Stop Anxiety from Stopping You: The Breakthrough Program For Conquering Panic and Social Anxiety(14)

CHAPTER VIII.





Understanding Social Anxiety





“Be who you are and say what you feel, because those who mind don’t matter and those who matter don’t mind.”

— Dr. Seuss





Mark sat in my office, perplexed. He was attractive, happily married, and had an enviable position at his company. He and his wife had a circle of friends, and he regularly played racquetball at the sports club. Recently, Mark had started to have panic attacks at work. At first, they started when Mark had to give a presentation. However, more recently he had found himself getting them out of the blue: when he was at his desk, on a conference call, or just walking to the water cooler. Mark was surprised when I suggested that he might be struggling with social anxiety.

We started talking about his life before he met his wife, Liz. Mark was generally shy around women and met Liz when they were both in college. Their freshman year, Mark was introduced to Liz by a mutual friend. Liz was a social butterfly and always had a large circle of friends. Mark quickly fit in with that circle and as a result, had a very busy social life without much effort. Later, when they got married, Liz continued to manage their social calendar. Mark often felt tired after socializing and anxious before any social event, but he assumed this was normal. He was very careful with his words and often rehearsed “small talk” topics before a party.

Things came to a head when Mark was promoted to a position where he had to take impromptu meetings and deliver company-wide reports. Without his preparation, Mark felt panicked, sure that he was going to say something foolish and become the laughing stock of the company. He went to work in a state of dread and frequently experienced panic attacks prior to starting therapy.



Mark’s problem is a common problem. In the United States, forty million adults struggle with an anxiety disorder, fifteen million adults struggle with social anxiety, and six million face panic disorder (adaa.org, accessed July 23, 2016). It is common for social anxiety to co-occur with panic disorder, and people frequently think it is panic that is the problem. The real issue only comes out after someone fully explains their experience and symptoms in my consultation room. Usually if you have social anxiety, you are also very worried about the social consequences of having panic attacks or any visible signs of anxiety. If you have social anxiety, you may be extremely uncomfortable in social situations and try to avoid them. You may feel intense anxiety about being judged by others and live in fear of doing or saying something shameful or embarrassing. When you do participate socially, it may feel as though there is a spotlight shining on you and all your mistakes will become not only visible, but also magnified. Because these situations are so difficult for you, you may not be able to do the things that you would like, such as dating and certain social, school, or work activities. A subset of people with social anxiety experience it only in performance situations, such as public speaking or performing on stage or in front of people.



Janet came in for a consultation due to experiencing frequent panic attacks. She described that they usually occurred when she was invited to a party. She would notice the anxiety building prior to the party and the day of. She would dread having to go for fear of embarrassing herself. She felt like if she went with other people, they would notice if she had to leave early (due to panic), and so she often went by herself and did not enjoy it. Sometimes she avoided the parties altogether, fearing that her symptoms might get so bad that they would be noticed. When she did go, she felt like there was a big spotlight on her and that any social error that she made was magnified.



Janet’s experience is common among people who struggle with anxiety. Let’s take a look at the formal clinical definition of social anxiety as defined by the Diagnostic and Statistical Manual V, published by the American Psychiatric Association. The current definition of social anxiety according to DSM V is:

A. A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act (or show anxiety symptoms) in a way that will be embarrassing and humiliating.



B. Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed panic attack.



C. The person recognizes that this fear is unreasonable or excessive.



D. The feared situations are avoided, or else are endured with intense anxiety and distress.



E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.



F. The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.



G. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder...

Copyright 2013, The American Psychiatric Association

At the heart of it, social anxiety is about the fear of judgment and embarrassment. It is understandable – most of us do not want to be ousted from our social circle. From an evolutionary perspective this makes sense – you were much more likely to survive if you were with your tribe; you would have protection and access to shared resources. People struggling with social anxiety often would like to have control over how they are perceived by others and have fairly strict rules about what constitutes acceptable behavior in a social situation. As a result, if you have social anxiety, you may have adopted the philosophy of “niceness” and politeness to a fault. This belief is often recognized by the person struggling with social anxiety as unreasonable or excessive, however, it is usually so powerful that it becomes the guiding force in making decisions about whether or not to engage in feared activities.