Dr. Roher

Imagine having a big presentation in front of a whole hall full of people you don’t know and who intimidate you. You are restless, agitated. Your palms are sweaty and clammy. Hour heart beats much faster than normal. You feel sick to your stomach. You are afraid you are going to pass out and everybody, all these intimidating people you want to impress, will notice and think there is something wrong with you. They will be disappointed in you. What a nightmare! Well, this is how people who suffer from social phobia or social anxiety feel all the time when they are in social situations. They feel the way you feel, but MUCH MORE INTENSELY!

About 7% of the population in the U.S. suffers from social anxiety disorder. This is a condition that can be so crippling that people affected by it cannot function in social situations at all. People suffering from social anxiety disorders are literally paralyzed by terror. This fear is usually of embarrassing themselves in front of people and feeling humiliated by the situation. They panic; their hearts race; they sweat; they get dry mouths, feel shaky, nauseous and may lose their voices. Because of the high anxiety they are experiencing, they may forget everything they know, going blank and temporarily losing their abilities to think clearly and discuss issues, even when they are very familiar with them. This contributes to their already negative feelings about themselves, making them more anxious, in a vicious cycle that makes them feel worse and worse about themselves.

Only 50% of social anxiety disorder sufferers seek professional help. The rest isolate themselves and avoid social situations as much as they can in order to evade the stigma that is associated with this condition. Because of the limited social exposure, these people are more likely than others to drop out of school, particularly if they are teenagers, leave jobs that involve a certain amount of social interactions, and miss opportunities for advancement because they don’t want others to know how they feel. They are even less likely to get involved in close intimate relationships, a lot of them living alone, at the social fringes of society, where they feel safer.

Social anxiety disorder typically starts in childhood, at around ages
9-10, as children begin to approach puberty. As they continue to grow, their fears very often get worse. Most adolescents experience times of shyness and self-consciousness. However, adolescents with social anxiety disorder experience much more severe symptoms in social situations. These persist most of the time and deeply affect their academic performance and social life.

Neurological studies of the brain indicate that people who suffer from social anxiety have a part of the brain – the amygdala – that is more active than usual. The amygdala is involved in processing emotions, in particular fear. Greater activity in the amygdala, therefore, indicates that people who suffer from social anxiety are highly sensitive to social situations that they experience as scary and unsafe.

As they become adults, their social fears, if left untreated, do not decrease. These people learn to live with their fears by avoiding stressful situations where such fears may get exposed, and tend to select activities and occupations that do not require a lot of social contact. As they continue to feel awkward in social situations, they progressively reduce their social activities, until they end up spending most of their time alone.

Well, the good news is that they should not have to suffer so much. Psychotherapy and medications (some antidepressants, beta blockers and some anti-anxiety) can relieve most of the symptoms sufferers from social anxiety experience, thus allowing them to “experiment” more with social situations. In this way, they gradually desensitize themselves from the anticipated risks and dangers of social situations. They can thus become more comfortable with others and develop more balanced social lives.

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