- Social Anxiety Disorder
- Performance Situations
- Interpersonal Interactions
- Negative thoughts (what you think)
- Physical symptoms (what you feel)
- Avoidance and safety behaviors (what you do)
- When Does Social Anxiety Become a Problem?
- Work and school
- Recreational activities/hobbies
- Day-to-day activities
- Avoidant Personality Disorder vs. Social Anxiety
- Social Anxiety
- Avoidant Personality Disorder
- John With Social Anxiety
- John With Avoidant Personality Disorder
- Treatment for Avoidant Personality Disorder vs Social Anxiety
- BEWARE THE SILKEN TRAP OF SAFETY BEHAVIORS
- Playing safe
- Commonly used safety behaviors
- Breaking free of safety behaviors with cognitive behavior therapy (CBT)
Social Anxiety Disorder
Social Anxiety Disorder
Feb 19 • 2019
Social anxiety disorder is one of the most common anxiety disorders. People with social anxiety disorder tend to feel quite nervous or uncomfortable in social situations. They are very concerned that they will do something embarrassing or humiliating, or that others will think badly of them. These individuals are very self-conscious and constantly feel “on stage.”
A social situation includes any situation in which you and at least 1 other person are present. Social situations tend to fall into 2 main categories: performance situations and interpersonal interactions.
These are situations where people feel they are being observed by others. Examples include:
- Public speaking (e.g. presenting at a meeting
- Participating in meetings or classes(e.g. asking or answering questions)
- Eating in front of others
- Using public washrooms
- Writing in front of others (e.g. signing a cheque of filling out a form)
- Performing in public (e.g. singing or acting on stage, or playing a sport)
- Entering a room where everyone is already seated
These are situations where people are interacting with others and developing closer relationships. Examples include:
- Meeting new people
- Talking to co-workers or friends
- Inviting others to do things
- Going to social events (e.g. parties or dinners)
- Being assertive
- Expressing opinions
- Talking on the phone
- Working in a group (e.g. working on a project with other co-workers)
- Ordering food at a restaurant
- Returning something at a store
- Having a job interview
Note: It is not uncommon for people to fear some social situations and feel quite comfortable in others.
For example, some people are comfortable spending time with friends and family, and interacting socially with co-workers but are very fearful of performance situations, such as participating in business meetings or giving formal speeches.
Also, some people fear only a single situation (such as public speaking), while others fear and avoid a wide range of social situations.
When faced with a feared social situation, people with social anxiety experience some of the following:
Negative thoughts (what you think)
- People with social anxiety tend to have negative thoughts about themselves (e.g. “I’ll have nothing to say”), as well as how others will react to them (e.g. “Others will think I’m weird”)
- People with social anxiety also tend to focus their attention on themselves during social situations. They focus on their performance and how anxious they feel and look
- Examples: “I’m going to say something stupid” ; “I’ll get anxious and others will notice” ; “They won’t me” ; “Others will think I’m stupid” ; “I’ll offend someone” ; or “No one will talk to me”
Physical symptoms (what you feel)
- People with social anxiety are often very concerned about visible signs of anxiety, such as blushing or trembling.
- Examples: racing heart, upset stomach, shaking, choking sensations, sweating, blushing, trembling, dry mouth, shortness of breath, nausea, dizziness, lightheadedness, blurred vision, urge to urinate, etc.
Avoidance and safety behaviors (what you do)
- People with social anxiety will often try to avoid or escape social situations. If they do go into social situations, they tend to do things to feel less anxious or to protect themselves from embarrassment or negative evaluation (e.g. if I’m worried about saying something stupid, then I’ll try to avoid talking).
- Examples: Avoiding (e.g. not going to the party), escaping a scary social situation (e.g. leaving the party early) or engaging in protective behaviours to try and stay safe (e.g. drinking alcohol, staying quiet and avoiding eye contact).
When Does Social Anxiety Become a Problem?
It’s normal to feel anxious in social situations from time to time. For example, many people feel anxious in job interviews or when having to give a formal speech. Social anxiety can be a problem when it becomes too intense or happens too often. When it does, social anxiety can cause significant distress and affect many aspects of a person’s life including:
Work and school
- Examples: difficulty with job interviews; problems interacting with bosses or co-workers; trouble asking and answering questions in meetings or classes; refusing job promotions; avoiding certain types of jobs or career paths; poor performance at work or school; decreased enjoyment of work or school.
- Examples: difficulty developing and keeping friendships and romantic relationships; trouble opening up to others; difficulty sharing opinions
- Examples: avoid trying new things; avoid taking classes or lessons; avoid activities that involve interacting with others, such as going skiing or to the gym
- Examples: difficulty completing daily activities, such as going grocery shopping, going out to eat, taking the bus, asking for directions, etc.
