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mental health "mondays" :: problem or no problem?

perhaps harold has a problem?
the first time i heard about "social anxiety disorder" was in a discussion with my mother. at the time, i believe that both of us gave a derisive snort and one of us said "great, now shyness is a mental disorder". frankly, i suspect that a lot of people had that reaction, because many of us have some level of social anxiety. what we missed in the initial evaluation is that the important part of the name, however, is that the emphasis should be placed on the third word. disorder means that something is clearly wrong, that the person is suffering and prevented from engaging in certain activities that they would otherwise want or have to do. it doesn't just mean reticence or a tendency to withdraw a little in public situations. a few years ago, i was going out to get some groceries and i became so terrified of going outside, of having to talk to a cashier or even of passing others on the street that i had to sit down on the stairs to get my breathing and heartbeat under control. i sat there for more than half an hour, paralysed between the knowledge that there were things we needed at the grocery store and the overwhelming dread at the thought of venturing beyond the doors. that's when i realised my mother and i had been wrong to snort. it's a real problem. but our reaction did point to a conundrum: how do you distinguish the harmless personality trait from the disorder?

the first thing that needs to be acknowledged is that the two things are not entirely separate. if shyness is severe enough, it can indeed be called social anxiety disorder, so there is space where the two overlap. however, social anxiety is not only a disorder of the shy. many sufferers are quite extroverted, but their internal dialogue prevents them from being able to do so.

shyness generally manifests itself as a discomfort in front of others, especially strangers. shy people are quiet and can be unwilling to talk about themselves or their opinions, but they can be comfortable listening to others and participating more passively in a social situation. for a person with social anxiety, the fear of interacting with people is so strong that they'll try to avoid it whenever possible. avoidance is a key factor in differentiating social anxiety disorder from general shyness. when a person avoids doing things that are perfectly normal or beneficial [like going for groceries] out of fear. shyness, even acute, will not cause this sort of panic and debilitation.

another factor to consider is how the person progresses in social interaction. shy people may lack self-confidence, but they may simply be slow to adjust to unfamiliar situations. this is an understandable evolutionary holdover. unfamiliar often meant threatening to our ancestors and so remaining guarded around strangers or in new surroundings served as protection. people who are shy will tend to relax and open up a little more as they realise that they are safe and accepted. people with social anxiety disorder never reach that point, because their anxiety is not driven by a fear of the unfamiliar. it's driven by an exceptionally low sense of self-esteem.

people with social anxiety disorder don't just feel awkward in front of people- they feel judged. they are usually terrified that others are finding fault in them, because they find great faults in themselves. this is not alleviated with time and sufferers will often recall incidents where they felt they humiliated themselves long after anyone else. social anxiety disorder is characterised by harmful thoughts, self-hating and defeatist ideas that are projected onto others. people with the disorder believe that they are subject to greater focus, with negative consequences.

a final key factor in separating routine shyness from disordered thought is anticipation. shy people might feel uneasy in social situations, but they don't generally think too much about it beforehand. they might have a distaste for public events, but the thought of attending one isn't enough to trigger panic attacks. people with social anxiety disorder become stressed just thinking about social situations. the anticipation in itself is enough to trigger panic and dread [and this in turn leads to avoidance].

one thing that most psychiatrists agree on is that social anxiety disorder is rarely the sole problem for sufferers. most often, it is comorbid with other conditions, such as depression, where low self-esteem triggers a number of other issues. people with social anxiety will often "self-medicate" in order to overcome their fear, which can lead to substance abuse. social anxiety can also be symptomatic of broader anxiety problems, such as generalised anxiety or panic disorder. the presence of other disorders makes treating social anxiety more complicated, as you might imagine.

if you think that you might have social anxiety disorder, the good news is that there is treatment. the first step is to consult a medical professional for their opinion and diagnosis, but since talking to others might seem problematic, you might also want to take a look at the following resources:

the criteria used to diagnose social anxiety disorder
the liebowitz social anxiety scale test [a very helpful quiz that evaluates levels of both fear and avoidance in a number of situations]
a self-help guide to differentiating social anxiety from shyness

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