Social anxiety disorder (SAD) is one of the most common mental disorders, affecting the emotional and mental wellbeing of millions of U.S. adults and adolescents 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. Statistics estimate 40 million U.S. adults will experience SAD. The National Institute of Mental Health estimates 9.1% of adolescents (ages 10 to 19) currently experience symptoms, and 1.3% have severe impairment. Statistics are imperfect for LGBTQ+ persons; the Anxiety and Depression Association of America estimates their susceptibility is 1.5-2.5 times higher than that of their straight or gender-conforming counterparts. All statistics are fluid, however; a high percentage of persons who experience SAD refuse treatment, fail to disclose it, or remain ignorant of its symptoms.
SAD is arguably the most underrated and misunderstood psychological dysfunction. Debilitating and chronic, SAD attacks on all fronts, negatively affecting the entire body complex. It manifests in mental confusion, emotional instability, physical dysfunction, and spiritual malaise. Emotionally, persons experiencing SAD are 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.
The commitment-to-remedy rate for those experiencing SAD in the first year is less than 6%. This statistic is reflective of symptoms that manifest perceptions of worthlessness and futility. SAD also has lower recovery-remission rates because many of the afflicted are unable to afford treatment due to symptom-induced employment instability. Over 70% of SAD persons are in the lowest economic group.
Social anxiety disorder is a pathological form of everyday anxiety. Feeling anxious or apprehensive in certain situations is normal; most individuals are nervous speaking in front of a group and anxious when visiting their dentist. The typical individual recognizes the normalcy of a situation and accords it appropriate attention. The SAD person anticipates it, personalizes it, dramatizes it, and obsesses on its negative implications. The clinical term “disorder” identifies extreme or excessive impairment that negatively affects functionality.
The generic symptom of SAD is intense apprehension—the fear of being judged, negatively evaluated and ridiculed. There is persistent anxiety and 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 fear that manifests in social situations is so fierce that many SAD persons believe it is beyond their control, which manifests in perceptions of incompetence and hopelessness. Negative self-evaluation interferes with the desire to pursue a goal, attend school, or do anything that might trigger anxiety. Often, the subject worries about things for weeks before they happen. Subsequentially, they will avoid places, events, or situations where there is the potential for embarrassment or ridicule.
The overriding fear of being found wanting manifests in self-perspectives of inferiority 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 uncomfortable center of attention. Their social interactions can appear hesitant and awkward, small talk clumsy, attempts at humor embarrassing–every situation reactive to negative self-evaluation.
‘Maladaptive’ is a term created by Aaron Beck, the ‘father’ of cognitive-behavioral therapy. Although maladaptive self-beliefs can occur with many psychological dysfunctions, they are most common to SAD. A maladaptive self-belief is a negative self-perspective unsupported by reality. SAD persons can find themselves in a supportive and approving environment, but they tell themselves they are unwelcome and the subject of ridicule and contempt. They ‘adapt’ negatively to a positive situation.
SAD persons are often concerned about the visibility of their anxiety and are preoccupied with performance or arousal. 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. The SAD subject meticulously avoids situations that might trigger discomfort. The maladaptive perceptions of inferiority and incompetence can generate profound and debilitating guilt and shame.
SAD is repressive and intractable, imposing irrational thoughts and behavior.
The key to SAD’s hold on its victims is its uncanny ability to sense vulnerability in the child/adolescent. SAD is like the person who comes to dinner and stays indefinitely. It feeds off its host’s irrationality. It crashes on the couch, surrounded by beer cans drained of hope and potential. It monopolizes the bathroom, creating missed opportunities. It becomes the predominant fixture in the house. After a while, its host not only grows accustomed to having it around but forms a subordinate dependency.
SAD persons crave the companionship 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 SAD are prone to low self-esteem and high self-criticism due to the dysfunction itself, and its causal disruption in natural human development.
SAD onset occurs during adolescence and can linger in the system for years or even decades before asserting itself. Any number of situations or events trigger the infection. The SAD person could have been subject to bullying or a broken home. Perhaps parents were overprotective, controlling, or unable to provide emotional validation. In some cases, its cause is perceptual. A child whose parental quality time is interrupted by a phone call can sense abandonment. The SAD person is not accountable for their dysfunction; there is the likelihood no one is intentionally responsible.
SAD is routinely comorbid with depression and substance abuse. Symptom are similar to those of avoidant personality disorder, panic disorder, generalized anxiety disorder, depression, substance abuse, eating disorders, OCD, and schizophrenia. Coupled with the discrepancies and disparity in its definition, epidemiology, assessment, and treatment, SAD is usually misdiagnosed.
For over 50 years, cognitive-behavioral therapy has been the go-to treatment for SAD. Only recently have experts determined that CBT can be ineffectual unless combined with a broader approach to account for SAD’s complexity and the individual personality. A SAD subject subsisting on paranoia sustained by negative self-evaluation is better served by multiple approaches, including those defined as new (third) wave (generation) therapies, developed through client trust, cultural assimilation, and therapeutic innovation. CBT, positive psychology, and neural restructuring might serve as the foundational platform for integration. SEE One-Size-Fits-All
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