MAP is designed to provide adults struggling with anxiety with practical strategies and tools to manage anxiety. To find out more, visit our My Anxiety Plan website.
Sandra is a 35-year-old single woman who lives alone. She feels extremely uncomfortable interacting with other people, and worries that others think badly of her. She was extremely anxious …
Michael is a 44-year-old married man who lives with his wife and two children. He is worried about being negatively evaluated when he interacts with authority figures at work (…
Avoidant Personality Disorder vs. Social Anxiety
Life in the modern age presents a whole host of different social complications.
The always “plugged in” nature of modern life and social media can lead to the constant comparing of yourself to others in a way that humans have never had to deal with before.
It’s only natural for some people to feel as though they are inferior or different from everybody else. But what if these feelings go beyond the occasional thought?
Anxiety disorders are the most common mental illness in the United States, according to the Anxiety and Depression Association of America. It affects 40 million adults aged 18 or older, or 18.1% of the United States population.
There are many different types of disorders under the umbrella symptom of anxiety. It’s no surprise that often many behavioral health conditions have overlapping symptoms. Because of this, self-diagnosis is often incorrect.
Treating the symptoms of behavioral health issues on your own isn’t always a bad thing but in certain situations, self-misdiagnosis can hinder mental health progress.
In some cases, the most effective approach to treatment can differ for separate mental health issues, so a misdiagnosis can affect treatment and make it more difficult for a person to improve.
In this article, we will be discussing two types of anxiety disorders: avoidant personality disorder and social anxiety disorder. We will explore how they relate, how they differ, and the anxiety disorder treatment.
Also known as social phobia, social anxiety is a specific type of anxiety that’s main characteristic is the fear of social situations.
It’s a very broad disorder that can affect every aspect of a person’s life that involves interacting with other people.
People with social anxiety tend to be preoccupied with the potential of embarrassing themselves in public or doing something that will cause others to judge them.
It is only natural to be anxious or uncomfortable in many social situations. Meeting a new boss or your significant other’s parents for the first time are two situations that come to mind.
The difference being that people with social anxiety disorder find social situations so distressing it starts to cause difficulties at school, work, and other parts of daily modern life.
People with social anxiety disorder have the desire to socialize with others, but the fear of social situations holds them back.
In order to better understand the difficulties that people with social anxiety face, let me tell you about my friend John.
John is an incredibly bright, insightful, and kind person to the people that have the privilege of being close to him. He’s 30 years old and attended a couple years of college before dropping out and working at a local grocery store full time as an overnight employee that stocks the shelves.
Of course, my friend John was certainly bright enough to pursue higher education, but something was holding him back. John and I had a few classes together in the journalism school. As the semesters would progress, I’d see less and less of John in our classes together. Naturally his grades began to slip because after all, half the battle is just showing up, right?
For John, and others with social anxiety, just showing up to social situations can be the whole battle.
My friend wanted to do well in school and socialize but the intense fear of other people judging him held him back from reaching his academic potential.
Socializing is arguably the most important part of traditional institutes of higher education. Networking with your peers can make the transition to real-world careers much easier.
John’s fear of social situations has robbed him of a traditional college experience. Instead, he works third shift at a grocery store, minimally interacting with other people. My friend is engaged to be married now and has found happiness, but I can’t help but think about what could have been if he was able to overcome his social anxiety disorder.
Avoidant Personality Disorder
As mentioned above, there are some behavioral characteristics that are common between both avoidant personality disorder and social anxiety disorder.
A main negative component in both of these conditions is the avoidance of social situations. Both conditions are marked by an intense fear of being judged or embarrassed in social situations.
The difference between them lies in the motivation behind this avoidance.
People with avoidant personality disorder often have strong feelings of shame or self-loathing that are absent from people that suffer from social anxiety. These people also tend to be very sensitive to criticism and rejection and often avoid pursuing friendships or participating in social events unless they are absolutely sure they are welcome.
Let’s explore how my friend John’s life may have been different had he suffered from avoidant personality disorder rather than social anxiety.
It’s quite possible that if he’d been living with avoidant personality disorder, John and I would have never met. You see, we met in the dorms our first semester at college.
The decision to attend a traditional university is most ly the biggest decision a teenager is asked to make up to that point and it’s a big undertaking. It’s much taking the training wheels off of your bike.
Your day-to-day decisions and social interactions are your cross to bear.
The prospect of living in a dorm with another person, on a campus of thousands of people may very well have proved to be an insurmountable challenge for my friend John.
His internalized feelings of inadequacy, insecurity, and worthlessness dictates that he lead a life of social isolation.
