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Biology 103
2003 Third Paper
On Serendip

Social Anxiety

Paula Arboleda

Social Anxiety

A woman hates to stand in line in the grocery store because she's afraid that everyone is watching her. She knows that it's not really true, but she can't shake the feeling. While she is shopping, she is conscious of the fact that people might be staring at her from the big mirrors on the inside front of the ceiling. Now, she has to talk to the person who's checking out her groceries. She tries to smile, but her voice comes out weakly. She's sure she's making a fool of herself. Her self-consciousness and anxiety rise to the roof...(Richards 1) (1).

A student won't attend her university classes on the first day because she knows that in some classes the professor will instruct them to go around the room and introduce themselves. Just thinking about sitting there, waiting to introduce herself to a roomful of strangers who will be staring at her makes her feel nauseous. She knows she won't be able to think clearly because her anxiety will be so high, and she is sure she will leave out important details...The anxiety is just too much to bear---so she skips the first day of class to avoid the possibility of having to introduce herself in class... (Richards 2) (2).

These are just two examples of how people who suffer from social anxiety disorder feel about social situations and everyday interactions. Their fears can be paralyzing.

Social anxiety disorder is the third largest psychological problem in the United States. It affects approximately 15 million Americans every year. It is a widely misunderstood disorder, where nearly 90% of people with social anxiety disorder are misdiagnosed. They are often misdiagnosed with schizophrenia, manic-depression, clinical depression, panic disorder, and or personality disorder (Richards 1-3). Misdiagnosis and undertreatment of anxiety disorders, according to "The Economic Burden of Anxiety Disorders," a study commissioned by the ADAA, costs the United States more than $42 billion a year and more than $22.84 billion is linked to the repeated use of healthcare services for symptoms that mimic physical illness. In addition, people with anxiety disorder are three-to-five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders when compared to those who do not suffer from anxiety disorders ("Brief Overview of Anxiety Disorders" 2) (3).

Social anxiety disorder can be defined as the 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, and where exposure to such situations provokes anxiety. People who suffer from social anxiety avoid or endure with severe anxiety or distress these much-feared situations. The avoidance, anxious anticipation, or distress in the social or performance situation interferes tremendously with the person's normal routine at work, in school, during social activities, and/or in relationships. Although people who suffer from social anxiety disorder recognize that this fear is unreasonable or excessive, they cannot merely will themselves to stop having these unreasonable or excessive preoccupations. Because social anxiety disorder has only been officially recognized since 1980, and since the problem did not become adequately explained until 1987, the definition is contestable, and not totally accurate ("DSM—IV Definition of Social Anxiety Disorder 1-2) (4).

The causes for social anxiety disorder are not fully known. They continue to be investigated and researched. However and according to the National Institute of Mental Health, some investigations implicate a small structure in the brain called the amygdala. The amygdala is a central site in the brain that controls fear responses. Activity at this site may be linked/responsible for social anxiety symptoms. Social anxiety symptoms include heart palpitations, faintness, blushing, and profuse sweating. Other investigations are trying to explore whether there is a biochemical basis for the disorder. Scientists are exploring whether heightened sensitivity to disapproval may be physiologically or hormonally based. Lastly, other researchers are investigating environmental influences on the development of social phobia ("National Institute of Mental Health--Facts about Social Phobia" 1) (5).

Although more research needs to be done regarding the causes and the characteristics that define social anxiety disorder, several treatment options are available. Social anxiety disorder can be treated with medication, psychotherapy, or both. A number of medications originally prescribed for the treatment of depression are now being used to treat anxiety disorders. They are selective serotonin reuptake inhibitors and monoamine oxidase inhibitors. Selective serotonin reuptake inhibitors act on the brain on a chemical messenger called serotonin; they tend to have fewer side effects than older antidepressants. Monoamine oxidase inhibitors are the oldest of the antidepressant medications; phenelzine, the most commonly prescribed MAOI, is helpful for people with panic disorder and social anxiety disorder. Meanwhile, high potency benzodiazepines and beta-blockers are specifically used as anti-anxiety medications. High potency benzodiazepines are used to relieve the symptoms caused by anxiety. They have few side effects but can be addictive. They are prescribed for short periods of time. Beta-blockers, often used to treat heart conditions, have been found to be useful for patients suffering from social anxiety disorder. They may be prescribed in advance of a situation that would produce anxiety like an oral presentation in order to keep anxiety related symptoms such as heart pounding, shaking hands, and other physical symptoms from developing ("National Institute for Mental Health—Anxiety Disorders" 9-10) (6).

Although medication may be very helpful and useful for the treatment of social anxiety disorder, cognitive behavioral therapy seems to be very effective and useful. The goal of cognitive behavioral therapy is to reduce anxiety by eliminating beliefs or behaviors that help maintain the anxiety disorder. Cognitive behavioral therapy has two components. The cognitive component helps people change thinking patterns that keep them from overcoming their fears. The behavioral component of CBT seeks to change people's reactions to anxiety provoking situations, exposure being an integral element in the behavioral component. Exposure is a technique used to help people suffering from anxiety disorders confront the things they fear. For example, when using the exposure technique, a person with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee. However, the exposure technique of CBT will only be used when the patient is ready. It cannot be done without the patient's consent. In order for the exposure technique to be effective, it must be done gradually and with permission. In order for cognitive behavioral therapy to be most effective, it must be catered to the person's specific anxieties. CBT usually lasts about twelve weeks. It is sometimes conducted in a group, with permission of course, and the positive effects are noted to last longer, upon discontinuing therapy, when compared to medication ("National Institute for Mental Health—Anxiety Disorders" 11-12) (7).

Social anxiety disorder is still widely and seriously misunderstood both by the medical world and by society in general. It is very important not only to medically and scientifically be able to obtain more information on social anxiety disorder, how it develops, and how it can be treated, but, it is equally as important to make this information accessible to a larger community. Information alone cannot educate people about what this disorder looks like and what people who suffer from social anxiety feel and think, but it is one step in a larger process. Social anxiety, like several other mental health related disorders, carries a stigma, which can only be dismantled if people are forced to recognize that these disorders exist and that they can be treated. In general, people need to learn to understand that people can overcome social anxiety. Overcoming social anxiety or learning how to live with it is a difficult task, but it is possible to live a "normal" life. Although it is more important for people who suffer from social anxiety disorder to be convinced that overcoming this disorder and its stifling effects are possible, it is equally as important for a larger audience to be aware that this disorder exists.


1)What is Social Anxiety ,

2)What is Social Anxiety ,

3) Brief Overview of Anxiety Disorders ,

4) Diagnostic Statistical Manual—IV Definition of Anxiety Disorder,

5) Facts about Social Phobia ,

6)Anxiety Disorders,

7)Anxiety Disorders,

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