Social Anxiety Disorder

The material on this page was original an e-mail sent to members of the BehaviorAdvisor.com B-list. To sign up, go to:

There are very few monsters that warrant the fear we have of them.~Andre Gide
Hello Fellow B-lister! You might be wondering why I’ve never knocked on your door to say “Hi”, or why you’ve never seen me at your local sports bar during the big game. Two words:Social Phobia. When the 5thedition of the Diagnostic and Statistical Manual of the American Psychiatric Association(DSM-5)comes out in May, it will be three words:SocialAnxietyDisorder. Yes, it’s sad, and yes, it’s "SAD". Let me tell you a bit about this disorder before we talk about how it presents itself in some of our students.
Social Anxiety Disorder (SAD), also known as “social phobia” is a persistent fear of social gatherings that is irrational(to those who are not affected by the condition… Remember: It’s not paranoia when they really ARE after you.). It involves an ongoing avoidance of situations in which we think that we might be judged or scrutinized by others.
Now, we’re not just talking about the understandable worry about what critics will say regarding the bleach bottle sculpture at your art show opening; if the director will look favorably upon your audition for the part of a rock in the upcoming play; whether the audience will enjoy your kazoo and zither recital rendition of Bach’s Toccata and Fugue in D minor, or whether the coach will think you’ve got the athletic ability to make the varsity tickle team. We’re talking about a pattern of overly strong and constant worry and negative stresspertaining to a wide variety of different events and issues. Great!I telepathically sensed that you just made the connection back to last week’s B-List communication on Anxiety(and PTSD). Yes,today’s topic: Social phobia/Social Anxiety Disorder is one of the variants of Anxiety Disorders found in the DSM.You say that you were shy as a kid, and still are? Shyness(being reserved in social situations in which more outgoingness would be desirable), performance anxiety, and “stage fright; are common in children(and adults). They do not necessarily signal the onset of social phobia. However, when this social insecurity reaches a pervasive and enduring pattern ofintense“shyness; it moves into the realm of social phobia(fear of social situations).
This week's video(see below)follows "Samantha", a girl with Social Anxiety Disorder.
Social phobia differs from shyness in one major way:Shy people are able to participate in social activities whereas kids with SAD actively seed to avoid such situations… gatherings such as:
  • Parties and other social occasions
  • Being in public places, including public bathrooms
  • Making the acquaintances of new people
  • Public speaking(everything from presentations in class to one-on-one conversations)
The shy and the extroverted have this in common - that they both fancy they are the center of attention. ~Robert Brault
When concerned about going to a social soiree(excuse my French), speaking in front of an audience(the most feared event on surveys… right above fear of death!), or talking to authority figures, individuals who are shy can feel quite unsure about their abilities to respond appropriately. However, they enter those uncomfortable situations. Those with social phobia actively avoid those situations, thus experiencing a disruption in school or social relationships.
While those with S.A.D. may engage in a social contact situation, it is the level of emotional and physical response that separates shyness from phobia. Often, though, fear prevents using a public restroom, eating at restaurants or cafeterias, writing/presenting in front of class, or even talking on the phone. Although many youngsters with social phobia recognize that their worries about being with others are excessive, they are unable to overcome their issues on their own.
Social Anxiety Disorder is an overwhelming fear that one might say or do something in a social situation that would bring embarrassment, shame, and/or humiliation.Side note: I now experience it in our B-List communication global and galactic headquarters… my office… after last week when many of you wrote to remind me that it was not the Mary Poppins character, but rather the other Julie Andrews character in“Sound of Music”that sang “Let’s start at the beginning…”