He still works third shift at the grocery store because of the minimal social interaction but he remains unmarried and isolated.
Let’s summarize these two versions of my friend John.
John With Social Anxiety
He desires the normal social life of his peers and takes baby steps towards that goal. While he often avoids intense social situations, he has the desire to make friends and be a productive member of society.
He recognizes that his uncomfortability in social situations is what’s holding him back. He made the attempt to take the social plunge that is traditional higher education and, despite dropping out, is better for having tried.
His experiences helped him gain the social confidence to find a life partner and personal fulfillment.
John With Avoidant Personality Disorder
This John’s irrational, deeply-rooted insecurity, and feelings of inadequacy held him back from pursuing higher education after high school.
His feelings of shame and self-loathing proved to be too much to overcome, leading to a life of social isolation.
This John doesn’t realize that the outside world doesn’t judge him as harshly as he judges himself and this lack of insight leads him to a life unfulfilled.
Neither of these situations are meant to downplay the debilitating nature of either disorder. They’re rather extreme examples used to differentiate the two mental health conditions.
Treatment for Avoidant Personality Disorder vs Social Anxiety
Therapy is a general recommendation for both avoidant personality and social anxiety but only a mental health professional can diagnose these issues. If anything you’ve read in this article strikes a chord with feelings you’ve experienced, making an appointment with one of our licensed and compassionate mental health professionals can be a great starting point.
One popular and effective treatment modality used in dealing with social anxiety is cognitive-behavioral therapy or CBT.
The goal of this therapy is to identify the thoughts that cause you distress or anxiety. Once identified, the goal becomes changing these ways of thinking.
CBT may begin as one-on-one sessions with your therapist but the ultimate and most effective goal is to engage in group therapy.
Anti-anxiety medication may also be used alongside therapy to help ensure the most positive outcome for people with social anxiety.
Many people believe that personality disorders such as avoidant personality are untreatable, but this is far from the case. They can certainly be difficult to treat, especially if you’ve been living with symptoms of the disorder for a long time.
Any type of therapy that involves talking can be helpful for avoidant personality. CBT is also commonly used as an effective treatment.
Research has also shown that therapy for people with avoidant personality disorder can have the best outcome when the person is supported by family members or loved ones.
There are no specific medications that are used to treat avoidant personality disorder but some anti-anxiety and antidepressant medications have been shown to be helpful for more severe symptoms.
To help you better understand the complexities of these two disorders, we’ve compiled a list of frequently asked questions:
- Why do people develop avoidant personality disorder?
Experiencing bullying, abuse, trauma, or other negative events in childhood can increase the risk for developing avoidant personality disorder. This is especially true when dealing with physical neglect in childhood. Avoidant personality is most often a learned behavior.
- What famous person has avoidant personality disorder?
Avoidant personality disorder is more common than you may think. “King of Pop” Michael Jackson, actress Kim Basinger, and singer Donny Osmond have all been vocal about their struggles with avoidant personality disorder.
- What are the similarities and differences between schizoid personality disorder and avoidant personality disorder?
People with schizoid personality disorder tend to not desire relationships with other people because they are unable to relate to people in a meaningful way. On the other hand, people with avoidant personality disorder desire relationships with other people but avoid them because of fear of shame, rejection, or feelings of inadequacy.
- Is avoidant personality disorder an anxiety disorder?
Yes, avoidant personality disorder falls under the umbrella category of “anxiety” disorder.
Both social anxiety and avoidant personality disorder can be incredibly difficult conditions to overcome. Difficult certainly does not mean impossible. SUN Behavioral Delaware is here to help you solve your unmet mental health needs and navigate the difficult path towards conquering these disorders.
Our licensed and compassionate mental health clinicians are here to help you develop an individualized plan to address your needs. Call us today at 302-604-5600 to get started.
BEWARE THE SILKEN TRAP OF SAFETY BEHAVIORS
When faced with a dangerous animal, what do we do? We get away as fast as we can, fight the animal if we cannot get away, or become still and hope the animal will not notice us.
While this may have been a common occurrence in prehistoric times when humans lived in jungles with predatory animals, today we live in a human ‘jungle’ with human beings who have opinions and judgements.
For an individual with social anxiety, the world seems a jungle filled with mostly judgmental people who can attack with their negative judgement.
People seem just as dangerous as the predatory animals and they find themselves responding as if they lived in a jungle.
It is not surprising that people who experience anxiety in social situations try their best to avoid, escape and not attract the judgmental gaze of others. These behaviors are termed as safety behaviors.
Safety behaviors are adopted in response to thoughts stemming from beliefs that informs the socially anxious person that he/she is at risk. Adopting the safety behaviors however only seems to confirm that the social situations they are avoiding and escaping are indeed dangerous.
