Social Anxiety Disorder / Social Phobia

Whilst many of my clients have been finding these last few weeks under the shadow of Corona difficult, some have found a positive side. Some clients with socially anxious, avoidant and introverted traits have felt relief about being removed from the public eye. This article, the second in my series on the most common psychological disorders in Australia, seems especially pertinent now.


The Past

At some stage, in childhood or adolescence, we develop the power to see ourselves through the eyes of others. Up until that point we were only capable of looking through our own eyes. Like Adam and Eve in the Garden of Eden, suddenly experiencing shame of their naked bodies, we develop self-consciousness.

For some of us, negative events of our childhood supercharge this self-consciousness. We feel scrutinised and judged by a critical audience. An audience whose expectations we are unlikely to meet. Events such as being bullied or embarrassed in front of a class, may lead to strong negative beliefs about being able to perform or cope when interacting with others.

When these events occur, the child can kick off a pattern of avoidance. Avoiding public speaking and performance. Avoiding talking in front of any groups at all. Even, in extreme cases, avoiding school, sport or anything outside of the house.

Children with shy or introverted temperaments might especially be affected by these types of events. The mixture of a temperamentally timid child, experiencing negative social events, habitually using avoidant coping strategies, is how Social Anxiety Disorder (SAD) develops.

The Present

Social Anxiety Disorder was the second most common disorder in 2007 according to the National Survey of Mental Health and Wellbeing. Nearly 5% of working age Australians met diagnosis for this disorder at that time. Data from the United States reveals that about one in 20 people will require treatment for SAD in their lifetime.

Social Anxiety Disorder may be specific to performance situations (like public speaking) or can be generalised to any social interactions. The performance-type of SAD is usually milder and easier to treat.

There are a range of sticky beliefs that maintain Social Anxiety Disorder:

“The real me is unlikable”

“I’m not good enough”

“Everyone can see how nervous I am, I’m making a fool of myself”

These beliefs, while exaggerated, can become a self-fulfilling prophecy. For example, people with social anxiety disorder are often so focussed on the audience’s perception of their performance that they don’t have enough mental energy to devote to doing the task well. With less resources left for the task, performance suffers.

Avoidance is the natural consequence of this anxiety disorder: People are scary, stay away from people!  Avoiding social or performance situations feels comfortable, but also prevents the affected person learning to be more at ease in social settings.

This disorder frequently leads to other disorders. Alcohol Use disorder (or other substance use problems) is a common consequence due to using alcohol as a social relaxant. Many people with SAD have learnt to treat their condition with the bottle.

Depression is common result also. People with SAD are less likely to marry and more likely to be working in jobs that are below the level of their educational attainment. It is difficult get one’s emotional needs met from others when a powerful force is commanding isolation.

The Future

The bad news: Once Social Anxiety Disorder reaches clinical levels it is unlikely to abate on its own.

The good news: Effective treatments exist for Social Anxiety Disorder.

You should talk to your GP about this condition. General practitioners can provide referrals and prescribe medication that may help.

Cognitive behavioural therapy (CBT) is an evidence-based treatment. Negative beliefs and examined and challenged. Avoidant patterns are broken down. Progressive exposure to uncomfortable situations leads to an increased comfort zone. Group therapy options exist that provide a ready-made social environment within which to practice.

Schema Therapy is a treatment that addresses more powerful core beliefs about being different and unlikable. A Social Isolation and Alienation Schema may underlie the disorder. Schema Therapy builds off CBT techniques and also seeks to resolve childhood traumas or difficulties which lead to the creation of this disorder.

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