Social Anxiety Disorder

Dr. David L. Kupfer, Ph.D.

We all feel shy and embarrassed at times. When the problem becomes severe enough to interfere with daily living, it can be seen as Social Anxiety Disorder, or Social Phobia. People with this disorder may fear meeting new people, dating, eating in public, using public bathrooms, speaking in public, or giving formal presentations. As Jerry Seinfeld has said, “People at a funeral would rather be the corpse than have to give the eulogy.” Social phobics may fear being criticism or disapproval of what they say. They might be afraid of how their speaking voice sounds, anticipate that they will lose track of their thoughts in mid-sentence and just freeze, or fear social rejection. Interestingly, their worst fear is often the fear of appearing fearful, anxious, or weak from others’ perspectives. Existentially, it can be understood as a fear of being truly known by other humans.

The symptoms of social anxiety often begin long before a feared event. Anticipating a disaster, someone might paint negative mental images of the bad scene they sense is coming. Anxiety and self-fulfilling prophecies can be the result. Physiologically, social phobia tends to include symptoms such as a rapid heart rate, sweating, blushing, and a trembling voice that makes the person even more self-conscious. People with social anxiety disorder tend to have irrational beliefs; they may feel that everyone in the room is paying total attention to them, they may believe that everybody else is a perfectly polished public speaker, and they might have perfectionist standards for their own social performance.

Beth came to therapy primarily because she was scared to interview for the new job that she very much wanted. She also had panicked and had to abruptly leave the room when giving a presentation to a group at work several years ago. She had begun to dread making phone calls to people whom she did not know. She believed that her Southern accent made her sound “stupid,” and tried to cover it up. Further interviewing led to her understanding that her accent was just the tip of the iceberg. Deep down, Beth feared that any misstep would lead people to see right through her and know about the family secrets that had led her to shame. She really believed that hers was the only alcoholic or dysfunctional family in the world.

Therapy included the type of role-playing that makes psychodrama effective. In the therapist’s office, Beth rehearsed speaking to groups and answering an interviewer’s questions. When she played the role of the judgmental interviewer she most feared, she realized that her expectations of ridicule were absurd. She transitioned from individual to group therapy, which increased her comfort and skill in social situations. She came to see herself realistically, as a lovable member of the human race.