What is Social Anxiety Disorder (Social Phobia.)

By David Joel Miller.

What is

What is Social Anxiety Disorder (Social Phobia.)
Photo courtesy of Pixabay.

Social Anxiety Disorder (Social Phobia.) Was 300.23 now F40.10.

Social Anxiety Disorder sometimes called Social Phobia is far more common and debilitating here in the United States than is generally recognized. The most recent estimates are that in excess of seven percent or over 22 million Americans have Social Anxiety Disorder. The U.S rate runs 3 to 6 times the rate reported in other countries.

Fully three-fourths of those who will revive this diagnosis first have symptoms during childhood from the fourth to the tenth grade. This results in significantly lower graduation rates by those with Social Anxiety Disorder. Lifetime someone with Social Anxiety Disorder is more likely to be lower-income and socioeconomic status.

The rates of Social Anxiety Disorder are highest among those who are single, unmarried or divorced. The disorder may be severe when young and single, become milder when the person is married and reemerge when they are divorced. The typical person with this disorder waits from fifteen to twenty years before seeking treatment.

The symptoms of Social Anxiety Disorder.

People with Social Anxiety Disorder become extremely, excessively, anxious when they will be in social situations where they may be judged or evaluated by others. While you are only required to be anxious in one social situation to be diagnosed with Social Anxiety Disorder most people with this condition are anxious in many situations.

Someone with Social Anxiety Disorder will report that they can’t relax around others. They may hide achievements that would get them noticed, avoid attention, avoid eating in front of others and when in social situations they will listen instead of speak.

Other ways this disorder will manifest include, avoid confrontations, preferring to work alone, being afraid to ask questions, avoiding social gatherings, parties etc. They will underachieve to avoid attention, may drop out of school or not apply for a job or promotion.

Performance Anxiety is a special case of Social Anxiety Disorder.

People who are in the public eye are at extra risk for Social Anxiety Disorder. Many people are afraid of public speaking, this will not count towards Social Anxiety Disorder if you do not normally need to speak in public. But if your job requires public speaking, or being on stage and when you do this you become extremely anxious then that would be considered a case of Social Anxiety Disorder.

Children with Social Anxiety Disorder.

For children, we do not count situations in which they become anxious in front of adults. Children who develop the disorder also need to be excessively anxious in front of their peers.

Children may try to avoid the social anxiety by crying excessively, having tantrums, being clingy or going mute.

With Social Anxiety Disorder you can run or suffer.

Most people with Social Anxiety Disorder will go to great lengths to avoid social interactions. Some attempt to stay at home with parents well into adulthood convinced that they simply can’t venture out around strangers. They may settle for living in poverty, staying in abusive or dysfunctional relationships rather than attempt to move outside their residence.

Social Anxiety Disorder is neither brief nor temporary.

When we talk about Social Anxiety Disorder we are expecting a problem that is ongoing not a brief temporary fear of a social situation. Typically this has lasted for six months or more. Though clinicians are encouraged to use some judgment here. If you come in asking for help after only five months and three weeks you should get the help despite it being less than six months. In this disorder, the fear also should be far more severe than the situation would merit. If the danger is real and severe, this is not Social Anxiety Disorder.

Treatment for Social Anxiety Disorder.

Treatment for Social Anxiety Disorder can be very effective if the client can get to the treatment. One promising development has been the use of distance counseling over the internet for those too anxious to travel to the counselor’s office. Treatment has been effective both in reducing the Anxiety symptoms and in shortening the duration of the disorder.

There are other things that kind of look like Social Anxiety Disorder.

Professionals need to look at a bunch of other things and make sure that they are not sticking this diagnosis on someone when another diagnosis would fit better. The DSM-5 lists fifteen things that need to be ruled out before deciding on Social Anxiety Disorder. At the top of that list? Social Anxiety Disorder needs to be more severe and cause way more problems than just normal shyness.

As with the other things we are calling a mental illness, Social Anxiety Disorder needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnosis if this is a preference, not a problem. If the only time this happens is when under the influence of drugs or medicines or because of some other physical or medical problem this fear needs to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get the Social Anxiety diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Is your Anxiety a disease?

