You're in a meeting when it starts to creep up on you. The ever-tightening knot in the pit of your stomach and the collection of thoughts that run haywire through your mind. You brace for the overwhelming wave of jitters and fear that roots you to your chair. Glancing out the corner of your eye, you check whether your friends and colleagues are staring at you. What if they see you in this state? What will they think and what will you say? Why is this happening to you? Does this sound familiar? Perhaps you, like many others, crave human connection and a normal social life, but find that your body and mind gets hijacked by your anxiety whenever you're around others. If this is the case, you may be living with Social Anxiety Disorder (SAD). The good news is that you've come to the right place: this is a forum and resource-center for those living with SAD; and in this article we will guide you through some of the basic facts that you need to know when it comes to the disorder.

What does SAD look like?

In a nutshell, people with Social Anxiety Disorder (previously known as social phobia) experience uncontrollable waves of fear in response to social situations; and this feeling is present for at least 6 months. Examples of anxiety-provoking situations might include attending a dinner party, going to the mall or giving a public speech.

How common is it?

Although prevalence rates differ between studies and countries, much of the research suggests that Social Anxiety is a remarkably common disorder. For example, according to the American Psychiatric Association, it is estimated that 7% of Americans carry this diagnosis. In Australia, nearly 5% of all people are thought to have Social Anxiety Disorder, according to a National Survey of Mental Health carried out in 2007.

I'm shy, does this mean I have SAD?

Shyness is a common personality trait and only a minority of shy people actually qualify for SAD. Unlike shyness, those with SAD feel such overwhelming pangs of discomfort that their day-to-day functioning is impacted: they struggle to function normally at work or to sustain normal friendships and relationships.

What are the symptoms?

Social anxiety may manifest in the form of thoughts, emotions, physical sensations or behaviors. For example, people with SAD often have worrying thoughts that other people are watching and judging them. Their emotional response may be one of intense fear; and although they may realize that their fear is irrational and excessive, this alone is not enough to change the feeling. Instead, they may choose to continually avoid putting themselves in uncomfortable situations - a behavioral hallmark of SAD which can severely impact on one's ability to live a normal life. Finally, social anxiety will typically show up in a physical form: blushing, tearfulness, sweating, nausea, dry-mouth, rapid heart-rate and a difficulty in breathing. At times these physiological responses may escalate into a full-blown panic attack, where the person feels they have completely lost control over their body and become incredibly fearful that they might die as a result.

All of these symptoms can be terrifying and debilitating. The good news, however, is that SAD can be treated; and success rates for treatment are relatively high, compared to other psychiatric disorders.

How is SAD treated?

There are two main treatment options for this disorder: psychotherapy provided by a psychologist; or medication, typically prescribed by a psychiatrist. Therapy is usually the first-line treatment, given that medication may carry side-effects or a risk of relapse when the person stops using the tablets. Nonetheless, medication can also be extremely effective in managing SAD symptoms and sometimes therapy and medication are used in conjunction.

There are several different types of psychological therapy available to people with SAD. Arguably one of the most effective and popular techniques is called Cognitive Behavioral Therapy (CBT). This involves learning to identify and challenge problematic thoughts and behavioral patterns that cause and maintain distressing symptoms. Other popular techniques include Mindfulness-Based Psychotherapy and Acceptance and Commitment Therapy (ACT). Both draw on Buddhist principles in bringing about feelings of calm, relaxation and acceptance in order to manage feelings of anxiety. Finally, psychodynamic psychotherapy is an approach in which a strong relationship with the therapist and an understanding of unconscious contributing factors are used together to understand and overcome social anxiety.

In terms of medication, psychiatrists may prescribe anti-depressant medications for SAD, in order to manage symptoms of anxiety and depression. Examples include Selective Serotonin Reuptake Inhibitors (SSRIs), such as Zoloft. Alternatively, tranquilizing medications called Benzodiazepines (e.g. Valium) may be used, although these carry an increased risk of addiction and may lead to one feeling groggy. Another class of medication called beta-blockers may also be prescribed. These work by reducing the impact of adrenaline, meaning that they reduce physiological symptoms such as a rapid heart-rate, sweating and shaking.

I think I may have SAD, what now?

If you think you might qualify for this diagnosis, you can find out more about treatment options by visiting your nearest Psychologist or Psychiatrist. If you don't know of a mental health professional close to you, you may consider consulting with your local GP and requesting a referral. Alternatively, a Google search may bring up services and resources that are available in your area. Finally, keep your eyes on this website, where ongoing articles and resources will keep you informed as to what's happening in the world of SAD.

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