Social anxiety disorder (SAD) is one of the most common mental disorders affecting the emotional and mental wellbeing of over 15 million U.S. adults who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. SAD is the second most diagnosed form of anxiety in the United States.[i] The National Institute of Mental Health[iii] report 31.1% of U.S. adults experience some anxiety disorder at some time in their lives. Statistics are imperfect for the LGBTQ community; the Anxiety and Depression Association of America estimates their rate is 1.5-2.5 times higher “than that of their straight or gender-conforming counterparts.”[iv]
SAD is the most common psychiatric disorder in the U.S. after major depression and alcohol abuse.[v] It is also arguably the most underrated and misunderstood. A “debilitating and chronic” affliction, SAD “wreaks havoc on those who suffer from it.”[vi] SAD attacks all fronts, negatively affecting the entire body complex, delivering mental confusion, emotional instability, physical dysfunction, and spiritual malaise. Emotionally, persons experiencing SAD feel depressed and lonely. In social situations, they are physically subject to unwarranted sweating and trembling, hyperventilation, nausea, cramps, dizziness, and muscle spasms. Mentally, thoughts are discordant and irrational. Spiritually, they define themselves as inadequate and insignificant. Approximately, only 5% of SAD persons commit to early recovery, reflective of symptoms that manifest maladaptive self-beliefs of worthlessness and futility. SAD has lower recovery-remission rates because many are unable to afford treatment due to SAD induced “impairments in financial and employment stability.”[vii] Over 70% of SAD persons “are in the lowest economic group.”[viii]
Feeling anxious or apprehensive in certain situations is normal; most individuals are nervous speaking in front of a group and anxious when pulled over on the freeway. The typical individual recognizes the ordinariness of a situation and accords it appropriate attention. The SAD person anticipates it, takes it personally, dramatizes it, and obsesses on its negative implications. Social anxiety disorder is a pathological form of everyday anxiety. The clinical term “disorder” identifies extreme or excessive impairment that negatively affects functionality.
The superficial overview of SAD is intense apprehension—the fear of being judged, negatively evaluated and ridiculed. There is persistent anxiety or fear of social situations such as dating, interviewing for a position, answering a question in class, or dealing with authority. Often, mere functionality in perfunctory situations―eating in front of others, riding a bus, using a public restroom—can be unduly stressful. The overriding fear of being found wanting manifests in perspectives of inadequacy and unattractiveness. SAD persons are unduly concerned they will say something that will reveal their ignorance, real or otherwise. They walk on eggshells, supremely conscious of their awkwardness, surrendering to the GAZE―the anxious state of mind that comes with the maladaptive self-belief they are the center of attention. Their movements can appear hesitant and awkward, small talk clumsy, attempts at humor embarrassing, and every situation is reactive to negative self-evaluation. They are apprehensive of potential “negative evaluation by others,” concerned about “the visibility of anxiety, and preoccupation with performance or arousal.”[ix] SAD persons frequently generate images of themselves performing poorly in feared social situations, and their anticipation of repudiation motivates them to dismiss overtures to offset any possibility of rejection. SAD is repressive and intractable, imposing irrational thought and behavior. It establishes its authority through its subjects’ defeatist measures produced by distorted and unsound interpretations of actuality that govern perspectives of personal attractiveness, intelligence, competence, and other errant beliefs.
SAD persons crave others’ company but shun social situations for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers. People with social anxiety disorder are prone to low self-esteem and high self-criticism.
Anxiety and other personality disorders are branches of the same tree. There is a significant degree of comorbidity between social anxiety disorder and other mental health problems, most notably depression and substance-abuse.
For over 50 years, cognitive-behavioral therapy has been the go-to treatment for SAD. Only recently have experts determined that CBT is ineffective unless combined with a broader approach to account for the disorder’s complexity and the individual personality. A SAD subject subsisting on paranoia sustained by negative self-evaluation is better served by multiple non-traditional and supported approaches, including those defined as new (third) wave (generation) therapies, developed through client trust, cultural assimilation, and therapeutic innovation with CBT, positive psychology, and neural restructuring serving as the foundational platform for integration.
[i] MHA (2019). The State of Mental Health Care in America. (Online.) Mental Health Association. https://www.mhanational.org /issues/state-mental-health-america.
[ii] ADAA. (2019a). Facts and Statistics. (Online.) Anxiety and Depression Association of America https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and-depression-lgbtq [iii] (NIMH, 2017)
[iii] NIMH (2017). Social Anxiety Disorder. (Online.) National Institute of Mental Health). https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder.shtml
[iv] Brenner, B. (2019). Understanding Anxiety and Depression for LGBTQ People. (Online.) Anxiety and Depression Association of America. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and-depression-lgbtq.
[v] Heshmat, S. (2014). Social Anxiety Disorder (SAD). SAD is a risk factor for addiction. Psychology Today. https://www.psychologytoday.com/us/blog/science-choice/201410/social-anxiety-disorder-sad
[vi] ADAA. (2019a). Facts and Statistics. (Online.) Anxiety and Depression Association of America https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and-depression-lgbtq
[vii] Gregory. B., Wong, Q. J. J., Craig, D., Marker, C. D., & Peters, L. (2018). Maladaptive Self-Beliefs During Cognitive Behavioural Therapy for social anxiety disorder: A Test of Temporal Precedence. Cognitive Therapy and Research, 42(3): 261–272 (2018). doi.org/10.1007/s10608-017-9882-5
[viii] Nardi, A. E. (2003). The social and economic burden of social anxiety disorder. BMJ, 327 (2003).doi:10.1136/bmj.327.7414.515
[ix] Tsitsas, G. D., & Paschali, A. A. (2014). A Cognitive-Behavior Therapy Applied to a Social Anxiety Disorder and a Specific Phobia, Case Study. Health Psychology Research, 2(3): 1603 (2014). doi:10.4081/hpr.2014.1603.