Social Anxiety Disorder

Discover how proven counselling can help you break free from the prison of social anxiety and step into a life of confidence and connection.

For those with social anxiety disorder, getting coffee, going to work, or attending a party can trigger panic attacks and unbearable distress.

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    We all get nervous when preparing for a big presentation or going on a first date, but what happens when butterflies become a gripping fear that penetrates your brain and body whenever you have to go anywhere?

    Social anxiety disorder is one of the most common mental health issues in Canada, with statistics estimating that between 8 to 13% of people will experience it.

    Also known as social phobia, the condition can impact your everyday life and result in avoidant behaviours. Many people avoid social situations due to fear of judgement from their peers, resulting in a lower quality of life. 

    Not getting support for your social anxiety disorder will impact your professional, social and romantic relationships, increasing the risks of depression. 

    With the right approach, social anxiety disorder is highly treatable, and there are plenty of medications or therapeutic options available. 

    Well Beings Counselling provides a specialist service for individuals with severe anxiety. Our dedicated therapists can help you – or a loved one – overcome their fears and enjoy a happier life. 

    A woman with social anxiety disorder, dreading having to present at her work in front of people, her palms are sweaty and her heart beats against her chest

    What is Social Anxiety Disorder?

    Everyone experiences anxiety at some point, but the Diagnostic and Statistical Manual (DSM-5) states that social anxiety disorder occurs when a person experiences symptoms that have a marked impact on their life.

    These symptoms must cause severe distress and be present for at least six months before receiving a diagnosis. Anxiety disorders go beyond general worrying, impacting both adults and children in different ways.For example, when meeting someone for the first time, it’s natural to worry about making a positive impression. People with social anxiety disorder will experience intense fear, which means they might actively avoid these situations.

    Social Anxiety Disorder in Children and Adolescents

    Social phobia can present early in life, but it’s most common in adolescents. Naturally, the symptoms of social anxiety can differ depending on how it manifests and the person’s age. Unfortunately, the prevalence of anxiety disorders in children has increased since 2009.

    Today, 9% of children and up to 19% of teens in Canada self-report an anxiety disorder. In 2011, 6% of adolescents had a professional diagnosis, but these numbers doubled by 2018 (Canadian Paediatric Society).

    The symptoms young children often present include:

    • Temper tantrums
    • Crying often
    • Not wanting to go to school
    • Unwillingness to partake in social activities
    • Getting distressed when separated from primary caregivers
    • Not interacting with lessons or being too scared to ask for help
    • Stomachaches and feeling sick
    Children as young as four can receive a social phobia diagnosis, and their symptoms often present differently to adolescents and adults, as they might not understand the intricacies of social interactions.

    Social anxiety disorder symptoms in adolescents include:

    • Looking or acting uncomfortable when they’re around others
    • Avoiding people they don’t know
    • Worrying about social interactions
    • Going over every conversation and criticizing themselves
    • Avoiding socializing with others
    • Blushing, feeling sick and sweating excessively
    • Problems making and keeping friends
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    Risk factors for children and adolescents developing social anxiety disorder

    Most parents want their children to be confident, resilient and open to new experiences, but social anxiety disorder can significantly impact their quality of life. While there’s no single cause of the condition, certain factors can contribute to a person developing a social phobia.

    Health issues

    Teenagers with certain conditions might lack self-esteem. For example, a birthmark, scar or other physical condition could make them feel different, resulting in low confidence and feeling like they don’t belong.

    Predisposition

    Some children are naturally shyer than others, and this can contribute to social anxiety disorder. An only child might also suffer when they start school – especially if they haven’t had much social interaction.

    Bullying

    Whether it’s in-person or online bullying, the impact of abuse can be devastating. Seven in ten children from Canada experience some form of bullying, and two in five are bullied every month (CPS). Bullying impacts a child’s self-esteem and can result in anxiety symptoms when socializing with others.

    Speech issues

    Speech impediments are one of the most common forms of disabilities among children in Canada, with 67,000 children under 14 experiencing them (Statistique). Feeling different, struggling to communicate and being picked on by other children can increase the risks of social phobia.

    Overprotective parents

    We live in a dangerous world, and parents are naturally more inclined to protect their children. According to Neuroscience News, overprotective and controlling parenting can lead to children developing social anxiety disorder.