By David Joel Miller

Anxiety provoking.

Anxiety.
Photo courtesy of Pixabay.com

Some fear is normal, too much is an anxiety disorder.

How can you tell if your fears and anxieties are normal or are they the signs of a more serious mental illness? In everyday language, there is not much difference between fears and anxieties. In technical, mental health terms there are some key differences between fears, anxieties and the times your anxiety symptoms get out of control and get diagnosed as a mental illness.

Of all the mental illness, Anxiety disorders are the most common. In any given year one in five Americans will experience Anxiety so severe it should be diagnosed as an anxiety disorder. Prevalence rates around the world are very similar to the U. S. experience. Anxiety disorders are also the ones most likely to be seen by medical doctors as the symptoms often look like symptoms of physical illnesses.

Fear in the mental health sense is a reaction to a thing or situation that cause an immediate reaction. You see something, something happens and you get that feeling you need to do something now. The standard reactions are to freeze, flee or fight.

Say you see a poisonous snake and you become very scared. This sounds rational. But if you are afraid to visit a school because they might have pictures of snakes up in the science classroom, that is excessive and should qualify you for some kind of mental health diagnosis. Which diagnosis? We are not there yet.

Anxiety, the mental health type definition, is a feeling of nervousness or uncomfortable about something that may happen in the future. People with anxiety disorders become so afraid that something will or might happen in the future that they have to alter their present to avoid these possibilities.

People commonly report that they have “Panic attacks” or “Anxiety attacks.” If the thing setting off the anxiety attack is something that has a real potential danger then having fear and freezing, fleeing or fighting might all be reasonable adaptive behaviors. Attacks of a symptom do not always equal a mental illness.

While some anxiety disorders are brief most, to get diagnosed, need to be more than temporary conditions. The criteria for many anxiety disorders it’s that you must have had this anxiety for six months or more. Of course, during that time period, your anxiety may have episodes of getting stronger and other times it may be less troublesome. If it has interfered with your life for 6 months or more you most likely have an anxiety disorder.

Not every case of nervousness or anxiety is the result of having an anxiety disorder. Someone who is depressed and has difficulty doing things they used to do is likely to become anxious. We include that kind of anxiety as part of the depression. Same thing when someone with a psychotic disorder becomes fearful and think people are watching them. That paranoia is part of the psychosis and does not get a separate diagnosis of an anxiety disorder.

What makes this fear diagnosable is when it begins to interfere with or change your behavior or upset you. If you can’t leave the house or work because of your anxiety, that is probably a diagnosable anxiety disorder. If your extreme fearfulness, anxiety or hyper reactiveness start affecting your relationships, that is a probable diagnosis.

There are a number of different types of anxiety disorders depending on what is causing your fear or anxiety. Further complicating this picture is that many people who have anxiety disorders have more than one kind. Having multiple anxiety disorders is considered very common.

Since people with anxiety disorders have by definition “excessive” fear or anxiety it takes an outside observer, usually a therapist to evaluate the risk and see if this person’s fear is reasonable given their situation and their life experiences.

Most anxiety disorders start in childhood, often before the end of middle school. Over time and untreated anxiety disorders get worse. The stats say two of every three people with anxiety disorders are women. I believe this is partly cultural. Boys and men are taught to approach what they fear. Attack it. Women are supposed to get away. This results in anxious men becoming more violent or using a substance to cover up their anxiety and as a result, they get a behavioral or substance use diagnosis.

Physical sensations may be symptoms of anxiety.

Different people experience anxiety differently. Anxiety symptoms are frequently physical and many people interpret their anxiety symptoms as a physical illness.

If you experience an anxiety attack you may feel dizzy or light-headed. You may feel disoriented, have difficulty breathing or swallowing. The heart may race, you might sweat or tremble all over.  Despite the feeling you want to run your legs could become rubbery or jelly-like.

