S ocial Anxiety Disorder (also called Social Phobia) is when certain social or performance situations (e.g., meeting new people or giving a speech) are avoided due to substantial fear of being judged or embarrassed in front of other people. When exposed to a social situation, someone with Social Anxiety Disorder is so afraid of being negatively evaluated or judged that it significantly interferes with his or her ability to live a normal life. This can cause him or her to avoid everyday social situations, like going shopping, speaking up in class, using a public bathroom, or participating in gym class.
It is perfectly acceptable to be anxious occasionally during social situations. This type of anxiety often helps us prepare for that situation. For example: practicing a speech before giving it in class; making sure you have enough money before going out on a date; etc. However, usual, expected, and normal social situations almost always provoke fear or anxiety in individuals with Social Anxiety Disorder. This fear or anxiety is way out of proportion to the situation. Someone with Social Anxiety Disorder often knows that his or her fears are unreasonable and that other people don’t feel the same way. This can make him or her feel really alone and think that no one else can understand how he or she feels, which can lead to feelings of loneliness or sadness.
Up to about 4% of 15-24 year-old Canadians report having Social Anxiety Disorder. Social Anxiety Disorder is slightly more common in women than in men. For 75% of people with Social Anxiety Disorder, it began when they were between 8 and 15 years old. Social Anxiety Disorder is thought to be caused by a combination of genetics, the environment, and learning (i.e., modeling parental behaviour).
Social Anxiety Disorder, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or other trained health provider who has spent time with the teenager and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances. Please do not attempt to diagnose someone based on the symptoms you read in magazines or on the internet. If you are concerned, speak to a trained health professional.
Someone with Social Anxiety Disorder experiences significant, excessive, and persistent anxiety when in a social situation where he or she might be judged. The person will go to great effort to avoid the anxiety-provoking social situation and if it cannot be avoided, he or she will experience intense fear or anxiety. This fear significantly interferes with the person’s ability to live his or her life and is way out of proportion to the actual concern/event.
Someone with Social Anxiety Disorder is mostly worried that he or she will do something that will result in embarrassment and/or rejection. This can be something that the person actually does or even just that he or she might show symptoms of anxiety (e.g., blushing, trembling, sweating, stumbling over one’s words, or staring). These feelings can be less intense if experienced around a trusted individual.
For a diagnosis of Social Anxiety Disorder, this fear must last for at least 6 months and not be caused by a substance (e.g., drug, alcohol, medication) or another medical condition.
*In accordance with the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
Remember, you cannot diagnose someone with Social Anxiety Disorder without a proper mental health assessment conducted by a properly trained health provider.
Encourage the person to seek help (or take him or her to a trained health professional yourself, if appropriate). Ask the person a few questions to get a better sense of what is going on:
- Are there certain social situations that make you feel really anxious? How do you deal with those situations?
- What are you worried will happen in those social situations?
- How long has this been going on?
It’s important not to confuse typical social anxiety or shyness with Social Anxiety Disorder. It is normal to feel anxious in a new situation – such as meeting a person for the first time or going to a new school. Everyone has anxious feelings in certain social situations. Most people, however, are able to overcome those nervous feelings and with practice, end up being able to confront those situations without anxiety. Young people with Social Anxiety Disorder are unable to overcome their feelings of anxiety, which are considerably more intense than those of teenagers without Social Anxiety Disorder.
Individuals with Social Anxiety Disorder will have anxiety that:
- Is much more intense than usually felt
- Is hard to control using usual methods such as exercise, relaxation, help from friends, etc.
- Interferes with many parts of usual life, which can significantly reduce his or her quality of life
If someone in your life has been diagnosed with Social Anxiety Disorder, here’s what you can do:
- Be well-informed. Learn about Social Anxiety Disorder and the treatment options available. Read books, trusted websites (like this one!), and discuss any concerns or questions with a health care provider. Check out Evidence Based Medicine for information on how to critically evaluate the information you read and Communicating With Your Health Care Provider for a list of questions to ask your health care provider.
- Encourage him or her to seek help from his or her family doctor. Social Anxiety Disorder is very treatable.
- Listen. Listen to his/her thoughts, worries and problems. Be supportive but ultimately be helpful by not enabling or supporting negative thoughts.
- Give positive feedback. Notice when he or she is doing a good job. Praising him/her in situations that you know make him or her nervous will help boost confidence and reduce avoidance behaviors.
- Don’t judge. Judging the person could make him or her withdraw from sharing his or her emotions. Not having someone to turn to could make him/her feel alone and make his or her symptoms worse.
- It is important to accept the perceptions and emotions of the person as genuine and valid. Even if his or her fears don’t make sense to you, the anxiety is very real.
- Help the person learn time management skills. Planning out your time and understanding what you have to do and how long you have to do it can help keep you from feeling overwhelmed.
- Remember that reassurance is not usually helpful and may worsen social anxiety. Although it’s natural to want to protect the person you care about from situations that frighten him or her, for people with Social Anxiety Disorder, this protection can backfire. Shielding the person from anxiety-provoking situations can actually make the anxiety much worse.
A variety of treatment options exist for Social Anxiety Disorder. The most common treatment for Social Anxiety Disorder is CBT. In certain cases, medication is also used. Determining which course of action is appropriate for each individual should be done with the guidance of a trained health professional. Options include:
- Psychological Treatments: Psychotherapy or “talk therapy” works by helping your brain better control your thoughts and emotions. The type of psychotherapy that has been found to be most effective for treating Social Anxiety Disorder in teenagers is called Cognitive Behavior Therapy (CBT). CBT helps people learn how to overcome their fears. It includes several components, including Cognitive Restructuring (e.g., changing the way someone thinks about his or her fears) and Exposure (e.g., gradually exposing the teenager to his or her fears while keeping him or her safe and teaching him or her effective strategies for coping with fear). Sometimes this therapy is provided in groups.
- Medication: Medication helps the brain correct the functioning of its emotional control circuits. A variety of medications can be prescribed to relieve symptoms of Social Anxiety Disorder. These medications are used in addition to CBT or added if the therapy has not had the expected outcome. For more information on how to properly use medications, check out MedEd.
- School supports: Sometimes certain adaptations can be made by the school to assist a student in coping with and managing his or her symptoms.
- Community supports: Community supports can include peer support groups for teenagers, support groups for families, and other helpful resources.
- Arousal Decreasing Techniques: Numerous techniques for decreasing physical arousal (that means: anxious feelings, rapid heart rate, rapid breathing) can help. These include: biofeedback, mindfulness, deep muscle relaxation, meditation, etc.
- Regular Routine: Maintaining a healthy, regular daily routine is very important for a person with Social Anxiety Disorder. For help maintaining the kind of healthy lifestyle that should accompany professional treatment for Social Anxiety Disorder, check out Taking Charge of Your Health.
It’s not uncommon for people to have more than one mental illness. Other common co-occurring disorders (also called comorbid disorders) include:
- Other Anxiety Disorders (e.g., Generalized Anxiety Disorder)
- Substance Use Disorders