    Social anxiety disorder in adults

    Adults can also experience social anxiety disorder, even if they didn’t have it as a child. The Anxiety and Depression Association of America (AADA) estimates that 15 million adults in the US have social phobia, with women experiencing it more than men.

    Dealing with excessive social anxiety can have a negative impact on an adult’s life, impacting their relationships.

    Physical symptoms of social anxiety include:

    • Heart palpitations and feeling dizzy
    • Excessive blushing
    • Trembling and shaking
    • Urgent need to use the bathroom
    • Nausea and vomiting

    Psychological symptoms include:

    • Low self-esteem in general, or feeling self-conscious around others
    • Dissecting every interaction and engaging in self-criticism
    • Worrying about people talking behind your back
    • Feeling judged and unworthy of friends
    • Depression and other anxiety disorders

    Behavioural symptoms include:

    • Withdrawing at work or in social situations
    • Being afraid to pay for items in shops
    • Avoiding parties and gatherings
    • Struggling in personal relationships
    • Eating alone to avoid others looking at you

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    What are the causes of social phobia in adults?

    Social anxiety can occur in adults for numerous reasons, including genetic and environmental factors. However, many adults with the condition first experience it in childhood, and it can return later in life. Let’s take a look at the common causes.

    Genetic factors

    While more research is needed, some studies suggest that social phobia and other anxiety disorders might be hereditary (NCBI). It’s important to remember that parents with severe anxiety might displace their fears onto children, which also increases the risks of developing a phobia.

    Bullying

    Adults aren’t immune to bullying, and the workplace is one of the key areas where people struggle. Around 40% of Canadians have experienced bullying as an adult, and this can cause them to develop social anxiety disorder.

    Relationship issues

    Being in a bad relationship can impact a person’s self-esteem and lead to anxiety disorders. Failing to keep and maintain friendships and even family problems can lead to a person withdrawing from social interaction.

    Environmental factors

    Significant life changes can also lead to social phobia. For example, moving home, starting a new job and losing a family member might cause considerable distress, and over time, it can lead to anxiety in social situations.

    Mental health conditions

    Some Autistic spectrum disorders mean a person might have poor social skills and extreme shyness. These symptoms can lead to depression and isolation, while psychiatric disorders can also cause social phobias. 

    Diagnosing social anxiety disorder

    There are no physical tests to diagnose social anxiety disorder, but your specialist will ask you questions to assess whether you meet the Diagnostic and Statistical Manual criteria. They’ll also want to rule out generalized anxiety disorder or other conditions that can present similar symptoms.

    Under the DSM-5, a person must:

    • Experience a prolonged and intense anxiety about social situations, with worries about how others will perceive and judge them.
    • Go out of their way to avoid social interactions or experience mental symptoms when having to deal with them.
    • Have severe anxiety that doesn’t often reflect the situation. For example, ordering something at a restaurant causes severe symptoms.
    • Deal with symptoms that reduce their quality of life and relationships.
    • Not have a substance abuse problem or other illness that would explain the symptoms.

    Why Treating Social Anxiety Disorder is Essential

    All mental disorders can have a profound effect on a person’s life, causing relationship problems, social isolation and limiting employment opportunities. Social phobia goes beyond just shyness and self-consciousness, but effective treatment can reduce the symptoms.

    Failing to seek support can lead to depressive disorders, substance abuse and suicidal ideation (Science Direct).

    As the person struggles with negative thoughts, they might not have a support network, which leads to them seeking other coping mechanisms.

    Children might continue to experience symptoms later in life, impacting academic achievements and causing them to shy away from potentially enriching opportunities.

    Luckily, there are a range of treatment options available.

    Medications for Social Anxiety Disorders

    Medications explicitly designed for social anxiety disorder are often a first line of treatment, but specialists can also prescribe other medicines off-label if they feel you’d benefit from them. Depending on your age and symptoms, you might use SSRIs, MAOIs or SNRIs.

    Selective Serotonin Reuptake Inhibitors (SSRIs)

    SSRIs boost levels of serotonin in the brain, which can reduce the impact of depression and anxiety. These medications are highly effective at treating social anxiety disorder and are known to prevent relapses in patients.

    Popular SSRIs include:

    • Sertraline
    • Fluoxetine
    • Paroxetine
    • Citalopram
    • Fluvoxamine

    The correct dosage can make a difference to your mental health, and specialists will often increase the dose until it reaches optimal levels.

