Feeling nervous or anxious about meeting new people is common among many of us at some point in our lives, whether in a personal or professional context. Some of our worries may relate to a specific situation, such as public speaking, performing on stage, or attending work-related meetings. The festive season, with its emphasis on social gatherings and activities, can be a particularly difficult time for sufferers. 

Social communication can be especially daunting for people who are naturally shy, self-conscious, or lacking in social confidence. But however troubling, shyness is categorised by the Royal College of Psychiatrists as a ‘mild fear’, that will not necessarily prevent you from getting on with your life. Sufferers vary in the degree to which they are naturally reserved or introverted, and some may show physical signs of unease or discomfort in social situations, for example blushing, stammering or searching for words, but generally they are able to get on with most daily life activities. 

When does a fear become a phobia? 

Fears and anxieties become a problem when they hold us back from living our best life, impairing our school or work performance, affecting our relationships, limiting our ability to take opportunities, and ultimately impacting our quality of life. 

What is social anxiety disorder?  

Social anxiety disorder, also known as social phobia, is one of the most common types of anxiety disorders, yet we know that it is under-recognised and under-treated.  

Despite being recognised as one of the most persistent anxiety disorders, and a cause of acute stress and sadness, only about half of those impacted will seek treatment. Those who do may wait 10 years or more before seeking help. 

Anxiety describes emotional discomfort, worry or fear. It can be experienced in many areas of life, and to varied intensity. Sometimes it is event-related, for example a looming exam, pressures of work, relationship problems or health issues. Short-term anxiety is linked to our ‘fight or flight’ response, preparing our mind and body to ward off threat or danger. However, when anxiety becomes longer-term and generalised, and starts to impact our day-to-day functioning, it becomes categorised as a disorder. 

For anyone with social anxiety disorder, leaving the house can in itself become an ordeal, the sufferer experiencing a persistent and overwhelming feeling of dread associated with meeting people in social settings.  

Problematic settings can vary from one individual to another. Many of us will be familiar with performance-related anxiety, when your mouth goes dry and your mind goes blank at the start of a presentation or important meeting. For some this can make it impossible to speak in public at all, even to ask a question. 

But social anxiety can become generalised, applying to many or all social environments, be it college, the workplace, public transport, a GP waiting room, a restaurant or café; it can even apply to speaking on the phone. Social gatherings and public performances may be totally out of the question.  

What is at the root of social phobia? 

Generally, it is characterised by a chronic and debilitating fear of being negatively perceived, scrutinised or rejected by others, including appearing incompetent, or embarrassing or humiliating oneself in a social setting. It can cause extreme distress, and although the individual experiencing it may recognise that their reaction is unreasonable or disproportionate to the actual threat posed by the situation, they are unable to do anything about it. 

Feelings you might recognise:  

  • You think about all the embarrassing things that could happen in anticipation of a particular situation 
  • You worry that other people are looking at you, or that you are making a fool of yourself in public 
  • You might find it hard to go into shops or restaurants, and especially to eat or drink in front of others 
  • You might have a crisis of confidence before walking into a social gathering, especially if alone 
  • You might worry that the conversation will dry up because you have nothing to say, or the person you are talking to will not find you interesting 
  • You have trouble focusing on what someone is saying, making it difficult for you to reply  
  • You may find it hard to set boundaries and be assertive with other people 
  • You might run event post-mortems to analyse the way you behaved, things you said, things you wish you had done differently 

Causes of social anxiety disorder 

The causes are largely unknown, but the anxiety stems from distorted or negative self-perception, or the sufferer may have problematic memories of social trauma. This can become compounded by aspirations to appear intelligent, witty, the ‘life and soul’ of the party.  

How does it start? 

Social anxiety commonly starts during early adolescence, a developmentally sensitive period when peer recognition becomes extremely important. It can improve without intervention, but early diagnosis may help minimise symptoms and reduce the chance of developing other mental health issues, such as loneliness and depression. 

Symptoms of social anxiety disorder  

These occur as a response to a social trigger or situation and can include: 

      • Blushing 
      • Sweating 
      • Shaking or trembling 
      • Nausea 
      • Dry mouth 
      • Stammering or forgetting what you wanted to say 
      • Palpitations
      • Feelings of tingling or numbness in your fingers or toes

The anticipation of these symptoms, and the crippling worry that they will be obvious to onlookers, may become a self-fulfilling prophecy. In its most extreme form, social anxiety can lead to a panic attack, during which the sufferer feels overwhelmingly anxious and terrified of losing control.

Treatment for social phobia

The good news is that social anxiety is a recognised condition that can be effectively treated, either through tailored CBT programmes, medication, or a combination of treatments.  

Anxiety exists to protect you from discomfort; you can’t erase it because it’s part of being human, but you can reduce its hold on your life. The best place to start is by booking an appointment with your GP to discuss the options that are available to you.  

Depending on the severity of your own experience, self-help can guide you to start challenging negative perceptions about yourself and identify goals to build your exposure to social settings. It can also help you to recognise unhelpful safety behaviours, such as avoiding eye contact, or relying on alcohol to boost confidence. Self-help therapy can be guided or supported as part of a CBT programme. 

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