Yes, I’ve taken SAD to a new place: Cyberspace. Hmm…C-SAD: Fear of showing up in internet chat rooms and facebook sites.While I continue to devise the diagnostic criteria for its inclusion in DSM-8 and the 2026 version of ICD, let’s return to the real-world SAD.
What might we see in school?
Children and youth with social phobia experience pronounced anxiety and self-consciousness in everyday social situations. They undergo intense, persistent, and chronic fears of being observed and evaluated and by others. They are highly concerned with the possibility that they might do something that will embarrass themselves.This fear can be so pronounced that it interferes with school, work, and other responsibilities.They might fret for days or weeks before the arrival of a dreaded situation such as an oral report or public performance.
Today is the tomorrow we worried about yesterday. ~Author Unknown
Social phobia in kids can be limited to particular situations(such as talking to others, eating or drinking while in a group, writing on a board or presenting information in front of others). It can also be extensively broad as with generalized social phobia in which the person feels anxiety in the presence of almost everyone other than members of the family. Despite the longing desire to be accomplished, and make and keep friendships, their reticent behaviour works against it.
We are most likely to notice an intense, ongoing concern in the youngster anytime s/he is required to interact with unfamiliar individuals, or will have their performance in some realm evaluated by others. A common and significant complaint uttered by these youngsters is the fear of appearing foolish and drawing ridicule from others. These kids often use various excuses and ploys to avoid school related events. They may avoid opportunities to socialize at recess, lunch, and other gatherings.

Physical symptoms that often present themselves when experiencing anxiety are ones you would expect when one has great worry, but not in the situations in which they are witnessed. They include:
  • Trembling
  • Sweating
  • Skin blushing
  • Difficulty talking
  • Feeling nauseous
Not evident to us is:
  • Elevated blood pressure
  • Rapid heart rate
We probably wouldn't worry about what people think of us if we could know how seldom they do.~Olin Miller
Incidence, etiologies, and risk factors
Boys and girls are affected at equal rates with Social Anxiety Disorder. While social anxiety disorder often presents itself in early adolescence, it can emerge during childhood. The fear and avoidance of situations in which they may be judged by others may be related, in some cases, to overprotective parents or limited social opportunities during childhood when social skills are learned during play and with guidance from elders.
Adolescents with social phobia are at high risk for engaging in alcohol or drug use, and developing a dependence upon them, as they might view these substances as relaxation facilitators, or at the very worse, convenient excuses for any actions that were indeed judged negatively by others.("Yeah, that was a dumb thing to do, but I was drunk.")

