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mental health mondays :: social disease

i can well remember the first time i heard about social anxiety disorder [aka social phobia]. my mother was commenting on a story she'd heard on the news about the condition. when she repeated the words "social anxiety disorder" she gave a derisive kind of snort and added "you mean shy. now being shy is a psychological condition." and therein lies the problem of social anxiety disorder: how do you differentiate between stigmatizing people who are just naturally more reticent in front of others and helping people whose reticence prevents them from living a "normal", fulfilling life?


most mental health web sites will tell you that social anxiety is "more than just shyness", but that doesn't really help a whole lot. how do you identify when your shyness has become problematic? scarier still, how do you identify it in a child? i add that second part, although i'm normally nervous writing about childhood mental disorders, because there is evidence to suggest that social anxiety is one of the earliest-onset anxiety disorders and can be a warning sign of conditions like depression later on in adolescence or adulthood. in fact, later onset of social anxiety disorder is comparatively rare. by the time we reach adulthood, our psychological skin seems to have thickened to the point where the outside world can't rattle us so much. unfortunately, once it's set in, social anxiety can start wreaking long-term havoc.



smarter people than i have tried to decode exactly when shyness becomes disorderly without success, but most concur that it is a problem when it starts to interfere with your regular life. a couple of years ago, i was headed out to pick up some groceries. it was something i'd needed to do for a few days and had put off for no special reason, but when i got to the bottom of the stairs and was about to exit the building, i was so paralysed with fear that i had to sit down before i fell. i sat there, hyperventilating for ten minutes or so, because i was irrationally petrified of going through the door. i wasn't in any danger. barring an ice-related slip [it was winter], i wasn't going to get hurt by leaving my building, but seeing the door frame was like staring into the grave.

that's a very blatant example of what social anxiety can look like, but it's a decent starting point. everyone is a bit shy or guarded when they're put in new situations, but it's a problem when stuff you do all the time is enough to stop you cold. likewise, an exaggerated reaction can be a warning sign. being nervous before a public speech is normal. feeling sick at the thought of it and being unable to go through with a public presentation is not. people with social anxiety don't just fear the new or the unknown, they fear the entire outside world. most would rather isolate themselves than deal with the stress caused even by going out to meet a friend for coffee. the fear of interacting with people, especially strangers, even incidentally, can be very pronounced, hence my panic attack about having to get groceries. i'd gone to the same store a hundred times, but when my anxieties were running high, the thought was hateful.

to be clear: i don't think that i have social anxiety disorder. i think that i did have it when i was younger, but that i've mostly got it under control. mostly. incidents like the one i've just related are happily rare. 

so how do people get this way? the likely causes are a litany of the usual suspects for mental conditions: brain chemistry that doesn't quite balance, a hypersensitive amygdala that heightens the fear response, genetics... more than other disorders, research seems to focus on environmental factors during childhood as key to understanding the disorder's development. children who are regularly shamed, bullied or ridiculed do seem more likely to develop shyness that impairs their social development. which i think is all the more reason to crack down on school bullies, if only to limit one part of the problem.

as with many anxiety disorders, you basically have two treatment options open to you: drugs to control the symptoms and therapy to address the cause. personally, i don't advocate giving psychiatric meds to children under any circumstances- there are too many studies that question their safety and long-term effects- but i do think that therapy is a good idea for working through anxieties of virtually any sort, provided that you can find a therapist to whom you can relate.

for a primer on social anxiety, this one from the mayo clinic is pretty solid.

you can also find a number of resources at the social anxiety institute.

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