Some people experience gastrointestinal symptoms, constipation, diarrhea, nausea or feeling like you may vomit. Sleep disturbances, mind racing, and confused thoughts can result in Anxiety disorders getting confused with Bipolar Disorder and other mental illnesses.

Here is the most recent list of recognized Anxiety Disorders. These are necessarily brief, general descriptions of the disorders in plain language. For the specific criteria consult the relevant edition of the DSM.  For more on each separate disorder look for the articles I have written on specific disorders. I plan to write more of these posts on specific anxiety disorders in the future.

You will find the link to other articles on anxiety below.

Separation Anxiety Disorder.

This disorder customarily starts early in life. The child is afraid to leave or be away from a caregiver. They may think that something bad will happen to them or the caregiver if they are separated. We used to think of this mostly as a disorder of children and that they should “grow out of it.” We are starting to think that you can have this at any point in your life and that many clingy needy adults had this and or an attachment disorder since childhood.

Selective Mutism.

Someone who speaks normally at home but is afraid to or refuses to speak when in public or around strangers fits the description of Selective Mutism. The criteria for this disorder does not imply that the child is being poorly behaved but just that they are so afraid they can’t speak around strangers. The result is poor grades or school failure. As they get older this may lessen but again there are adults who just avoid speaking around strangers as much as possible.

Specific Phobia.

Spiders and snakes, blood, heights or flying can all be objects of a specific phobia. With Specific Phobia we can point to things or situations that are the cause of the anxiety. People with specific phobias often had fears of several things or situations and may have other anxiety disorders as well.

Social Anxiety Disorder (Social Phobia).

In this disorder the anxious person is afraid of social situations where others may watch them, evaluate them or otherwise form an opinion about them. The fear here is about doing something “wrong” or being judged. This is about having your peer’s think poorly of you, what you wear or how you do things. In severe cases, people avoid eating in public or going to social gatherings.

Panic Disorder.

A Panic disorder involves many of the physical symptoms we talked about above. The person having the panic attack may have shortness of breath or chest pain and think they are having a heart attack. Having had one attack people become afraid to leave the house for fear they will have another and not be able to get help in time.

Agoraphobia.

Agoraphobia translates as “fear of the marketplace” mostly this involves crowded situations. Fear of buses, standing in lines, crowded places, stores, and similar situations. In severe cases, the person becomes unable to leave the house to go shopping and either needs someone to go with them or just go at times the store will be very empty.

Generalized Anxiety Disorder.

This involves being over-anxious all the time. A person with Generalized Anxiety Disorder is anxious all the time about most anything. There may be real life causes for this anxiety, like living through a war or being assaulted or harmed. The professional has to look carefully to separate this from PTSD or other Trauma and Stressor-related disorders.

There are also diagnoses for anxiety problems caused by drugs, medications, medical conditions or other factors.

For more on Anxiety, treatments for anxiety and related issues see:

counselorssoapbox.com Anxiety Post list.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Anxiety – fears and phobias can be treated.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Fear

Get rid of fear.
Photo courtesy of Pixabay.com

Are you afraid of spiders, snakes or public speaking?

If you are afraid of a particular thing or situation and go to lengths to avoid that thing you may well have a Specific Phobia. Specific Phobia involves the fear that a particular thing is going to harm you. This fear may be irrationally strong even when you have never been harmed this way before and the risk is low.

There are five types of specific phobias, Animal type, Natural environment type, medical type, places, and “other” type. Other type includes diverse things like a fear of choking and a fear of costumed characters. People with a specific phobia, except very young children, know their fear is excessive and is interfering with their life but they will go to great lengths to avoid the thing that scares them and to avoid getting treatment for their phobia.

Animal type refers to the spiders and snakes as well as any number of other creatures great and small that may scare us. Some animals may really be harmful or dangerous but a phobia is not restricted to only those things we should fear but is enlarged to fear all creatures whether they are likely to harm us or not.

Natural environment phobias include heights, weather, and water. The “medical type” includes such things as blood, needles and medical procedures. Place phobia is best known for fear of flying and elevator fear.