Treatment & Interventions
The goal of treatment is to promote more normal levels of functioning. The speed and degree of success of the treatment depends, in large part, on the severity of the condition.
  • Anti-anxiety and antidepressant medications are sometimes used to help relieve the symptoms of phobias. More information on these medications can be found at:
  • Cognitive behavioral therapy (CBT) helps youngsters to reframe distorted perceptions and feelings in order to better comprehend and manage/modify the thoughts that are impairing social inclusion. The result is more positive and rational thinking (and responses).
  • “Systematic desensitization” is a common assistive strategy. The youngster attempts to first relax, then imagine social situations that cause fear. S/he moves, over time, from the least fear invoking to the most fearful situation. It can also involve reality-based procedures in which the youngster engages in progressively more intense exposure to the feared situations.
  • Social skills training, involving role playing and modeling, is used to teaching appropriate actions for implementation in recurring situations.
  • Group treatment is often utilized so that a support group of empathetic others provides chances for interaction with peers as they work toward increased social comfort.
*If you are theparent or teacherof a youngster overwhelmed with anxiety, check outDr. Gary’s pageofsupports and materials on the issue. You’ll findbooks, games, and morethat are geared toward helping to ease the social strain.
THIS WEEK'S VIDEO,part 1 of 2 parts, comes courtesy of one of the wonderful grad students in my teacher training program for kids with emotional and behavioral disorders. (Thanks, Edie!)
I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.~Nelson Mandela
*Since engaging in our discussions regarding anxiety, a few folks have written to me saying “HEY! What about my stress and mental distress?”If you too need supportto be able to crawl out from under this pile of pressure, consider the strategies mentioned above, andescapewith a wonderfulrelaxation audiofrom my esteemed colleague, Dr. Doniaat:
More information on anxiety and depression can be found at: Anxiety and Depression Association of America)
A well adjusted person is one who makes the same mistake twice without getting nervous.~ Alexander Hamilton, a “Founding Father” of the United States.
PART TWO OF SOCIAL ANXIETY (sent one week after the part above)
BehaviorAdvisor.com
“The only thing we have to fear… Is fear itself.”Franklin Delano Roosevelt President of the United States 1933 to 1945
Hello Fellow B-lister!Have you been biting your nails all week, worrying about me coming to your e-mail inbox again this weekend? Hmm... social anxiety, or just "nerves"?Welcome back to part two of the BehaviorAdvisor.com newsletter issue regardingSocial Phobia, a form of anxiety. First, a brief refresher designed to bring you back up to speed. Then the link to part 2 of the video onsocial anxiety disorder.
Dorothy:“Don't you know the Wizard's going to give you some courage?”Cowardly Lion:“I'd be too scared to ask him for it.”
Anxiety, like anger is a “secondary emotion”… a reaction to theprimary, and primal reaction of fear. Kids(and adults)with anxiety disorders have an intense feeling that something bad could or will happen in a current or future situation. This class of mental health disorders consists of a state of psychological(and often accompanying physical)tension that results in trouble concentrating, difficulty making decisions, and a pervasive feeling of discouragement. This intense and unbearable fright occurs in the face of social threats that are not apparent to others. These phobias persist before or during situations that do not present any real threats to the person.
While the phobias develop and occur under fairly specific circumstances, these youngsters are often unaware of the reasons for their fear. In part 1 of this 2-part communication, my scholarly and humorous graduate student, Edie, told us about Samantha a 13 year old girl with ‘Social Phobia’, a condition that is expected to soon be known as ‘Social Anxiety Disorder’… beginning with the publication of the 5th edition of the Diagnostic and Statistical Manual of the American Psychiatric Association(DSM-5)in May 2013.
Today, inthe sequelto the first social anxiety video, we become familiar with the everyday definition and the definition/diagnostic criteria found in the DSM. Samantha’s symptoms are then compared to the DSM criteria. Does she meet the criteria or not?Tune into find out. Also in the video is an overview of the various interventions from the realms of medicine, psychology, and education, and information on the prognosis for youngsters with this condition. At the end, we find out how Samantha fares in her struggle with anxiety.
OH YES!…For any of the disorders we have talked about,Dr. Garyhas something to help us help our kids. He’s got books on their condition that are on their reading level, board games that teach while having fun, and lots of therapeutic items.TAKE A LOOK!Espanol!
Next Week:Another anxiety related neurosis: Obsessive Compulsive Disorder in Kids(An obsession is a recurring thought that persistently intrudes into the youngster’s consciousness. The compulsive behavior is an attempt to suppress the anxiety associated with unpleasant persistent and recurring thoughts.)
*A number of our highly stressed colleagues report that they have begun to find solice and re-energized strength in listening to the calming voice of my esteemed colleague, Dr. Doniaat:
More information on dealing with our feelings of being under great pressure can be found at: Anxiety and Depression Association of America)
*As requested by a large number of folks(and to prevent having to send out old e-mails to the crowd that is requesting back copies), I’ll soon be archiving all of our past communications on BehaviorAdvisor.com Another driving force f or this soon-to-be feature is my firm belief that all educators need to be “mental health literate”. A large segment of kids in your classrooms will be struggling with emerging or persistent disorders of thinking/feeling. We educators need to have knowledge, skill and wisdom bases if we are to serve them well.
..
.
.
Thanks for being a member of our B-List... Working hard to reach and teach kids with behaviour challenges.
BehaviorAdvisor store|Dr.Mac's Positive Parenting App or Podcast|The Behavior Survival Guide for Kids

Author: Tom McIntyre, Ph.D.