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Just Shy or Social Anxiety Disorder

Is social anxiety disorder just another name for being really shy?

By Gina Shaw
WebMD Feature

Reviewed By Brunilda Nazario

Peter (not his real name) was a smart, savvy businessman with a PhD and a bright future. He had quickly climbed the corporate ladder, but when he was offered another promotion -- one that would put him at the top of his division -- he turned it down, jeopardizing his career. Why? The thought of being the center of attention in a major meeting, required in the new position, threw Peter into a blind, desperate panic, complete with physical symptoms like flushing, sweating, and heart palpitations.

Peter had what psychiatrists call circumscribed social anxiety disorder (SAD) -- an intense, irrational, and persistent fear of being scrutinized or negatively evaluated by other people. People with SAD, also known as social phobia, tend to be sensitive to criticism and rejection, have difficulty asserting themselves, and suffer from low self-esteem. Social anxiety disorder can be "circumscribed," like Peter's (he only feared being scrutinized at work), or "generalized" -- a much more debilitating condition that can make everything from walking to a table at a restaurant to attending your best friend's wedding a cause for sheer terror.

In February, two antidepressant drugs, Effexor and Zoloft, were added to a list of about a dozen approved medications for social anxiety disorder, sparking renewed interest in this little-known condition. Is social anxiety disorder just another name for being really shy?

Putting the Brakes on Life

Not at all, say many leading psychiatrists. "Many people are a little bit shy. If you're shy, you might be somewhat uncomfortable in situations such as going to a party where you don't know anyone, but you do it. You give yourself a push, you go to the party, after a while you relax and talk to people," says Rudolf Hoehn-Saric, MD, who heads the Anxiety Disorders Clinic at Johns Hopkins University School of Medicine. "The social phobic person, at the prospect of the same party, would be overwhelmed by such anxiety that [he or she] would have a physical reaction -- perhaps nausea, sweating, heart racing, dizziness -- and would avoid it if at all possible. It's a matter of degree."



More Common Than You Think




Most experts advocate a combined approach, using both approved medications and what's called cognitive behavioral therapy, to treat SAD. "Medication does decrease the general anxiety and also the depression that is frequently present in people who don't function so well socially," says Hoehn-Saric. "It can combat the surge of anxiety when you go into a social situation, and if you can diminish the initial responses -- chin quivering, hands shaking and sweating, face flushing -- if you take away those triggers, the person doesn't get into a vicious cycle of embarrassment."

But that's usually not enough. Cognitive behavioral therapy for social anxiety disorder usually involves "exposure" -- confronting the patient's fears. "First, people imagine the situation, and look at it as an outsider. How realistic are their fears? They're taught to reorganize their thinking, and then they expose themselves to social situations to decrease their anxiety," says Hoehn-Saric.

Group therapy often works particularly well for social anxiety disorder, since people with SAD are usually uncomfortable in groups and being exposed to other people. "They see that other people are like them, and they're doing better now, so there's some hope for them too. And as they start to feel more comfortable in a therapeutic group setting, they can transfer that to other social situations."

It's a long process. Don't expect social anxiety disorder to disappear after eight weeks of treatment, says Saeed -- closer to eight months or a year may be more realistic. "One of the difficulties with SAD is that since people have had it for so long, they've had to start avoiding things," he says. "Even when the symptoms are under control, unless you go out and engage in the activities you've been fearing, you won't know what your response is. So ultimately you have to face your fears."

Published March 24, 2003.

SOURCES: Rudolf Hoehn-Saric, MD, professor of psychiatry and behavioral medicine and head of the Anxiety Disorders Clinic, Johns Hopkins University School of Medicine. Sy Atezaz Saeed, MD, chair of the department of psychiatry and behavioral medicine and co-director, Anxiety and Mood Disorders Clinic, the University of Illinois College of Medicine at Peoria. Saeed and Bruce, "Social Anxiety Disorder: A Common, Underrecognized Mental Disorder," American Family Physician, Nov. 15, 1999. The Anxiety Disorders Association of America.

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Last Editorial Review: 1/31/2005 5:47:33 AM

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