A closely related anxiety disorder “Social Phobia” includes things like public speaking and eating in public. In social phobia, the fear is not of being physically injured but a fear of doing something that is embarrassing or uncontrollable.

Both social phobia and specific phobia are treatable. For some people, medication can help to manage symptoms in the short run but over time the symptoms of anxiety may reappear. A specific counseling method called systematic desensitization or exposure therapy is especially helpful for treating specific phobia and a related method works well for fear of public speaking.

If the phobia becomes excessive someone may seek treatment. Here is an example of a treatment episode for a mother; we shall call Ellen, who had a terrible fear of snakes. She was practically pushed in the office door by her husband Bob. Her son and her husband Bob both wanted to go camping and she had refused. While on vacation they had wanted to visit a zoo. Both of these activities might involve snakes and snakes terrified Ellen.

The therapist began by teaching Ellen how to relax using deep breathing and other relaxations techniques. It is impossible to be both frightened and relaxed at the same time. Over the next week, Ellen practiced her relaxation methods every time she became anxious, whether it was about snakes or just day-to-day life.

At the second session, they discussed what things about snakes provoked what level of fear. Could Ellen write the word snake on a piece of paper with only modest fear? Could she say “S-N-A-K-E.?”

For each item on the list, they assigned a number from one to ten. The goal was, to begin with, the “snake’ exposures that were the least frightening and progress to the more threatening ones. Her fear hierarchy might come out something like this.

  1. Write the word snake on a piece of paper.
  2. Say snake.
  3. Talk about snakes.
  4. Read a word book about snakes.
  5. Look at pictures in a book about snakes.
  6. Watch a video about snakes on T. V.
  7. Visit a local pet store with her son and look at snakes in the cages.
  8. Touch a snake while the pet shop owner held him.
  9. Visit the local zoo and look at snakes in the Herpetarium with her son and husband.
  10. Go on a camping trip where they might encounter a snake.

After developing the “snake fear scale” Ellen practiced her relaxation. She was then able to write down the list of “snake steps” and read them back to the counselor at the second meeting.

By the third session she was reading an article the counselor had brought in about types of snakes and some of the good things snakes can do.

Her efforts to look at pictures in a book took longer, several times she had to stop, do her relaxation exercises and discuss her feelings with her therapist.

Ellen watched the snake video in the counselor’s office, being prompted to do her breathing and relaxation as needed. She was able to take the video home and watch it a second time with her family and reported it went well and she did not have to close her eyes even once.

By the time summer came Ellen reported to the counselor she had completed steps one to nine.

This same sort of method can be used for social phobia. A common fear is public speaking. Many people report they are more afraid of public speaking than death. The old approach to fears and phobias was the “throw them in the deep end and they will sink or swim.”  Too many people were traumatized by that approach and never went in the water again.

Turns out that Bob, (Ellen’s husband remember?) was not afraid of snakes, but he was terrified of speaking in public. His company wanted him to make a presentation later in the year at a large convention and Bob was terrified. The counselor worked with Bob for a while on relaxation techniques and then gave Bob some choices.

For those with a fear of speaking there are classes at the local college or adult education and there are clubs whose purpose is to help people overcome their fear of speaking in front of others. Working with a small group of others who are all trying to learn to speak in public can ease the tension. Building up gradually from talking around a table to standing up and speaking to the group and finally to speaking in front of progressively larger audiences can build your confidence.

Bob took the college classes. He was able to complete the class and began speaking to groups his company sent him to speak at. Things were going fine. – Sort of.

Then the counselor got a frantic call from Bob and Ellen. Despite all their efforts and all that progress, Bob was terrified of the speech he needed to give at the convention, he was thinking of quitting his job to avoid it. Ellen had been in the bedroom crying for the last week. She was not going to the convention with Bob, as much as she wanted to be supportive because that meant the camping trip after the convention and her fear of snakes had returned with a vengeance.

Why after all that work had Bob and Ellen had a relapse of Anxiety? We know systematic desensitization works to reduce anxiety.

Stay tuned for a post on what causes an anxiety relapse.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.