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In SAD the intense and persistent fear is of being in the company of unfamiliar people, scrutiny by others in a social situation, or a fear of behaving in a way that might cause embarrassment, humiliation and/or ridicule.
While it is normal for people to experience anxiety about certain social or performance situations such as job interviews or public speaking, the person with SAD experiences persistent, extreme anxiety out of proportion to the actual situation. The very normality of social anxiety has meant that SAD is often undiagnosed.
The person becomes anxious as he/she anticipates humiliation and embarassment days or weeks before the dreaded event (anticipatory anxiety). During the event he/she is immediately anxious and extremely uncomfortable throughout. After the event, the person may be plagued by concerns about their performance and how others judged them or thought of them. In this way a vicious circle is created.
The person may feel that everyone else is far more competent in public and that he/she is not. Small mistakes may appear much more serious than they really are and the person feels that his/her every move or reaction is noticeable to others. Blushing may in itself be painfully humiliating to the person.
SAD can be limited to only specific situations. The most common anxiety-provoking social situation is public speaking. However, other situations such as signing cheques or contracts before witnesses, using public toilets, eating and drinking in public, and talking on the phone may also cause anxiety.
In some cases, fears are more generalised and include most social situations.
The intense anxiety may lead to avoidance behaviour. Children may not be able to avoid feared situations and may be unable to identify the nature of their anxiety. When the person faces the feared situation, it is endured with great anxiety and discomfort.
Adolescents and adults with SAD realise that their anxiety is irrational and excessive but are unable to control it. This is not, however, always the case in children.
SAD shouldn’t be confused with shyness. Shy people may feel very uneasy around others but do not experience the same anxiety in anticipation of the event and do not typically avoid social situations. People with SAD are not necessarily shy. They may be completely at ease in social situations most of the time and the anxiety only surfaces in certain situations.
Anxiety can take the form of panic attacks during or before the feared situation.
The fears and anxiety cause great distress to the person and/or may be so intense and overwhelming that it significantly interferes with work or school, social life or other activities. For example, a person may not reach his potential in his career because he is anxious in the presence of authority figures or colleagues, or too anxious to go for a job interview.
In children, there may be a decline in school performance due to test anxiety or classroom participation, school refusal or avoidance of age-appropriate social activities.
As social situations are often avoided, many people with SAD do not develop important life and social skills. In severe cases, people do not have friends and refrain from dating.
SAD is often accompanied by another psychiatric disorder, especially another anxiety disorder such as panic disorder or obsessive compulsive disorder, or depression. As people with SAD often “self-medicate” by drinking alcohol or taking drugs, they are at risk of developing substance abuse or dependence. SAD usually precedes these disorders. - Ilse Pauw, health24
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