Scratch the surface and there it is. Social anxiety is much more prevalent than people realize. I hesitate to use the word ‘disorder’ because many people who suffer from it don’t meet the DSM criteria. In more lay man’s terms they would be considered painfully shy. Saying one is very shy seems more acceptable than saying they have ‘social anxiety disorder’. Severe shyness is often something that’s been there since childhood.
In my practice over the years, I would say that more than a third of those I see have social anxiety in varying degrees, even if never diagnosed. Many are able to hide it so well, no one would ever know. They are good actors & often that helps. But more often they are avoiders, afraid to deal with the world. Then there are those with more overt symptomatology who suffer from panic attacks, are almost are unable to speak, shake visibly, and will actually faint if the stress is enough. Medication has been very helpful for some as well as psychotherapy along with the use of CBT. In my practice I have noticed it gets significantly better but it rarely goes away completely.
Most people have a certain amount of anxiety in obvious situations like making a speech or meeting new people or confronting a difficult situation. But for people who have social anxiety, the triggers are not necessarily visible. They can be afraid to make phone calls, get on a bus or walk down the street for fear they may meet someone, talk with shop clerks, have difficulty going out in general, and without a drink or two, barely function in social situations. It may not always be apparent, but inside they are struggling. They are severely self-conscious. I believe that many alcoholics suffer from social anxiety and that that may be a contributing factor to their disease. Intimacy and social anxiety is another difficult combination. Meeting people is hard enough for those who suffer from it, but add the pressure of relationship, and the situation can become impossible. Loneliness and social anxiety are not strangers.
Over the years I have noticed that not only is the anxiety itself dehabilitating, but the shame and judgments that accompany it make it much more painful and problematic. Often those who suffer from it consider themselves, wimps, cowards and just plain stupid for not being able to do things that seem to come so easily for others. Self-hatred & self-criticism are very common. They are aware that most of the fear is irrational and hate themselves for not being able to overcome it. It constricts their lives and they feel they are at fault. Consequently the self-hatred is continually reinforced, and that makes the anxiety even worse. It’s bad enough to have it to begin with, but with the added constant erosion of self-image, the pain is that much greater.
Unfortunately, like most things, intellectual knowledge does not always help with how one feels. Most social phobics have been chipping away at their self- esteem for a long time. These judgments about themselves can feel like a religion. In their core they know how bad they are. It’s a long standing belief system that has offered a certain amount of protection & explanation for their plight. That makes it harder to help alleviate the anxiety. Acceptance is the friend of someone with social anxiety. It takes away the added burden of self-hatred which in turn makes life easier. Getting to a place of acceptance is very difficult for most. There are usually some very unrealistic fantasies about what they would be like if they weren’t so shy. But it is the first step in the healing process. Liking oneself better usually is.
Paula Zuckerman, LCSW. Random thoughts on a 30+ year psychotherapy practice 