10 April 2007

The fear of being social

Tony dreads going to work tomorrow. For him, and million others with social anxiety disorder, interaction with others is particularly difficult.

Tony dreads going to work tomorrow because there is a staff meeting scheduled. These meetings intend to update the team on different projects and to brainstorm.

Just the thought of speaking in front of his colleagues fills him with fear and gives him a sleepless night. In the morning, Tony can't stomach his breakfast, he sweats profusely and his heart pounds. Once the meeting is over, a big wave of relief spills over him as he begins to relax. But memories of the meeting haunt him.

Tony is sure he made a fool of himself and he is convinced that everyone in the room saw how afraid he was when he spoke, and how stupid he acted in their presence. At next week's meeting, the boss is going to be there. Even though this meeting is seven days away, his stomach turns with anxiety, and fear floods over him again.

He knows that he will stammer, hesitate, his face will turn red, he won't remember what to say, and everyone will witness his embarrassment and humiliation. He has seven miserable days of anxiety ahead of him - to think about it, worry about it, and magnify it in his mind.......again and again and again.....

His condition
Tony is one of the 3-13% of all people who suffer from Social Anxiety Disorder. Social phobia is the fear and anxiety of being judged and evaluated negatively by other people, leading to feelings of inadequacy, embarrassment, humiliation and depression. It is normal to feel ill at ease when speaking in public or joining a group of people you don't know. However, people who suffer from social anxiety, fear social interactions such as doing something in front of others (eating, drinking, writing, signing, working). They avoid being the centre of attention, as they fear being teased or criticised. Most social encounters are difficult for them, especially going to parties and being introduced to new people. Meeting people in authority ("important people") is extremely anxiety provoking. These social interactions can set off intense anxiety that does not go away, blushing and stuttering, dry throat and mouth, trembling, muscle twitches, or even a full-blown panic attack. This causes intense distress and interferes with day to day life (work, hobbies, relationships) as people with social anxiety can never fully relax when other people are around. It always feels like others are evaluating them, being critical of them, or "judging" them in some way.

The person with social anxiety knows that people don't do this openly, of course, but they still feel self-conscious and judged while they are in the other person's presence. This may lead to complex patterns of avoidance that restrict the person's life greatly. However, once the diagnosis is made, this illness can be treated very effectively by either a specific type of psychotherapy (cognitive behavioural therapy with an exposure component) and/or medication (Selective Serotonin Reuptake Inhibitors). The MRC Unit on Anxiety Disorders is doing research on a novel treatment. For more information, please contact the Mental Health Information Centre at 021 938 9229,


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