Social Anxiety

George is a 22-year-old university student. He describes himself as being a shy kid, but since starting university 18 months ago, he has become increasingly anxious about talking to other people. He first noticed that he would analyse his ‘performance’ after spending time with his friends. He would think about what he said and did, and wondered if any of his actions were likely to draw criticism from others. George has since become increasingly preoccupied about people forming a negative impression of him. To cope, he started reducing his social contact by turning down invites to socialise, giving various excuses such as having too much work to do, or faking illness. He now experiences a surge of anxiety when going to lectures. He sits at the back of the room during class, and pretends to text on his phone to look busy. He experiences a number of physical signs of anxiety, such as racing heart, chest tightness, feeling ‘shaky’, and excessive sweating. Last week, George’s girlfriend forced him to go to her parent’s house for dinner. George was scared about having to hold a conversation, and this made his stomach churn on the car ride over. At the supermarket, George now finds it unbearable to stand in line for the checkout because he thinks people are looking at him and can tell how anxious he is. George will not stand in line at the bank, and refuses to eat a meal in public, again because he thinks people are staring at him.

Social phobia is the overwhelming fear that your behaviour in public situations will be evaluated negatively and criticised by others. While George is a fictional character in the above passage, his experiences are similar to those who experience high levels of anxiety in public settings. Like other mental health problems, social anxiety can vary in severity. Some experience barely detectable twinges of anxious discomfort while suffer from extreme anxiety that prevents them from leaving the house; people can be diagnosed with social anxiety disorder at this severe end of the spectrum. George is likely to be in this severe range given the extent of his anxiety and the effect this has on his life.

Social anxiety shares many common features with shyness. The difference between the two involves severity and negative impact upon day-to-day life. Shyness is usually not a big deal in terms of holding you back on completing regular day-to-day tasks. Social anxiety, by contrast, can totally disrupt a person’s ability to live life and perform even basic tasks. Lynne Henderson is one of the big names in the field of social anxiety. She talks about a concept called ‘social fitness’. In this approach, social anxiety is placed on a continuum of increasing/decreasing anxiety. This is different to many other approaches that view people as socially anxious or not socially anxious (a ‘dichotomy’). The concept of social fitness also gives the idea that, like physical fitness, you need to work on your social skills to get 'fitter' or more socially competent.

People may suffer from social anxiety in specific situations, or more commonly, experience anxiety that occurs across multiple public settings ('generalised' social phobia). Feared situations can include attending parties, eating in public, or standing in a queue (e.g., at a bank), writing in front of others, having to introduce yourself to a group of people, or playing sports. Interestingly, speaking in public is the situation feared by the highest number of people (1). Socially anxious people are highly focused on how they think other people see them. This tends to be real problem because, useless you ask directly, it is very hard to know what other people actually think about you (and there are no guarantees even if you did ask directly!). Trying to guess in your own mind can easily led to all sorts of distorted thinking that can ultimately lead you down the track of negative conclusions that also turn out to be false. Reviewing your ‘performance’ after contact with others is also common to social anxiety. What tends to happen here is that you repeatedly think about what you said and how you acted after social contact. People do this because they are 'looking' for a slip-up of some kind such as breaking an un-written social rule (e.g., saying something 'stupid'- “Damn! I should have said Borg was the greatest men’s tennis player of all time, not Federer”......lame example no. 1 for this blog post Ladies and Gents).

Social anxiety can become a self-fulfilling prophecy in that anxious people can experience problems showing the skills needed to function smoothly when around others. For example, the communication skills of socially anxious people can suffer (2). In other words, the anxiety changes your behaviour (e.g., you don’t make eye-contact with others) and this leads others to make a negative conclusion about you (e.g., ‘He’s not interested in talking to me. He’s not even looking at me’). This in turn changes their behaviour and you might interpret this as ‘evidence’ that people do not like you. As you have probably heard, communication is a reciprocal process- your behaviour influences the other person’s behaviour and vice versa. It is very easy for the anxious person to get caught up in their own mind and only think of a limited number of negative interpretations for a situation.

There is little difference in prevalence rates between men and women. Males are commonly identified as suffering from social anxiety disorder at the same or slightly less rates than women (3). Females are said to experience more severe social anxiety, while men and women can differ on the specific circumstances they fear (4). For instance, it has been claimed that men are more fearful when, wait for it, urinating in public along with dating and having to return goods/products to a shop (5) (by 'urinating in public', we mean in a public toilet, not in full view at the local mall).

Social phobia usually develops during adolescence and the incidence decreases into the 20's (6). Social phobia tends to continue over time with few people naturally recovering (7). The average duration of social phobia is over 16 years with over 80% of suffers not receiving treatment (8). This is a problem that goes on for years with help rarely being sought. Aside from a direct negative effect on a person’s social life, there are several knock-on or ‘secondary’ effects including a general decrease in quality of life (9), poor vocational achievement (e.g., lower levels of education, income, and rates of employment), higher prevalence of physical health and mental health problems (10). This shows that social anxiety can be a major problem, not just as a problem in itself, but the potentially wide-ranging negative effects on life and a person’s potential.

More information on social anxiety can be found at Social Anxiety UK.

A useful book on coping with social anxiety is called 'Managing social anxiety' by Debra Hope and colleagues. It is published by Oxford University Press USA.

(1) Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008). Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. Psychological Medicine, 38(1), 15-28.

(2) Bruch, M. A., Berko, E., & Haase, R. F. (1998). Shyness, masculine ideology, physical attractiveness, and emotional inexpressiveness: Testing a mediational model of men’s interpersonal competence. Journal of Counseling Psychology, 45, 84–97.

(3) McLean, C. P., Asnaani, A., Litz, B. T., Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027-1035.

(4), (5) Turk, C. L. et al. (1998). An investigation of gender differences in social anxiety. Journal of Anxiety Disorders, 12(3), 209-223.

(6) Wittchen, H. U., Nelson, C. B., Lachner, G. (1998). Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychological Medicine,  28(1), 109-26.

(7) Wittchen, H. U., Fehm, L. (2001). Review Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. Psychiatric Clinics of North America, 24(4), 617-641.

(8) Grant, B. F. et al. (2005). The Epidemiology of Social Anxiety Disorder in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(11), 1351-1361.

(9) Stein, M. B., & Kean, Y. M. (2000). Disability and Quality of Life in Social Phobia: Epidemiologic Findings. The American Journal of Psychiatry, 157(10), 1606-1613.

(10) Dahl, A. A., & Dahl, C. F. (2010). Are there gender differences in impairment associated with high social anxiety? A community-based study. Journal of Anxiety Disorders, 24, 487-493.



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