More Than Shy: How to Cope With Social Anxiety

It’s a condition that can make leaving one’s house a terrifying ordeal. Ordering food at a restaurant can induce panic attacks. And the thought of speaking up in class or at a meeting can be so frightening that sufferers will try to avoid the situations entirely. It’s called social anxiety disorder or social phobia, and while often debilitating, it’s treatable.

At times, however, the disorder is difficult to distinguish from normal shyness ? many of us get nervous before speaking or meeting new people, after all ? and some experts claim it’s over-diagnosed and over-treated. Most estimates place the number of Americans with social anxiety at about 15 million, but critics counter that those estimates include many people who are merely shy, not sick. For those affected, the distinction isn’t trivial: Compared with others, people who have social phobia are more likely to abuse drugs and alcohol and have higher rates of depression, which can make the anxiety worse.

As with many psychological conditions, the symptoms of social phobia lie on a spectrum, ranging from mild to extreme. Some people experience the anxiety only in very specific situations ? talking on the phone, for example, or using a public restroom. Others have a more generalized phobia that makes most kinds of human interaction stressful. Still others may be comfortable on stage or in other public settings and yet have trouble with one-on-one encounters. At the heart of the condition, say experts, is not merely shyness but a paralyzing fear of humiliation or being judged negatively as boring or unintelligent. A shy person will eventually acclimate to an anxiety-inducing situation. A person with pathological and pervasive social anxiety will not.

Social phobia is not just mental; it can have distressing physical symptoms as well. Severe blushing, hand tremors, dizziness, excessive sweating, and heart palpitations can intensify the already deep-seated fear of public humiliation, says Jerilyn Ross, president of the Anxiety Disorders Association of America.

Paradox. Puzzlingly, people with social anxiety are often gregarious and outgoing individuals ? in certain contexts. Many have little trouble interacting with close friends and family in familiar settings. But when they are taken out of this comfort zone, their reactions can take a damaging toll on their relationships, education, and careers. “Those with social phobia tend to marry later in life, if at all,” says Ross, “and regularly have trouble dating for fear of embarrassment.” They tend to avoid participating in classroom activities and, according to a 2000 study in the American Journal of Psychiatry, may drop out of school or college entirely. Many, experts say, are underemployed and may even forgo career advancement if it means assuming public speaking roles in the conference room or managing other employees.

Their fear of stumbling socially or embarrassing themselves in front of others may not be entirely unfounded, a new study suggests. Researchers found measurable deficits in social interaction when subjects with social phobia were asked to hold one-on-one conversations. On the other hand, the study, published online in the February edition of Journal of Anxiety Disorders, also found that the same people tend to overestimate their shortcomings when giving a speech or performing in front of a crowd, suggesting that their fears may be exaggerated.

Disputed diagnosis. Some experts contend that the definition of social anxiety disorder is overly broad, sweeping up people with normal personalities and rational fears. In Shyness: How Normal Behavior Became a Sickness, his recent book, Northwestern University research professor Christopher Lane argues that psychiatrists and drug manufacturers have inflated the prevalence of social anxiety disorder. Lane says the line between shyness and social phobia should be drawn to “limit diagnosis to those chronically impaired.”

For people suffering from severe social anxiety, it may be validating to know that a biological problem is now thought to lie at the heart of the disorder, much as depression has been found to have biological underpinnings. Researchers have found, for example, that there’s a link between social anxiety disorder and elevated activity in an area of the brain that processes fear.

By Matthew Shulman