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Social Anxiety Disorder

Any number of situations or events trigger the infection; it might be hereditary, the result of some traumatic experience, or environmental. The adolescent could have been subject to bullying or a broken home. Perhaps the parents were overprotective or controlling, or unable to provide emotional validation. 

Social anxiety disorder shares commonalities with general anxiety disorder (GAD), and both may occur together. Depression, as well as issues of motivation and self-esteem, are also common factors.

Feeling anxious or nervous in certain situations is normal and not indicative of a personality disorder. Most individuals are apprehensive about speaking in front of a group of people, and anxious when pulled over on the freeway. A “normal” person recognizes the ordinariness of a situation and gives it appropriate attention. Persons with SAD experience excessive or disproportionate anxiety, dramatize it, catastrophize it, and fixate on the worst-case scenario.

SAD sustains itself by irrational thoughts and actions motivated by negative self-evaluation and fear of rejection. Often the SAD subject will arbitrarily reject someone in order to avoid the humiliation of being rejected.

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) experience symptoms, and 1.3% have severe impairment. These statistics are fluid, however. A high percentage of persons who experience SAD refuse treatment, fail to disclose it, and remain ignorant of its symptoms. 

The superficial overview of SAD is intense apprehension—the fear of being judged, negatively evaluated, or rejected in social situations. The overriding characteristic of SAD is acute feelings of incompetence and worthlessness. SAD sustains itself through repression and intractability, imposing irrational thought and action. Its dominance is strengthened by anger, mistrust, agitation, frustration, and self-denigration. Perceptions of personal attractiveness, intelligence, and competence become distorted and unsound. 

The logical reaction to a PPM is to seek awareness and treatment. 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. The SAD subject meticulously avoids situations that might trigger discomfort. Multiple symptoms produce feelings of futility and unworthiness, and the perception of incompetence generates profound and debilitating shame.

Subjects experience symptoms of intense apprehension in social situations—dating, interviewing for a position, answering a question in class, dealing with authority. Functioning on an interpersonal level—eating or front of others, riding a bus, using a public restroom—can cause undue stress and anxiety. In a nutshell, the SAD subject is afraid that he or she will be humiliated, judged, and rejected.

The fear that manifests in social situations is so fierce that many conclude that it is beyond their ability to control, which manifests in perceptions of incompetence and futility. Negative self-evaluations interfere 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 the actual occurrence. Invariably, they will avoid places, events, or situations where there is the potential for embarrassment or ridicule.

The key to SAD’s success is its uncanny ability to detect weakness and sense vulnerability. It swoops in to fill the void, taking control, telling the subject how to think and act. SAD is the like the man who comes to dinner and stays indefinitely. He feeds off his host’s irrationality. He crashes on the couch, surrounded by beer cans drained of hope and potential. He monopolizes the bathroom, creating missed opportunities. He becomes the predominate fixture in the house. After a while, his SAD host not only grows accustomed to having him around but forms a subordinate dependency.

In many ways, interpersonal relationships are at the heart of SAD. We find it challenging to make new friends or have any at all. Healthy relationships demand that we emerge from our protective environment and take risks—not a comfortable commitment for someone resistant to change. 

SAD attacks the entire body complex, bringing intellectual confusion and irrationality, emotional instability, physical dysfunction, and spiritual malaise. Emotionally subjects feel melancholic, heartbroken, and useless. SAD persons are subject to unwarranted sweating and trembling, hyperventilation, nausea and cramps, lightheadedness, muscle spasms, and tension. Spiritually they perceive themselves as incapable, unworthy, and insignificant.

You are all familiar with the free association test. The authority figure in the white coat tosses words at you, and you respond with the first reactive word that comes to mind. Here is a list of responsive words: useless, incompetent, timid, ineffectual, chicken, insignificant, and stupid. Has anyone used those words to describe you? Do you use any of those words to describe yourself? When you break a dish, do you blurt out the word, stupid? When you cannot figure the right driver to remove a screw, do you feel useless? When you forget to pay a bill, do you think, what an idiot? Most people toss out these pejoratives daily, but few take them to heart like the SAD individual. These are the automatic negative thoughts (ANT’s) the SAD subject implants in the neural network. ANTs determine reactions to situations or circumstances. They inform how to think and feel and act. The ANT voice exaggerates, catastrophizes, and distorts. It demeans the subject, denigrates their abilities, makes them feel inept, robs them of their dignity and self-esteem, and makes their future appear hopeless.

Overall, the SAD subject worries too much about what someone else thinks of them. They fear being evaluated and judged, afraid they will say or do something that will reveal their incompetence or ignorance. They walk on eggshells, conscious of every eye in the room, feeling like they are the center of attention and everyone is judging them. Movements are awkward, attempts at humor embarrassing. They try to make conversation but do not know what to say. Their mind blanks, their response hesitant and timid.

Many rely on alcohol and pharmaceuticals to dull the pain of their condition, giving them false confidence, allowing them to be someone else for a while, someone who does not suffer from SAD.

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 and positive psychology serving as the foundational platform for integration.