Is it shyness or Social Anxiety Disorder?

Anxiety disorders are, by far, the most widely experienced disorders (American Psychiatric Association, 2013). It is important to note that it is more common to experience more than 1 disorder at a time (aka comorbid) than it is to experience just 1 condition by itself. For example, among those who are diagnosed with Social Anxiety Disorder (SAD), 39% are also diagnosed with Obsessive Compulsive Disorder and 65% diagnosed with Agoraphobia (Al-Asadi et al., 2015). Thus, when addressing the challenges to work, school, social and emotional well-being, it is important to acknowledge the likelihood of co-occurring disorders and the complexity posed by adapting to more than 1 condition.

People with SAD are afflicted with impairing anxiety related to social performance, not a fear of people, per-se. The feared stimulus is not other people, but the potential for embarrassment or judgement by other people. Social anxiety disorder can be more global (e.g., fear of embarrassment or judgement from others in a variety of contexts for an array of behaviors) or more specific (e.g., public speaking, conversation, eating). Since people are potential observers of our behavior at any given time, SAD can become particularly impairing for people who develop the most severe presentations. At work or school, communication with co-workers, customers, peers, or instructors could be thwarted, as the unpleasantness of anxiety may result in the avoidance of interactions altogether. When not able avoid situations that trigger their social anxiety, many people with SAD experience heightened aversive physical (e.g., sweating, heart racing, stomach upset, chest pains, depersonalization) and cognitive symptoms (e.g., negative thoughts, difficulty concentrating, altered attention), which may interfere with their ability to think, speak, and respond to social cues.

As a result, people with SAD may choose work or school-settings that allow for them to avoid the burden of their anxiety, perhaps opting to work alone or remotely. They may avoid leadership positions, which come with better pay, or avoid schoolwork that requires teamwork or public presentations. Painfully, SAD impairs the development of social support networks, as the symptoms are worsened by social interaction, though social connections can help to reduce symptoms in the long-run, via the role of exposure to a feared stimulus and habituation. The avoidance of social situations results in an unfortunate feedback-loop, whereby symptoms of anxiety are worsened by avoidance, resulting in further emotional suffering. Breaking the cycle of avoidance is the primary focus of intervention, whether by exposure behavior therapies or alteration of thoughts through a cognitive approach. The social, emotional and occupational outcomes for a person with SAD may be greatly, albeit slowly, improved by the pursuit of appropriate treatment.

**It is recommended that treatment for Social Anxiety Disorder be pursued with a licensed professional. On average, Psychologists obtain 7 years of graduate-level training in mental health. Other mental health therapists are required to obtain at least a Master's degree, which requires 2 years of graduate training. Psychologists with prescriptive rights (currently available in 5 states) obtain an additional 2 year Master's degree in psychopharmacology. Psychiatrists are Medical Doctors. Psychiatric Nurse Practitioners obtain at least 2 years of graduate level training. Physician's Assistants obtain 2 years of graduate-level training. ** These are estimates of the years of graduate study and do NOT include the amount of time the aforementioned practitioners spend in post-degree practical rotations.

Al-Asadi, A. M., Klein, B., & Meyer, D. (2015). Multiple comorbidities of 21 psychological disorders and relationships with psychosocial variables: a study of the online assessment and diagnostic system within a web-based population. Journal of medical Internet research, 17(2), e55.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

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