Social Anxiety and Social Anxiety Disorder (Social Phobia)

Social anxiety, also known as social phobia, will often accompany generalised anxiety as its integral part, but it can also be quite prevalent, which is when it could be considered separately. If severe enough, we can also talk about it as social anxiety disorder or social phobia. Because of the modern social values in the cosmopolitan world, its underlying triggering mechanisms are quite embedded in collective psychology.

Symptoms of social anxiety disorder (social phobia)

On symptomatic level social anxiety will manifest itself as fear of social situations, open spaces, public places, especially when one is in centre of attention or seemingly not able to get out of the situation—e.g. shopping in a supermarket.

Bodily sensations can range from feelings of fainting, wanting to run away, heart palpitations, sweating, agitation, disorientation, fear of dying or having a heart attack, sometimes fear of defecation.

The symptoms of social anxiety, similarly to any other anxiety, are intra-psychically induced, often on unconscious level. However, when a person is faced with symptoms on bodily and cognitive level—and they can be quite dramatic—they will often induce them further by fear of catastrophe occurring. So, for example, fear of fainting will become worse and worse because of self-inducing element of it.

Social anxiety and stages of life

In the case of social anxiety disorder, the majority of intra-psychic processes—views of self, others and the world—actually develop in early childhood. However, through my work with clients that presented this problem, I have seen a quite significant pattern of them reporting being bullied in school. This often times deepened the sense of perfection, appearance, performance, popularity, social acceptance with the sense of self-worth and only made a stronger base for later manifestation of anxiety.

Also, clients will usually present starting to suffer from problems of social anxiety at times of significant changes in life. This will include transition from schooling to beginning of career, which symbolises personal independence and adulthood. Or sometimes, at significant changes in their career when their life path diverges from the path they set themselves in their younger years. That’s when fear of how one is to survive in this world bubbles to the surface.

What is behind social anxiety

Social anxiety can be associated with fear of public places or open spaces. People experiencing social anxiety may fear potential catastrophe that might occur in such environment. When this fear is associated with being seen by others, it may range from the fear of fainting, losing control, going insane, becoming violent, having a heart attack, or any other catastrophe that might occur in public and put the person in humiliating position as an object of attention. When severe shame is the underlying cause, fear of defecation is often reported as a symptom. But sometimes symptoms can be quite “innocent”, for example merely being uncomfortable talking to people and hence avoiding them thinking they will perceive us as worthless, stupid, or negating any other value that we feel important to us. A common denominator with people presenting with social anxiety is their poor self-esteem.

Such anxiety, along with panic attacks, is often more severe at times when a person cannot get away from a situation. This involves closed spaces, such as elevators, public transport, supermarkets or crowded events. The reason for that is that the anxiety that builds up when a person fantasises what shameful might happen to them, only builds up because they know they will not be able to get away should it in fact happen. This dynamics will initiate spiralling into a self-propelling panic attack.

Shame, embarrassment, humiliation—the core of social anxiety disorder (social phobia)

The underlying factor with social anxiety is most of the times shame and humiliation one can be exposed to in the event of catastrophe. People who fear criticism and experience others’ opinions as a reflection of their worth are prone to social anxiety disorder and social phobia.

People that present with social anxiety put high emphasis on how others see them. They strive for perfection, however, that is most often an attempt to hide the side of themselves they feel ashamed of. They will not want to identify with aspects of themselves that they consider shameful and push them into the unconscious. “This is not who I am. This is not a part of me.” As these aspects of self get provoked, they start penetrating back into awareness as anxiety. Because of the nature of this intra-psychic process and how it is actually similar to narcissistic process, narcissists will tend to experience social anxiety more than people who lack narcissistic traits.

This process will often be accompanied by other repressed feelings one does not associate with, which will increase the intensity of anxiety. For instance, because of the strive for perfection, one can be seen repressing anger—especially towards their loved ones—because they feel it’s inappropriate to feel it. For them anger is negation of love. Their ability to identify with anger is so poor that it will come out as anxiety.

Social anxiety disorder in relation to generalised anxiety disorder

The underlying causes of social anxiety disorder are in fact not much different from the causes behind generalised anxiety disorder. Similar to generalised anxiety, social anxiety will also stem from person’s perceived inability to survive or perform in this world according to their, often very harsh, standards. Also, they will tend to be repressing parts of themselves they do not identify with. However, the main differentiator of social anxiety to generalised anxiety seems to be the role shame plays. People with social anxiety will tend to be more prone to fearing that others will see their flaws, their inability to keep up with their expectations—and in their eyes that makes them an unworthy person.

Negative personal and social aspects of social anxiety disorder

When a person is dealing with social anxiety, especially when symptoms are quite severe and we can regard it as social anxiety disorder, they will usually avoid social situations in order not to get themselves anxious. Given that occurrence seems random to a person, they will often tend to avoid any social situation where they usually find themselves experiencing symptoms. This will result in isolation and make the problem worse, since internal negative dialogue will gain in its intensity.

Often times, people that have problems with social anxiety will turn to alcohol or misuse of drugs in order to relive and numb both their bodily sensations, as well as the negative parts of their cognition and feelings. This can lead to addiction.

Modern day manifestations of social anxiety can also lead to isolation from real life contact and turning to social media and internet to fill this basic human need for relationships. Social media and internet addiction can occur, as well as social media depression.

When diagnosing social anxiety disorder, it is important to be aware we might be facing Body Dysmorphic Disorder (BDD), which is also an anxiety disorder, but where a client will be preoccupied with their appearance and how others view them in terms of their appearance or bodily characteristics. The distinction between the two disorders is important in relation to treatment plan.

When dealing with social anxiety and social anxiety disorder (social phobia) in psychotherapy, I am the advocate of getting rid of the cause and not solely address the symptom. This usually deals with the problem indefinitely and prevents it to manifest itself through other mental health issues.