Social Anxiety Disorder (SAD)

Social Anxiety Disorder (SAD) is having intense fear or anxiety when in social situations, that people may judge and can onset as early as 13 years old. It is common to be nervous and anxious when being in new and unfamiliar situations, but those who are suffering from SAD continue to feel discomfort and uneasiness even in familiar situations or being with people they are close to (e.g. family and friends). In such cases, the symptoms are often very distressing and the consequences can be dysfunctional (e.g. avoiding social events, absence from school). 


Unlike Generalised Anxiety Disorder (link to GAD page), individuals suffering from SAD experience fears and anxiety focused on social events and meeting new people. Whereas for GAD, the fears are a wide range from performance, perfectionism, relationship with someone after a fight etc. Lastly, the onset of GAD is usually much later, around 31 years old.  


Causes of Social Anxiety Disorder (SAD)

✽   Genetic (Family history of SAD increases likelihood) 

✽   Environment (Exposure to abuse/neglect/bullying)


Signs and symptoms of SAD

✽   Fear and anxiety about social situations (e.g. having a conversation, being observed when drinking/eating, giving a speech)

✽   Fear humiliation from others (e.g. anxiousness is showing)

✽   Avoidance of social events 

✽   Overthinking of own behaviour in public 

✽   Nauseousness, dizziness or chest palpitations (even at the thought of the event) 


The endless cycle of SAD 

When individuals first notice such symptoms, they become cautious and afraid to do or try anything in order to avoid negative evaluations from others. Some might also believe that it will get better over time or they may “outgrow” these symptoms. Most individuals use avoidance as a coping mechanism (e.g. avoiding conversations, meeting friends) and these methods are often maladaptive (inappropriate methods) and unhelpful. By avoiding their fears, they are unable to disconfirm their negative beliefs and are continuously reinforced that being alone is safe and being in public will make them panic or feel faint. 


Looking at this example: “The last time I talked to someone, I felt so nauseous I thought I was going to die. But when I am at home, I don’t get dizzy or chest palpitations. I will only be fine if I am by myself.”


This person fails to expose him/herself to situations like talking to others, to allow the body to adapt to the initial nervousness or fear, and do not realise that they are not being judged as badly as they thought. Hence, the cycle of SAD will be endless because their fear will not be overcome and they cannot overcome their fear as they are afraid to try. 


Treatments for SAD 

✽   Medication 

  • Antidepressants 

SNRIs: regulate serotonin, dopamine and norepinephrine 

  • Benzodiazepine 

Psychoactive: relaxing effect 

  • B-Blockers 

Physical symptoms of performance anxiety 

✽   Psychotherapy 

  • Cognitive Behavioural Therapy (CBT) 

Changing their thinking, beliefs and behaviour in social situations 


It is important to note that medication only relieves the symptoms of SAD, but psychotherapy will be able to tackle the root cause(s) of the issues. 

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