammy hands.

When interacting with other people affects you in this way, over time it may hurt your social skills, or lead to extreme sensitivity to criticism and low self-esteem.

Symptoms of social anxiety disorder tend to persist over time, but they can change. Symptoms may flare up if you're facing a lot of stress or demands. You may have fewer problems if you can avoid situations that would make you anxious.

Talk to your doctor if your symptoms disrupt your life, such as by making you feel distressed, affecting your daily functioning or causing you to avoid activities.

Diagnosis of social anxiety disorder typically involves having a detailed discussion with your doctor or mental health care provider and often filling out psychological questionnaires or self-assessments. If a diagnosis of social anxiety disorder is reached, initial therapies - which are often used in combination - include cognitive behavioral therapy and certain anti-depressant medications.

Cognitive behavioral therapy improves symptoms in up to 75 percent of people with social anxiety disorder. It's based on the idea that social situations generally won't change or go away. However, you can decrease your anxiety by changing your patterns of thinking and acting.

In therapy, you may learn to recognize and change negative thoughts about yourself. You may also practice exposure therapy, which involves gradually working up to facing situations that you fear. Social skills training and role-playing also may be part of your treatment plan.

You can also talk with you physician about medication options for managing social anxiety. Coping with social anxiety disorder can be challenging. In addition to appropriate treatment, consider coping methods, such as:

• Reaching out to people with whom you feel comfortable
• Working to maintain connections and build relationships
• Joining a support group
• Engaging in healthy, pleasurable activities when you feel anxious
• Getting adequate sleep, including physical activity in your daily routine and eating a healthy diet
• Avoiding excessive alcohol or other substances that may be used to counteract intense anxiety

Although social anxiety disorder tends to persist over a lifetime, expert medical or psychological help can make it easier for you to learn to manage your anxiety and become more comfortable and relaxed in social settings.

— Stephen Whiteside, Ph.D., Psychology, Mayo Clinic, Rochester, Minn.