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More than being shy: Social Anxiety Disorder

More than being shy: Social Anxiety Disorder
By Nagaland Post | Publish Date: 5/19/2019 5:00:01 AM IST

 Prakash was a 35 year old man and he seems to have it all. He was married to a beautiful and caring woman, he has two adorable children, and a job that pays well. On closer observation, you will notice certain features of Prakash’s behaviour. For example, his wife handles all the daily and family responsibilities. Meeting relatives, attending parent teacher meetings, other community events, taking the children out for shopping, buying groceries and to the extent of placing the orders in a restaurant are all taken care of by his wife. 

This was not because Prakash was a lazy man or didn’t want to share responsibilities; it was because of the anxiety that accompanied any and all social interactions, whether it be attending a call or talking to his child’s class teacher. Prakash had to eventually seek treatment because his anxiety interfered with his ability to do his job. Prakash had no friends and always felt out of place at social gatherings/parties. 

He felt awkward and was constantly worried that he would say or do something ridiculous which would lead to an embarrassing situation. When a social interaction could not be avoided, he would spend the time leading up to the interaction in a state of nervousness and panic, thinking of all the potential ways that the interaction could go wrong. 

To describe Prakash as being a shy individual will not only be inadequate but also incorrect. Prakash presents a case of social anxiety disorder (social phobia) which is often passed off as someone being shy or an introvert; both would be wrong. The cardinal feature of social anxiety is “a marked and persistent fear of social or performance situations in which embarrassment may occur.” 

Underlying the fear of social situations/performance situations is worry about humiliating oneself, being ridiculed, feeling embarrassed or being rejected. The fear then begins to work as a self-fulfilling prophecy. Being so acutely aware of oneself and nervous can itself make social interactions difficult and may lead to negative evaluations or uncomfortable situations. Thus, the fear and worry work in a cyclical manner, often leading to avoidance of different situations. 

While some people with social anxiety avoid social situations, others specifically only avoid performance situations such as giving a speech, a public presentation, dancing or playing sports. When exposed to a feared situation, individuals may experience considerable anxiety as evidenced by sweating, palpitations, respiratory distress, nausea, tremors and so on. People are also likely to experience anticipatory anxiety. 

Social anxiety disorder can significantly interfere with our daily functioning and lead to a deterioration in the quality of life. Often, the individual as well as the family members brush aside the signs as “shyness” and enable varying kinds of avoidance behaviours. 

There is a fine line of distinction between those suffering from social anxiety disorder and those who have an introverted personality. In case of the former, social interactions are avoided because of fear of being ridiculed or humiliated. 

In case of the latter, there is a preference for spending time in solitary activities and enjoying small gatherings that is not driven by fear or underlying anxiety. 

Social anxiety usually starts during adolescence and may first appear to be shyness. There is some evidence suggesting a genetic link as it has been found to be present in families across generations. Other researchers have posited a hypothesis that individuals with social anxiety have a tendency to misread the behaviours of others (thinking that someone is frowning when they are not). 

This suggests an underlying tendency which may have a genetic component or could be a result of observing others around you. Though there isn’t much consensus among investigators about the cause of social anxiety, there is agreement that interplay of genetic, neurobiological, developmental and environmental factors play a role. 

There is a clear line of distinction between shyness, introverted personality and social anxiety disorder. A central point being that the last of these requires intervention. Often, co-morbid mood disorders or substance dependence may be present which complicates diagnosis and treatment. 

Psychotherapies primarily used for social anxiety disorder includes cognitive behaviour therapy, exposure therapy, and social skills training among others. 

Group therapies have been found to be effective in treating social anxiety primarily because individuals have a chance to interact with others experiencing similar difficulties and find a safe space to learn new behaviours without fear of humiliation. Pharmacological treatments are also used, primarily to deal with the symptoms of anxiety. 

The focus of intervention is to help overcome the worry and fear such that social interactions or performance situations do not become the most avoided or most feared. Life can be difficult for individuals with social anxiety, constantly living as if under a microscopic lens. However, it doesn’t have to be that way. 

Parvathy Nair, Clinical Psychologist, Pure Mind Clinic, nairparo@gmail.com

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