It’s May Mental Health Awareness Month.
The happy times were nightmares for Kristen Rogers.
A chance encounter with a co-worker would make her heart pound so hard she thought it would burst out of her chest. Her mind would be blank—she was stuttering trying to make conversation while pools of sweat pooled under her arms. Even impromptu conversations with close friends or family caused this kind of extreme anxiety.
But the result was even worse.
“I would always end these interactions feeling really embarrassed and ashamed and would spend hours or days thinking about how the other person must think I’m stupid or incompetent,” Rogers said. “I would be so upset and stressed and physically ill – it was an unfortunate cycle.”
Rogers was a teenager when the symptoms began, and they only intensified as she got older. She didn’t date or make many new friends — she didn’t even dance at concerts because she was terrified that everyone was watching her. Judging her.
Rogers thought he was just an anxious person. But when she started seeing a psychiatrist in 2020, she learned it wasn’t just anxiety — she had it social anxiety disorder.
What is social anxiety disorder?
Social anxiety disorder (SAD) is the persistent, intense fear of social or performance situations where a person expects to be scrutinized, judged, or humiliated. For people living with SAD, common everyday activities such as talking to new people, eating in public, or presenting at work can cause crippling anxiety and fear.
“When you have social anxiety disorder, that fear of being exposed as inadequate or worrying that people will judge you gets in the way of living your life,” she said. Ellen Hendriksen, Ph.D.psychologist and author of How to be yourself: Calm your inner critic and rise above social anxiety.
Hendricksen said people with social anxiety experience discomfort, disability, or both. Distress in this context means discomfort, stress, anxiety and feeling unsettled before, during and/or after a social interaction. Impairment that means social anxiety prevents you from doing things you want to do. “If you turn down a promotion at work because you have to visit satellite offices and talk to a lot of strangers — that’s a disability,” Hendricksen said.
People living with SAD also experience physical reactions such as flushing, fast heartbeats, nausea, tremors, dizziness, and difficulty speaking in social situations.
“You may feel your stomach drop, flush, sweat — all the classic physical symptoms of fight or flight,” Hendricksen said.
SAD symptoms can vary from person to person and change over time. And while it’s perfectly normal to feel nervous or anxious every now and then, SAD is a chronic medical condition that requires treatment.
The root of social anxiety
Social anxiety disorder is not caused by one thing. Instead, SAD is usually a combination of biology, life experiences and learning patterns, according to Laura Johnson, LMFT, LPCCcognitive behavioral therapist and author of Social anxiety for dummies.
In terms of biology, Johnson said people with SAD may be born with a tendency to be inhibited. “Social anxiety could be linked to an overactive amygdala, the part of the brain that controls your fear response.”
Having a family history of SAD can also increase your risk. One study found that people with a first-degree relative (parents, siblings) with SAD are up to six times more likely to have the disorder.
And because SAD usually begins in childhood or early adolescence, negative life events such as abuse, neglect, or growing up with a medical condition that causes unwanted attention, and the way you were raised by your parents can be risk factors for SAD.
“Some ways your parents could have influenced the development of social anxiety include modeling anxious behaviors, being overprotective, or being judgmental,” Johnson said.
Women and social anxiety disorder
SAD affects both men and women, but research shows that women are more likely to have SAD—and have more severe symptoms as well as higher levels and greater numbers of social phobias—compared to men.
“From a young age, many women are taught subtly—and sometimes not so subtly—to be pleasant, likable, and not take up too much space. This can translate into over-watching how they come across, second-guessing their own opinions, and holding back in conversations, especially in environments like the workplace where men may dominate conversations or interrupt themselves.
Although SAD usually develops earlier in life, major life events such as moving to a new city or being diagnosed with an illness can trigger symptoms in adulthood for the first time.
“Middle-aged women with social anxiety disorder have probably had it for decades, and the key thing to know is that social anxiety disorder is fed, watered and maintained by avoidance, so it’s important to try to face your fears and think about where you’ve built avoidance into your life,” Hendriksen said.
Social anxiety never goes away — but it can get better
The most common treatments for social anxiety disorder are prescription medications and cognitive behavioral therapy (CBT), which involves identifying and reframing negative or irrational thoughts over time.
“The most effective treatment is cognitive behavioral therapy, especially when it involves exposure,” Johnson said. “This means gradually facing the situations you fear instead of avoiding them, while learning how to respond differently to anxiety-provoking thoughts.”
Exposure exercises involve identifying fear and worst-case scenarios in social situations and testing them to see if the outcome is really as bad as the person with SAD thinks. “The point is to face our fears, and our feared outcomes are almost always worse than what actually happens. Even if the worst-case scenario happens, we have to remind ourselves that we are resilient and that we can handle whatever life throws at us,” Hendriksen said.
For Rogers, CBT made a huge difference. “In many ways, CBT saved my life,” she said. “I had some early life experiences that instilled perfectionism in me, so part of it was undoing that and finding relationships and people who are much more open-minded about not having to be perfect all the time.”
It’s been six years since Rogers started treatment and she no longer experiences social anxiety every day. When it does, it’s nowhere near as intense as it once was. “I still sometimes find myself taking different paths to avoid conversation or feeling weird that I don’t always have something to say when I meet someone, but most of the time I try to start a conversation with either strangers or colleagues,” she said.
Rogers’ advice for anyone struggling with SAD: Find a good cognitive behavioral therapist. “The process can be painful and challenging, and sometimes you may not want to listen to what the therapist has to say, but it really does get better.”
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