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Social Anxiety Disorder

and Its Complexities

By: Teresa Reading

Too comfortable with staying home during COVID?  You were not alone. You may even have been relieved. 


According to the CDC (Centers for Disease Control and Prevention), 79.5 percent of U.S. citizens supported government-issued stay-at-home orders to mitigate the spread of  COVID-19. That was in 2020. However, now that much of the United States has been vaccinated, and even now that the boosters have played an important part in the structure of safety and prevention, there are some who just prefer to stay at home. Many are more comfortable with skipping the parties, get-togethers, travel, and outings that they previously tolerated due to pointed suggestions and urgings from family and friends who may have meant well. However, they did not perceive what lay beneath the comfortable exterior of that individual: a comfort of keeping more to themselves and avoiding social situations. This could be social anxiety disorder.  
 

What Is Social Anxiety Disorder? 

Social anxiety disorder, according to the DSM-5 (Diagnostic and Statistical Manual of Mental  Disorders), the Bible for psychiatrists and clinicians, is characterized by a marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Social situations are avoided or endured with intense fear or anxiety. This typically lasts for six months or more and is out of proportion with the situation. It is the third most prevalent psychiatric disorder. Though treatable, it is underdiagnosed, and about two thirds of the people suffering from it do not receive treatment.   


How Is Social Anxiety Disorder Diagnosed? 
Social anxiety disorder typically starts in childhood or adolescence, but a small subgroup does develop symptoms later in life. Screening tools for the condition do include the DSM-5, but it is not the only tool used to make a diagnosis. Other tools might include psychological assessments and scales, clinical interviews, and self-assessments like SPIN (Social Phobia Inventory). Additionally, there may be physical manifestations from this diagnosis. A family physician could be instrumental with any other diagnosis, such as irritable bowel syndrome, migraines, or another diagnosis related to this illness, and make a referral to a psychiatrist. Remember, the mind and the body work together.  

What Are the Signs and Symptoms of Social Anxiety Disorder?
Avoidance is one of the most characteristic signs of social anxiety disorder. While people may see the irrationality of it, they just can’t help the fear. Dr. William H. Reading states, “Thought, presence or association of the particular phobic stimulus will illicit an emotional and physiological response. A fight-or-flight response produced by adrenaline (epinephrine) from the adrenal glands is usually what happens during this time.” Other symptoms might include profuse sweating, nausea, heart racing, shaking, and even overwhelming dread. Negative thinking patterns, such as personalizing, mind reading, catastrophizing, and fortune telling may all feed into the mind of someone with this disorder. The National Institute of Mental Health has more information on this and additional resources at http://www.nimh.hih.gov.

 
What Are Some Interventions and Treatments for Social Anxiety Disorder?
As mentioned earlier, social anxiety disorder is underreported and under- diagnosed. Unless it starts to interfere with everyday things, some people may choose not to get it treated. Psychotherapy and medication are normally the treatments, and there is even a third. One is a type of psychotherapy called CBT, or cognitive behavioral therapy, that can help. Exposure therapy is another. Some medications, such as anti-anxiety medications, antidepressants, and beta-blockers may aid as an adjunct therapy. Ideally, some should be short term and work with psychotherapy. Acupuncture is another option. On his website, Healing Acupoints, Dr. Seema Sharma L.AC MAOM Board Certified in acupuncture states, “Studies have shown that cumulative effects of acupuncture contribute to relaxation and decreased episodes of anxiety over time.”  


In conclusion, while social anxiety disorder does have its complexities, the upside is that it is treatable. Through treatment, it may make your social experiences more pleasurable, your physical ailments more manageable, and your quality of life more ... well ... full of life.  
 

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Dr. William H. Reading and Teresa Cox Reading
Dr. William H. Reading and Teresa Cox Reading run The Offices of William H. Reading, MD, Recovery, Psychiatric, and TMS services, a neuropsychiatric practice in Stafford, Texas. Dr. Reading has an undergraduate degree from UT Austin and a Doctor of Medicine from the Medical School at UTSA. As well as being a practicing physician, he has been an educator and an assistant professor for over five years and is the author of numerous articles for professional publications. Teresa received her nursing degree from Excelsior College. As registered nurse and practice administrator for The Offices of William H. Reading, MD, Teresa is instrumental in its clinical and administrative operations. Teresa and Dr. Reading have four sons and have been involved with the Fort Bend community for over twenty years.