Shyness or a Deeper Problem? Social Anxiety Disorder


Social Anxiety Disorder (also known as SAD or Social Phobia) is a mental illness affecting more than 15 million Americans today. This disorder usually usually manifests itself during early adolescence, and affects more women than men. Unfortunately, however, it is also currently one of the most misunderstood mental illnesses. An individual with Social Anxiety Disorder may experience intense self consciousness in social situations. They worry boundlessly that they will be rejected or judged negatively by others. They may also fear that their actions and behaviors will embarrass or assimilate them. You might consider SAD to be an extreme form of shyness. An individual suffering from Social Anxiety Disorder recognizes that their fears are irrational, but still can not seem to shake them. This disorder can negatively affect every area of ​​a person's life, as Social Phobics will often go to extreme lengths avoid situations that trigger their anxieties. Some individuals suffering from Social Anxiety Disorder can become severely isolated, having little to no personal contacts, jobs, education, etc. This can lead to a pit of depression, loneliness, and despair.


Social Phobics often fear situations where they will be forced to interact with new people. These situations are either ended with severe anxiety, or avoided completely.

Individuals suffering from Social Phobia often fear and avoid situations in which they will be observed, or watched by someone while engaged in an activity. Often, they will feel too uncomfortable eating, drinking, or writing in the presence of other people.

Social Phobics are often intensely self conscious when it comes not only to their physical appearance, but also their actions, and behaviors around others. They may feel they are behaving in an awkward manner, or that they look nervous, or "crazy". They may avoid conversation, for fear that they will say the wrong thing, offend someone, or sound unintelligent.

A person suffering from Social Phobia will often speak using a soft, quiet voice, in short sentences, and may avoid eye contact. They may appear fidgety, or tense, and may forget to smile out of nervousness. Others however, may smile or giggle nervously. These angry behaviors, among others, may be perceived as rudeness or rejection by the other person.

Children and teenagers will often skip or perform poorly in school. A classroom is a big group of people, and intense anxiety can ensue. Kids who are quiet are often an easy target to bullies, which worsens the problem by further damaging a sufferers already fragile self esteem, and causing them to feel alone, and alienated.

These fears can lead to physical symptoms of anxiety including: trembling, muscle tension, twitches, lower jaw tension / shivering / teeth clenching, racing heart, stuttering, mind going blank, heart palpitations (sensation of heart pounding in chest), shortness of breath , dizziness, numbness or tingling in the extremities, hyperventilation, falseing, depersonalization (feeling of unreality or being disconnected from one's sense of self), fear of dying or going crazy, etc. These physical manifestations of anxiety are termed Panic Attacks.

Social Phobia can easily lead to Agoraphobia, in which a sufferer is afraid of leaving his or her house for fear of embarrassing themselves by having a panic attack in public. Someone with Agoraphobia may worry so excessively about having a panic attack in public, that they may actually have one. This may lead to extreme isolation.

Social Anxiety Disorder can also lead to profound depression. Sufferers have an estimated 40-50% lifetime coexisting depressive disorder. Loneliness, isolation, emptiness, nostalgia, alienation, and despair. A sufferer may feel that they are too socially incompetent to have friends, or that they are a terrible person that nobody could ever love. They may worry that they will never marry, or have children, or a family. They may also be unable to prepare or find the career they had always dreamed of, as job interviews, new places of employment, schools, etc. trigger intense anxiety or panic. They may question whether life is worth living, and why it is worth living. These thoughts, combined with a sense of hopelessness can lead to suicide.


Fortunately, Social Phobia is a highly treatable disorder. Social Phobia has a lifetime prevalence rate of approximately 13%. Early afternoon of the disorder, and coexisting substance abuse are associated with a more guarded prognosis.

There are several treatment options for Social Anxiety Disorder.

Upon visiting a doctor or psychiatrist, a sufferer may try a variety of medications before finding the one suitable for their needs. Often, a doctor or psychiatrist will start with a drug known to cause relatively few side effects to begin with, and move up to comparatively less safe options.

Cognitive Behavioral Therapy is the overall best treatment option for Social Phobia. CBT asserts the individual in dealing with his or her phobia as opposed to merely masking the symptoms as most medications do. CBT is associated with the greatest long term success in treatment. This form of therapy helps patients re-examine thinking patterns and beliefs that are contributing to their anxiety. Gradual exposure (Exposure Therapy) to anxiety triggering situations helps to desensitize the individual. Group therapy, as well as social skills training are often a part of Cognitive Behavioral Therapy.

Beta Blockers such as Propranolol (Inderal) may be prescribed to control the physical symptoms of anxiety, ex. shaking hands, etc. Propranolol may help immensely with physical symptoms, however, not the anxiety itself.

SSRIs (Selective Serotonin Reuptake Inhibitors) such as Luvox, Paxil, and Serzone are often prescribed to begin with in treating Social Phobia. They are considered to be one of the safest medication options, with fewer side effects than others. They are usually not side effect free however, and may work well for some people, but not others. They must be taken for a period of 2 weeks to a couple months before the effects are noticed. They are also known to cause potentially sever withdrawal symptoms in some people, lasting anywhere from weeks to several months after the last dose.

Tricyclic antidepressants are sometimes considered, although they are usually not as effective as SSRIs. Trycyclics such as Effexor are often used to treat severe depression.

MAOIs (Monoamine Oxidase Inhibitors) are another option for the treatment of Social Anxiety Disorder. They are considered only if all other types of antidepressants have failed, due to potentially lethal dietary and drug interactions. MAOIs are particularly useful in treating atypical depression. However, one specific MAOI, Nardil, has been known to work wonders for some individuals' Social Anxiety. However, some users claim that since Nardil was reformulated in 2003, the drug is no longer as effective as the older formulation.

Benzodiazepines, particularly Klonopin, are the most effective medications for Social Anxiety. Unfortunately, due to their high potential for abuse, and the risk of potentially severly withdrawal symptoms including rebound anxiety, doctors do not often prescribe these medications. Benzodiazepines should not be taken for longer than a period of 2 weeks to avoid physical dependency.

Many of us experience shyness at some point in our lives. However, if you are experiencing significant shyness or symptoms of Social Anxiety Disorder, it is best to make an appointment with your family physician or a therapist. There are also many effective self help books available on the topic of Social Phobia, as well as other disorders such as clinical depression. Please do not wait to seek treatment, SAD is a highly treatable disorder. Finding help will vastly improve your quality of life.