Social anxiety disorder: Not just extreme shyness


“Anita, a college-going girl, loves chatting with her few selected close friends. But on this Saturday evening, she is sitting at home. Her friends have called her several times to ask her to come to a party at a mutual friend’s house. But Anita just won’t budge. The very thought of attending a party makes her break out into a sweat. Nothing was going to induce her to enter a room full of people and strike up conversations with strangers.”

Do you dislike being the life of a party?

Would you rather not make a speech in front of a hundred people?

Do you have trouble speaking to strangers?

Do you feel you will be judged if you interact with people?

You’re not alone. There are many people like you who feel inhibited, reticent, and/or anxious in social and performance situations. This is a mental health disorder that affects every fifth Indian (as of 2013) which shares some characteristics with shyness. It is poorly understood, thus sufferers remain untreated or do not seek treatment. It is called social anxiety disorder (SAD). Females are slightly more likely to be affected by this disorder as compared to males. In fact a large number of organisations invest millions in employee engagement to help their employees dealing with social anxiety issues.

So misunderstood is this disorder that even mental health professionals differ in their opinions about it. The DSM-IV (American Psychiatric Association) calls SAD as social phobia also. However, some doctors consider this name to be a misnomer because all the SAD does not always manifest as phobias or extreme fears.

Social anxiety disorder in India

According to Dr. Bharat Shah, a psychiatry teacher at Somaiya Medical College in Sion, Mumbai, anxiety disorder has not been properly studied in India. Thus, there are no comprehensive statistics about the prevalence of the disorder. Mental health doctors believe that the incidence of anxiety disorders among patients is increasing. This is surely a bad sign.

Shah blames this increase in anxiety disorders to excessive crowding in cities, the drive for more money, and heightened competitiveness. All these factors cause more stress, leading to anxiety.

Social anxiety disorder among Indian adolescents


SAD Indian adolescents

SAD frequently has its onset in adolescence. The only study on SAD in Indian adolescents was conducted by Mehtalia and Vanker. The research examined 421 high-school children, out of which 54 (12.8%) children were found to be suffering from SAD.

The study found that the most common expression of SAD in these children was the tendency to avoid giving speeches. Girls and boys were found to be equally affected. Other factors found to be associated with SAD in the children are:

  • different treatment from that of siblings
  • less or no intimacy with parents
  • worries about weight
  • trouble coping with studies
  • having fewer friends

Younger children with SAD cannot focus on academics, making friends, or developing hobbies.

Social anxiety disorder vs. Shyness

SAD vs. shyness

While shyness is a normal part of one’s personality, SAD is not normal. Shy people prefer not to be in new and unfamiliar situations, but once they warm up to it they find that they can tolerate it. Whereas, people with SAD simply cannot tolerate any social or interpersonal situation. So much so that they strongly avoid all such situations. If such a circumstance is forced upon them, they suffer from physical reactions such as a racing heart, sweating, dizziness, nausea, stomach ache, hyperventilation, and headache. Ultimately, it may cause a panic attack.

What’s the difference between social anxiety disorder and shyness?

  • Shyness is a personality trait, whereas social anxiety disorder is not.
  • Shyness is usually described positively by a person, whereas social anxiety disorder is described negatively by the sufferer.
  • Shyness is a normal facet of one’s personality, whereas social anxiety disorder is not normal behavior.
  • Shyness does not debilitate one’s functioning, whereas social anxiety disorder impairs one’s social and physical functioning.

SAD sufferers are afraid of being judged, criticized, or rejected in circumstances where they have to perform. What is interesting is that a person with SAD may be quite competent socially until he or she perceives that he or she has to “perform” in some way.

Myths about social anxiety disorder


SAD myths

Some amount of anxiety is good for us and is considered normal. When we feel anxious, our body triggers an adaptive response to the upcoming challenges. But when SAD manifests, it causes significant distress and derails normal functioning. Some misconceptions about SAD are discussed ahead.

(1) People with social anxiety disorder cannot be extroverts. Extroverts suffering from SAD may long to be the center of attention, but their condition prevents them from doing so. Once treated, they find that they enjoy interpersonal and social situations immensely.

(2) Social anxiety disorder is uncommon. Epidemiological data on the prevalence of SAD in India is scant. Also, the existing studies have been conducted on a sample population of less than 6,000 people. Thus, the results cannot be considered to be accurate. However, an unwritten consensus among mental health professionals in India is that the prevalence of social anxiety disorder is increasing. Anxiety disorders in children and adolescents have been seen to increase over the last 20-30 years.

(3) Social anxiety simply causes you to feel nervous. Sufferers of social anxiety disorder do not just feel nervous. They experience a variety of symptoms, such as dizziness, headaches, shortness of breath, stomach trouble, rapid heartbeat, and muscle tension.

SAD is not just shyness taken to the extreme. While the boundaries of both entities do meet, they are quite different things.

Result of social anxiety disorder

SAD result

Adults find that their work life and their family life are severely impaired. Thus, they are at risk for developing other mental health conditions such as depression, anxiety disorders, and substance abuse.

Diagnosis of social anxiety disorder

SAD diagnosis

It is not easy to diagnose social anxiety disorder because usually patients approach doctors for treatment of their physical symptoms. Doctors prescribe medication to resolve the symptoms and the matter is closed. Only when these physical symptoms are not relieved do doctors investigate further. After this, a specialist comes into the picture who examines the patient’s history and circumstances carefully before pronouncing a diagnosis.

Management of social anxiety disorder

management of SAD

To effectively treat a patient suffering from social anxiety disorder, the origin of anxiety needs to be discovered. A typical management regime includes exposing the patient to lower levels of the trigger in order to desensitize him or her. Gradually, the intensity is increased until the patient is no longer anxious. Counseling is also done to help the patient understand the issue. In certain cases, anti-anxiety medication may be prescribed.

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