    Monoamine Oxidase Inhibitors (MAOIs)

    MAOIs are powerful antidepressants that break down monoamine oxidase, an enzyme that can reduce levels of serotonin and other hormones. While they’re highly effective, MAOIs can cause various side effects, so specialists only prescribe them when other medicines don’t work.

    Available MAOIs include:

    • Phenelzine
    • Tranylcypromine

    Treatment-resistant social anxiety disorder can respond well to these medicines, but it’s essential to discuss the potential impact of them with your doctor.

    Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

    SNRIs are a popular alternative to traditional SSRIs and might be prescribed if other medications aren’t working. The main difference between SNRI and SSRI medicines is that they also work on the norepinephrine transmitter, which is responsible for attention and alertness.

    Popular SNRIs include:

    • Duloxetine
    • Venlafaxine
    • Levomilnacipran
    • Desvenlafaxine

    Some people with social anxiety find these medications to be more effective, depending on their presenting symptoms.

    Beta-Blockers

    People with severe physical symptoms of social anxiety can take beta-blockers before a triggering event, such as giving a presentation or being in a group of people. They block adrenaline receptors, reducing the effects of heart palpitations, blushing and trembling.

    The good thing about beta-blockers is they don’t compromise cognitive functioning, but they’re more of a short-term solution than a long-term treatment option.

    Therapies to Treat Social Anxiety Disorder

    While medications can treat the immediate symptoms associated with social anxiety disorder, therapeutic interventions will reveal the underlying cause and teach people valuable coping mechanisms, which help them recover fully.

    Psychotherapy

    Psychotherapy is an intensive process that helps an individual identify the underlying cause of their anxiety and deal with any trauma that might have caused it. During sessions, a therapist will help the individual understand more about their anxiety, allowing them to navigate through recovery.

    However, it can be a challenging time as successful treatment involves uncovering past traumas, and the process can take longer than other forms of therapy.

    Cognitive Behavioural Therapy (CBT)

    BT is a highly effective treatment for social anxiety disorder, as it helps people identify thought patterns and triggers that impact their behaviours. As a structured approach, it involves replacing harmful thought patterns with healthier ones.

    The great thing about CBT is that people can also have online counselling sessions, which helps them gradually deal with their anxiety.

    Exposure therapy

    Exposure therapy is another CBT approach that requires individuals to expose themselves to situations that trigger anxiety gradually. The process can be intense, but a supportive counsellor can help with gradual exposure.

    Therapies to Treat Social Anxiety Disorder

    With the proper support, you can overcome social anxiety disorder and enjoy a fulfilling life. Yes, it takes work, but people who have therapy for social anxiety disorder tend to learn vital coping mechanisms that can remove negative thinking patterns.

    If you’d like to seek treatment, Well Beings Counselling has a dedicated team of qualified therapists who offer in-person and online counselling. Please get started today, and we’ll help you on the road to recovery.

    FAQ's

    Yes, we have a range of dedicated therapists who have experience in treating children with social anxiety. Family therapy is also an option if you want to learn how to support your child.

    If there's a family history of social anxiety, it's a good idea to seek couples counselling or explore support groups.

    Social anxiety disorder treated with medication alone means you might experience fewer symptoms. However, counselling gets to the root of the problem and helps you combat negative thoughts, reducing the need for antidepressants or other medications in the future.

    Young children often present different symptoms than adolescents and adults, but common signs include your child not wanting to interact with their peers, having tantrums or crying when you're leaving them somewhere and spending a lot of time alone.

    These symptoms can be due to other conditions, so it's best to get a clinical psychology review where a specialist can assess your child.

    No matter what you are struggling with, we are here for you.

    No matter what you are struggling with, we are here for you.

    Pareen Sehat MC, RCC

    Pareen Sehat MC, RCC

    Pareen’s career began in Behaviour Therapy, this is where she developed a passion for Cognitive Behavioural Therapy approaches. Following a Bachelor of Arts with a major in Psychology she pursued a Master of Counselling. Pareen is a Registered Clinical Counsellor (RCC) with the BC Association of Clinical Counsellors. She specializes in CBT and Lifespan Integrations approaches to anxiety and trauma. She has been published on major online publications such as - Yahoo, MSN, AskMen, PsychCentral, Best Life Online, and more.

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