Even the most emotionally healthy and balanced among us know what it is to occasionally feel like a wallflower, to be on the outside looking in, or shy in an unfamiliar social situation. But for sufferers of social anxiety disorder (SAD), the problem goes far beyond the occasional tense social scenario.
People afflicted with SAD understand the world to be a frightening, judgmental place fraught with people ready to point out their shortcomings, where seemingly benign social interactions are potentially soul-crushing experiences. And while shyness, social anxiety, and unsociability are terms used interchangeably to describe inhibited behavior in social situations, not all people who are shy meet the criteria for SAD, despite the overlapping nature of either condition1.
Social anxiety disorder is among the most common mental disorders, and its symptoms often lead to major life-altering fears such as eating or drinking in public, using public restrooms, and even being seen writing in public. Symptoms of less severe forms of the disorder often include fear of public speaking, fear of being assertive and avoidance of parties, and other common social functions 2. Left undiagnosed and untreated, SAD can contribute to any number of health, family, and financial problems, which can then lead to thoughts of suicide3, increased drinking (specifically when alone)4, and long-term disability (usually defined as lasting more than four years and impairing mobility), self-care, social interactions, and general life activities5.
Compounding what is already a debilitating disorder on its own, SAD is often comorbid (commonly occurring with other psychiatric disorders) with situational panic attacks6, intermittent explosive disorder7,selective mutism8, or the inability to speak in select social settings, and others.
SAD Has Many Causes
The causes of SAD are understood to be an interplay between factors such as an individual’s genetic, biological and cognitive processes, and social skills, as well as environmental factors like parental influence, aversive social experiences, and negative life events9. As an illness that usually becomes evident early on in a person’s life, its effects on the already fragile adolescent years can be especially damaging, increasing the risk of both depression10 and alcohol and cannabis dependence in early adulthood11. And that’s not to mention its seriously compromising educational progress and completion at the high school level12, and serious avoidance and school difficulties during the college years13.
But It’s Highly Treatable
Despite the illness’s far-ranging effects, a recent meta-analysis indicates that social anxiety disorder responds well to treatment, even though there are some lingering effects once the acute treatment phase has concluded. The most effective psychological intervention iscognitive behavioral therapy (CBT), which studies showed has a greater effect when compared to psychodynamic psychotherapy, interpersonal psychotherapy, mindfulness, and supportive therapy. Among the pharmacotherapy interventions, the most effective treatment for adults is the use of SSRIs14.
An important step, however, is simply to approach the illness and those affected by it with knowledge and compassion. Share information on the whys and hows of SAD and communicate that it is both common and treatable. Encourage those suffering to seek treatment and to see the process through to completion while gently helping them find ways to engage socially, but never pushing too hard