Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. The tendency for individuals with high social anxiety to avert their attention toward neutral stimuli is termed attention bias. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time may develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations. Social anxiety can be observed by both physiological and cognitive symptoms. Cognitive symptoms that arise from social anxiety can impair quality of life, interpersonal relationships and satisfaction in social life.
Disorder
Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by a significant amount of fear in one or more social situations causing considerable distress and impaired ability to function in at least some parts of daily life.National Institute for Health and Clinical Excellence: Guidance. Social Anxiety Disorder: Recognition, Assessment and Treatment. Leicester (UK): British Psychological Society; 2013. These fears can be triggered by perceived or actual scrutiny from others. Social anxiety disorder affects 8% of women and 6.1% of men. In the United States, anxiety disorders are the most common mental illness, affecting 40 million adults. Anxiety can come in different forms. Panic attacks can lead to panic disorders, the recurrence of unexpected panic attacks. Other related anxiety disorders include social anxiety disorder, generalized anxiety disorder, obsessive compulsive disorder (OCD), various types of phobias, and post traumatic stress disorder (PTSD). Social anxiety is treatable, though not everyone requires treatment.
Physical symptoms often include excessive blushing, excess sweating, trembling, palpitations, and nausea. Stammering may be present, along with rapid speech. Panic attacks can also occur under intense fear and discomfort. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. It is common for sufferers of social phobia to self-medicate, especially if they are undiagnosed or untreated. This can lead to alcoholism, eating disorders or other kinds of substance abuse. SAD is sometimes referred to as an "illness of lost opportunities" where "individuals make major life choices to accommodate their illness". According to ICD-10 guidelines, the main diagnostic criteria of social anxiety disorder are fear of being the focus of attention, or fear of behaving in a way that will be embarrassing or humiliating, often coupled with avoidance and anxiety symptoms. Standardized rating scales can be used to screen for social anxiety disorder and measure the severity of anxiety.
== Stages ==
Child development
Some feelings of anxiety in social situations are normal and necessary for effective social functioning and developmental growth. The difficulty with identifying social anxiety disorder in children lies in determining the difference between social anxiety and basic shyness. Typically, children may be diagnosed when their social fears are extreme or cannot be outgrown. Cognitive advances and increased pressures in late childhood and early adolescence result in repeated social anxiety. More and more children are being diagnosed with social anxiety, and this can lead to problems with education if not closely monitored. Part of social anxiety is fear of being criticized by others. In children, social anxiety causes extreme distress over everyday activities such as playing with other kids, reading in class, or speaking to adults. Some children with social anxiety may act out because of their fear, or they may exhibit nervousness or cry in the event they feel anxious.
Adolescence Adolescents have identified that their most common anxieties are connected to their relationships with peers they are attracted to, peer rejection, public speaking, blushing, self-consciousness, panic, and past behavior. Most adolescents progress through their fears and meet the developmental demands placed on them. Adolescents who continue to struggle with social anxiety tend to be more withdrawn, and have decreased feelings of being accepted by their peers. Adolescents who continually withdraw and disengage from social relations tend to experience increased peer victimization and decreased peer acceptance, which can increase the social anxiety they are experiencing.
Adulthood It can be easier to identify social anxiety within adults because they tend to shy away from any social situation and keep to themselves. Common adult forms of social anxiety include performance anxiety, public speaking anxiety, stage fright, and timidness. All of these may also assume clinical forms, i.e., become anxiety disorders (see below).Harold Leitenberg (1990) "Handbook of Social and Evaluation Anxiety",
Criteria that distinguish between clinical and nonclinical forms of social anxiety include the intensity and level of behavioral and psychosomatic disruption in addition to the anticipatory nature of the fear. Social anxieties may also be classified according to the broadness of triggering social situations. For example, fear of eating in public has a very narrow situational scope, while shyness may have a wide scope with a person being anxious in a variety of different situations. Clinical forms are divided into general social phobia (i.e., social anxiety disorder) and specific social phobia.
Signs and symptoms
Physiological symptoms Blushing is a physiological response unique to humans and is a hallmark physiological response associated with social anxiety. Blushing is the involuntary reddening of the face, neck, and chest in reaction to evaluation or social attention. Blushing occurs not only in response to feelings of embarrassment but also other socially-oriented emotions such as shame, guilt, shyness, and pride. Individuals high in social anxiety perceive themselves as blushing more than those who are low in social anxiety. Three types of blushing can be measured: self-perceived blushing (how much the individual believes they are blushing), physiological blushing (blushing as measured by physiological indices), and observed blushing (blushing observed by others). Social anxiety is strongly associated with self-perceived blushing, moderately associated with observed blushing, and weakly associated with blushing as measured by physiological indices such as temperature and blood flow to the cheeks and forehead. The relationship between physiological blushing and self-perceived blushing is small among those high in social anxiety, indicating that individuals with high social anxiety may overestimate their blushing. Social anxiety being associated most strongly with self-perceived blushing is also important for cognitive models of blushing and social anxiety, indicating that socially anxious individuals use both internal cues and other types of information to draw conclusions about how they are coming across.
Individuals with social anxiety might also refrain from making eye contact, or constantly fidget during conversations or public speaking. Other indicators are sudden physical symptoms including rapid heartbeat, muscle tension, dizziness and/or lightheadedness, stomach issues, diarrhea, trouble breathing, or “out of body” sensations.
Cognitive symptoms People with social anxiety disorder typically feel quite uncomfortable when they might be judged or watched by others. They may be afraid of making mistakes or being embarrassed, even when they are just talking to strangers or being in a group. These worries can make people feel anxious all the time and make them expect bad things to happen before they happen. This kind of thinking may lead to more avoidance behaviors over time and make it harder to interact with others in social, academic or work settings.
Individuals with social anxiety have a heightened level of internalizing symptoms such as trait anxiety, depression and self conscious behavior. The emotional and mental results of these cognitive symptoms include a lesser satistion in social life and bigger interpersonal problems. People who are prone to higher levels of social anxiety tend to suffer in many cognitive aspects such as lacking cognitive resources, maintaining tasks, distraction and lowered inhibition.
Attention bias
Individuals who tend to experience more social anxiety turn their attention away from threatening social information and toward themselves, prohibiting themselves from challenging negative expectations about others while maintaining those high levels of social anxiety. For example, a socially anxious individual may perceive rejection from a conversational partner, turn their attention away, and never learn that the individual is actually welcoming. Individuals who are high in social anxiety tend to show increased initial attention toward negative social cues, such as threatening faces, followed by attention away from these social cues, indicating a pattern of hypervigilance followed by avoidance. Research also suggests that individuals who have high levels of social anxiety often divert their attention to neutral stimuli to avoid eye contact and threatening communication. There is a positive correlation between social anxiety and attentional bias toward neutral stimuli as a distraction mechanism. Some claim that long-term memory for the distractor stimuli is enhanced because of involuntary attention bias.
Attention in social anxiety has been measured using the dot-probe paradigm, which presents two faces next to one another. One face has an emotional expression and the other has a neutral expression, and when the faces disappear, a probe appears in the location of one of the faces. This creates a congruent condition in which the probe appears in the same location as the emotional face and an incongruent condition. Participants respond to the probe by pressing a button and differences in reaction times reveal attentional biases. This task has produced mixed results, with some studies finding no differences between socially-anxious individuals and controls, some studies finding avoidance of all faces by socially-anxious individuals, and other studies finding vigilance by socially-anxious individuals only toward threat faces. The Face-in-the-crowd task shows that individuals with social anxiety are faster at detecting an angry face in a predominantly neutral or positive crowd or slower at detecting happy faces than a non-anxious person.