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Ashok is a project manager with an IT company. He hates to go to work because a team meeting is scheduled for the day. He knows the routine: team members talking and debating with each other about their current and upcoming projects. As a line manager, he has to do a lot more talking and convincing than the others. Just the thought of speaking in front of his colleagues raises his anxiety. On many previous occasions he couldn’t bring himself to sleep the night before because of the anticipatory anxiety that builds up…

Finally, the meeting is over. A big wave of relief spills over him as he begins to relax. But the memory of the meeting is still uppermost in his mind. He is convinced he made a fool of himself and 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 raw with anxiety and fear floods over him again. He knows that in front of the boss he'll 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, ruminate over it, worry about it, over-exaggerate it in his mind, again and again and again...

Kavitha, a BCom student, won't attend classes on the first day of the semester because she knows that in some classes the professor will instruct the students to come up to the podium and introduce themselves. Just thinking about sitting there, waiting to introduce herself to a roomful of people who will be staring at her – and judging her - makes her feel nauseous. She knows she won't be able to think clearly because her “tension” will be so high, and she is sure she will leave out important details. Her voice will quiver and she will sound scared and tentative. The anxiety is just too much to bear - so she skips the first day of class, just to avoid the possibility of having to introduce herself.

Senthil, 23yrs, wants to party - indeed, he feels very lonely - but he never goes anywhere because he's very nervous about meeting new people. Too many people will be there and crowds only make things worse for him. The thought of meeting new people scares him - will he know what to say? will they stare at him and make him feel even more insignificant? Will they reject him outright? Even if they seem nice, they're sure to notice his frozen look and his inability to smile naturally. They'll sense his discomfort and tension and they won't like him --- there's just no way to win --- "I'm always going to be an outcast," he predicts. And he spends the night alone, at home, watching television - again. He feels comfortable at home. In fact, of late, home seems to be the only place where he does feel completely comfortable.

Everyone can relate to feeling anxious before giving a presentation, asking someone out on a date or attending a job interview. Butterflies in your stomach, sweaty palms, pounding heart – all of these are normal feelings when confronting a new or intimidating social situation. But for nearly one crore Indians suffering from social anxiety disorder (SAD), also known as social phobia, the intense fear of being scrutinized and negatively evaluated by others in social or performance situations is so severe that they literally become “sick with fear”. This can happen in even the most seemingly non-threatening day-to-day social interactions, such as ordering food in a restaurant, signing one’s name in public or making a phone call.Though they recognize that the fear is excessive and unreasonable, people with SAD feel powerless against their anxiety. They are terrified that they will act in a way that will be embarrassing or humiliating. The anxiety interferes significantly with their daily routine, occupational performance or social life. Physical symptoms of SAD include blushing, profuse sweating, trembling, nausea, rapid hearteat, shortness of breath, dizziness and headaches.

What’s the difference between normal anxiety and SAD?

Normal Anxiety SAD
Feeling anxious prior to making a presentation,leading a meeting or asking your boss for a raise. Turning down a well earned promotion that might involve occasional public speaking.
Feeling shy and awkward when walking into a room full of strangers. Feeling too anxious to attend your office party.
Butterflies or jitters before a date. Refusing a dinner invitation from someone you’ve known for years for fear of blushing and embarrassing yourself.

Triggers for social anxiety

The following are some examples of situations that are often particularly stressful for people with social anxiety disorder:

  • Meeting new people
  • Being the center of attention
  • Being watched while doing something
  • Making small talk
  • Public speaking
  • Performing on stage
  • Being teased or criticized
  • Talking with “important” people or authority figures
  • Being called on in class
  • Going on a date
  • Making phone calls
  • Using public toilets
  • Taking exams
  • Eating or drinking in public
  • Speaking up in a meeting
  • Attending parties, marriages, receptions etc.

Recognizing the illness…

Social anxiety disorder can have emotional, behavioral and physical signs and symptoms.

Emotional and behavioral signs and symptoms of social anxiety disorder include:

  • Intense fear of being in situations in which you don't know people
  • Fear of situations in which you may be judged
  • Worrying about embarrassing or humiliating yourself
  • Fear that others will notice that you look anxious
  • Anxiety that disrupts your daily routine, work, school or other activities
  • Avoiding doing things or speaking to people out of fear of embarrassment
  • Avoiding situations where you might be the center of attention
Physical signs and symptoms of social anxiety disorder include:
  • Blushing
  • Profuse sweating
  • Trembling or shaking
  • Nausea
  • Stomach upset
  • Difficulty talking
  • Shaky voice
  • Muscle tension
  • Confusion
  • Palpitations
  • Diarrhea
  • Cold, clammy hands
  • Difficulty making eye contact
Associated characteristics include:
  • Low self-esteem
  • Trouble being assertive
  • Negative self-talk
  • Hypersensitivity to criticism
  • Poor social skills
Worrying about having symptoms

When you have social anxiety disorder, you realize that your anxiety or fear is out of proportion to the situation. Yet you're so worried about developing social anxiety disorder symptoms that you avoid situations that may trigger them. And indeed, just worrying about having any symptoms can cause them or make them worse.

Causes

Like many other psychiatric illnesses, social anxiety disorder likely arises from a complex interaction of environment and genes. Researchers continue to study possible causes, including:


  • Genes. Researchers are seeking out specific genes that play a role in anxiety and fear. Social anxiety disorder seems to run in families. But it's not clear whether that hereditary component is related to genetics or to anxious behavior you learn from other family members.

  • Biochemistry. Researchers are exploring the idea that certain chemicals in your brain may play a role in social anxiety disorder. For instance, an imbalance in the brain chemical serotonin could be a factor. Serotonin, a neurotransmitter, helps regulate mood and emotions, among other things. People with social anxiety disorder may be extra-sensitive to the effects of serotonin.

  • Fear responses. Some research suggests that a structure in the brain called the amygdala may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.

How can SAD affect your life?

Social anxiety disorder can disrupt family life, reduce self-esteem and limit work efficiency. For some, it can be socially and economically devastating. It may make it difficult to complete school, interview and obtain jobs and create and maintain friendships and romantic partnerships. SAD may be selective. A person may have an intense fear of a single circumstance such as giving a speech, talking to a salesperson or making a phone call but be perfectly comfortable in other social settings. Others may have a more generalized form of SAD. They become anxious in a variety of routine activities in which their performance might be observed, such as initiating or maintaining a conversation with strangers or people in authority, participating in meetings or classes or attending parties or dating.

Treating the illness…

The good news is that social anxiety disorder treated, just like most medical problems. People who have had this problem for long periods of time have blossomed with treatment. After treatment, people with this problem report a changed life - one that is no longer totally controlled by fear and anxiety.

Most patients benefit with medication; the most commonly used drugs are the serotonin reuptake inhibitors (SRIs), benzodiazepines and beta-blockers. Relaxation techniques also help. Additionally, some patients will need to involve themselves in psychotherapy (cognitive behavior therapy; CBT).

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