Frequently Asked Questions about Social Anxiety

Will social anxiety disorder damage my health?

Many people with social anxiety disorder have suffered anxiety in social situations for decades without apparent injury to their health or development of the high blood pressure, ulcers, asthma or other physical disorders that are commonly (but erroneously) thought to result from stress.

It is our strong impression that social anxiety disorder alone does not cause physical illnesses and does not shorten people's lives. It's not uncommon, however, for individuals with social anxiety disorder to believe that alcohol reduces their anxiety. Long-term overuse of alcohol is a complication of social anxiety that can damage your health.

Is it good advice to avoid what bothers you?

No! For social anxiety disorder, such antiexposure can actually make a person's social anxiety, anticipatory anxiety and avoidance behaviors worse. In addition, it may interfere with otherwise effective treatments.

Will I ever outgrow social anxiety disorder?

Social anxiety disorder usually begins in adolescence and is often most severe in the late teens and the 20s. In 25% of individuals it begins in early childhood. Most people learn early how to avoid stressful social situations, thereby temporarily decreasing their anxiety. Over time, though, this leads to relative social isolation. Research indicates that social anxiety disorder, when left untreated, tends to become chronic. For a few there may be some improvement with age, but rarely does it disappear completely. With treatment, however, social anxiety symptoms can improve dramatically.

What if my social anxiety disorder occurs only on rare occasions such as at a special event where I am performing?

This problem is relatively common, especially among professional performers. The treatment for performance-type social anxiety disorder differs from generalized social anxiety disorder. The first line of treatment is gradual exposure therapy.

Can traumatic events cause social anxiety disorder?

Traumatic events seem to increase the risk of developing social anxiety disorder. People with social anxiety disorder are twice as likely to have experienced trauma as a child. Many people who experience traumatic events develop posttraumatic stress disorder (PTSD) and they are much more likely to develop depression or social anxiety. However, many people with social anxiety disorder have never experienced a traumatic event. Trauma may be a trigger in some people who have a predisposition for social anxiety disorder.

Should I use alcohol to control my anxiety when I go to parties or other social situations?

Using alcohol to decrease anxiety in social situations is a common strategy for individuals with social anxiety disorder. Unfortunately, alcohol creates a false sense of relief from symptoms. In many situations, at work or during a performance, for example, drinking alcohol is inappropriate at best and may cause substantial impairment in functioning and judgment. In addition, people who have social anxiety disorder are at an increased risk of developing alcohol abuse or dependence, which is often worse than the social anxiety disorder itself.

Are families affected by an individual's social anxiety disorder?

In addition to sharing the somewhat increased risk of developing social anxiety disorder, family members may be asked (or even coerced) to give up social activities or to attend them alone, leaving the socially anxious person at home. However, permitting the affected family member to avoid appropriate family functions and responsibilities may actually make the problem worse. Those who give up social contacts are missing the possible benefits of naturally occurring behavior therapy. Once the process of leaving the socially anxious family member out of social interactions starts, however, it can become so habitual that family members often view the arrangement as "just the way we do things in our family."

How can families and friends help people with social anxiety disorder?

Some individuals with social anxiety seek reassurance from family members about their condition. They may ask for reassurance that the situation won't be stressful. They may ask whether others can tell that they are anxious or see them trembling, sweating, blushing, etc.

Family members naturally want to reassure the affected person, but unfortunately that can be counterproductive. Because socially anxious individuals do experience anxiety and physical symptoms, and truly may be more noticeable because of it, such reassurance can seem hollow. It may even undermine the effective components of behavior therapy, which include repeated exposure to the phobic situation and remaining in it until the anxiety symptoms subside (habituation).

However, family and friends can help correct overly negative assessments of a performance and support even the smallest positive steps. Encouragement to confront social situations is supportive; the counterproductive reassurance we've just covered is not. All of us benefit from support and encouragement as we struggle with troubles in life, and this is certainly true for people with social anxiety disorder.

You should be aware that some people with social anxiety disorder become reassurance "junkies," seeking their regular "fix" of reassurance. As with other addictions, the fix doesn't last long and soon they are back for another fix. Like other addictive substances, reassurance eventually makes their overall condition worse. It is important not to be harsh or sarcastic in the process of withholding reassurance. It may be helpful to have a neutral statement that can be repeated in a monotone voice each time the situation comes up. Statements such as, "The instructions are that I'm not to reassure" are often beneficial. (Practicing neutral statements aloud with others before using them with the patient is often helpful.) While withholding reassurance may sound uncaring, it's important to remember that you're actually using a behavior therapy approach that has been shown to be helpful.