In addition, their use also reinforces the belief that one would be at risk if it were not for the use of safety behaviors.
Using safety behaviors help people feel less anxious in the moment. In the long run, however, safety behaviors impose many limitations on individuals and operate as a trap that prevents them from living their life fully. Thus, socially anxious individuals often experience dissatisfaction with themselves and their lives.
Safety behaviors offer short term relief, but in exchange they have long term discomfort. The behaviors that keep them ‘safe’ prevent them from learning that not everyone is judgmental, and even if some people are judgmental nothing devastating happens and it has no major implications.
They never learn that they can stand up to unfair judgments and criticism and that constructive judgement/criticism can be beneficial, too.
Commonly used safety behaviors
Below are examples of safety behaviors in action:
- Selecting a position in social situations that will allow the person to avoid excessive scrutiny (e.g. sitting in the back of the room).
- Taking on roles in social situations so that one does not have to interact (staying busy behind the scenes, helping in the kitchen or setting up equipment).
- Avoiding eye contact to avoid interaction or being noticed by others.
- Over-preparing for presentations or meetings to ensure there will be no opportunity for negative judgment.
- Mentally rehearsing conversations before they happen, and scripting what to say next during a conversation.
- Always having a trusted friend or family member by one’s side so responsibility for social engagement becomes limited and scrutiny is also less.
- Frequently checking or going on electronics during social interactions as a means of limiting the interaction.
- Consuming alcohol, recreational drugs, or other substances to curb anxiety.
- Avoidance of social situations that increase anxiety by refusing invitations to most social events.
- Wearing very neutral or excessive amounts of clothing when in public to avoid attention.
- Talking fast during a meeting or other social situations to be able to leave situations quickly after saying what has to be said.
- Asking the other person many questions when speaking with someone to keep the focus off oneself.
- Wearing high necked clothing or styling hair in certain ways to cover blushing.
- Behaving and appearing in as perfect a manner as possible.
- Being pleasing and not doing anything to displease for fear of judgement and rejection.
Breaking free of safety behaviors with cognitive behavior therapy (CBT)
Safety behaviors operate protective parents who whisk their child away from the playground for fear that their child will fall and get hurt. The child unwittingly learns that the playground is dangerous and it is best avoided, just as the socially anxious person learns that people are judgmental and best avoided.
The only way for the child to learn that the playground is not dangerous and that he/she can deal with the challenges and ultimately have fun would be to go to the playground and explore it in stages. Similarly, the socially anxious person will learn that not all people are so dangerously judgmental only if he/she were to face anxiety provoking social situations and forgo the safety behaviors.
This is where it would be helpful to seek the help and guidance of a cognitive-behavioral therapist (CBT).
The therapist would work with the client to build a hierarchy of socially anxious situations that are ranked from the least to the most difficult ( the distress related rating given to each situation).
Therapists will then support individuals through the process of approaching these situations while dropping safety behaviors in stages.
The process results in experiential learning that the situations that had been identified as unsafe and requiring the use of safety behaviors to survive are not unsafe and they can be dealt with successfully.
This learning prompts diminishing anxiety. The safety behaviors become easier to give up and they are no longer needed over time.
It is recognizing that a tiger they feared was actually a paper tiger all along!
In addition to exposure, CBT therapists will also work with the socially anxious client to help them develop skills to cope with the anxiety that is typically triggered before and during the exposure exercises. Cognitive restructuring work is also carried out to help modify the anxiety provoking thoughts and self-critical ruminations that commonly occurs.
Learning about social anxiety disorder and how it can be treated is the first step. Finding a good therapist that one feels comfortable with would be the next. Chipping away at the social anxiety may cause one discomfort initially but the rewards are well worth it.
Keep in mind the long term reward of living a value-laden life that is unfettered and free as you move forward in your journey to break free from the silken bonds of safety behaviors.
The National Social Anxiety Center is a national association of regional clinics with certified cognitive therapists specializing in social anxiety and anxiety-related problems. We have compassionate therapists who can help you to reduce social anxiety.
Currently, we have regional clinics in San Francisco, District of Columbia, Los Angeles, Pittsburgh, New York City, Chicago, Newport Beach / Orange County, Houston / Sugar Land, St.
Louis, Phoenix, South Florida, Silicon Valley / San Jose, Dallas, Des Moines, San Diego, Baltimore, Louisville, Philadelphia, Montgomery County, Maryland / Northern Virginia, Long Beach, Staten Island, North Jersey, Brooklyn, and Santa Barbara. Contact our national headquarters at (202) 656-8566 or visit our Regional Clinics contact page to find help in your local area.
Written by,Suma Chand, Ph.D.
NSAC – St. Louis