Understanding the Unique Barriers for People with Social Anxiety Disorder

Today we begin a series from the Anxiety and Depression Association of America, a national organization of researchers and clinicians focusing on science, treatment, prevention, and cure of these disorders. In the coming weeks we will share posts from members of this organization shedding light on the disorder, by creating awareness about symptoms, treatment and support.

Mark Pollack, M.D.
Grainger Professor and Chairman, Department of Psychiatry,Rush University Medical Center, and President, Anxiety and Depression Association of America

People with social anxiety disorder (SAD) face unique challenges when it comes to accessing mental health care, and many struggle for years before seeking any type of treatment. For family members supporting an individual with SAD, gaining a deeper understanding of the disorder can help you guide your loved one toward appropriate care and an improved quality of life.

About social anxiety disorder
Social anxiety disorder(SAD), also called social phobia, causes extreme self-consciousness in everyday social situations. (http://www.adaa.org/understanding-anxiety/social-anxiety-disorder) People with SAD have a strong fear of embarrassing themselves or being judged by others. It interferes with an individual’s ability to form relationships, succeed at school or work, and complete everyday tasks that involve interacting with others in person or even on the phone. SAD can have a significant impact on nearly every aspect of a person’s life.

Three barriers to care
People with SAD face internal and external barriers in accessing mental health care. The primary barrier results from the disorder itself. Like many people with mental health problems, individuals with SAD tend to experience a sense of personal failing that can interfere with their willingness to seek treatment. This is magnified in SAD because, by its definition, people have more anxiety in social or interactive settings. If a person is already feeling anxious or stigmatized about seeking mental health treatment, generally, heightened concerns about doing or saying something embarrassing will make the barriers to care even greater.

The second barrier is the lack of awareness of the disorder among people who experience SAD. Further complicating people’s path to treatment is the fact that many sufferers tend to feel that social discomfort is an inherent part of who they are, rather than a disorder, especially if they have felt this way since a young age. This can further inhibit people with SAD from seeking care because it makes it hard for them to present the difficulties they’re having.

Finally, the lack of awareness of the disorder among medical providers and the general public reduces the likelihood of a potentially supportive environment for recognizing and addressing the disorder. Although there is increased understanding of SAD today, much of the general public and even some in the medical profession still fail to recognize social phobia as a diagnosable disorder that requires treatment. In part, this stems from the fact that almost everyone has experienced some level of anxiety in a social situation. Many people get nervous speaking in front of a crowd, for example.

However, for most of us, these feelings are transient and we are able to move ahead, despite our nervousness; but for people with SAD, something as seemingly insignificant as attending a staff meeting can cause paralyzing anxiety for weeks. And while most of us experience less anxiety with every social interaction we attend, people with SAD never acclimate to these kinds of social situations, and the anxiety doesn’t lessen with familiarity. Each time they encounter such a situation, it causes marked distress and impairment.

This is not the way it has to be
The number one lesson for anyone who suffers extreme self-consciousness is this is not the way it has to be. This is a condition for which effective treatment is available and seeking treatment can have a positive life-altering effect. And if you are a family member supporting a loved one with social phobia, if you see this kind of anxiety making a difference in their life—interfering with their ability to socialize, get the kind of job they want and have a fulfilling life—encourage them to get treatment and support their need to seek care. It will make a huge difference in their life.

Your Turn

  • What might be done to alleviate the internal barriers to seeking treatment?
  • What role might education—of medical professionals and of the general public—take in addressing these barriers?
  • What should society’s policy be about providing help to people like those with social phobia who are not seeking treatment, especially if they are not harming anyone?

[poll id=”23″]

Facebook Comments

12 comments
steph A
steph A

Thank you. My oldest went through this andalthough is is doing better most days it can sometimes be a struggle. Its good to read something on it. I don't think there is enough public info published on this for other to truly understand .

ergonomic mats
ergonomic mats

I am finally getting some help and support. It has been a difficult and hard road at times, as it is for most people, but like you, should I have been able to understand or have someone understand and intervene then who knows.

kimgallen
kimgallen

In terms of the internal barriers patients face, I think that we should do whatever we can to help others and part of it is validating how people feel. Certainly this includes listening to those who suffer with social phobia. We need to learn to be empathic and compassionate in our responses. There are days when people may not be able to face the very things we feel would help. If we are not the patient however, it is very hard for us to grasp how this must feel and I think listening plays a key role. The education surrounding this for all of us should include the fact that the condition exists and social phobia is a real thing. In terms of how to educate all of us on how to best approach this, I hope that both patients and families can learn from peers who have, or have had social phobia. Perhaps there are ways that are easier to connect at varying times; for example, maybe mobile devices, laptops, desktops, or whatever allows them to connect, would be helpful at those particular points, versus holding face-to-face dialogues. If that is not helpful, perhaps written words would help. The point is, there are times where people may not be able to face others and I think we need to help people to set their own goals on what is tolerable to them and work from that point, forward. I certainly do not feel we should do nothing, purely because we do not know what to do. We all need education to help reduce the stigma and all people deserve validation for what they truly experience. 

StephenBonin
StephenBonin

As was emphasized in this year's D.C. Mental Health Advocacy training, we need to speak up! People who have struggled with mental illness through many periods of wellness and many periods of chaos,  have the capacity to help. We have the competence to initiate dialogue with leaders--governmental, medical, et. al. Moreover, we have ever-growing knowledge, conviction, and passion to persist, which involves patience! Per question #3, to leave a person with social phobia alone is unloving. We are here on this earth--for a time period not known--to serve each other. Resourcefulness is of the essence; communication methods including writing and sending via snail mail or handing directly to someone, texting, emailing, calling, twittering. . . Messages of encouragement and constructive criticiism are important. Finally, this notion of "not harming someone is illogical. Loved ones of the person with s.p. who is isolating feel frustrated, afraid, confused. . .Home health providers come to mind as a force to collaborate with the loved ones of the person suffering from s.p.

LindaFerguson
LindaFerguson

i have suffered for many years , and have welcomed the help i have recieved from my spesalist s dr ect but some times i have been so down famall y and friends just dont undestand you and you feel so helpless .

StephenBonin
StephenBonin

Thank you for sharing. I like your photo; it impels me to get my photo in this space asap. Please know that you are in a good place knowing about helplessness. Now, with knowledge comes power! Help yourself by spending time exercising indoors, as I did this morning as I feel uncomfortable exercising in public. The experience of exercise will do wonders for your brain. You will be able to think of the next step in conquering s.p. 

Kurt Wilkens
Kurt Wilkens

Great article,  Dr. Pollack!  I do understand both depression and anxiety disorder having suffered from major depressive disorder and obsessive compulsive disorder.  Fortunate to use 3 simple actions to gain wellness.  Affirmations (positive statements that effect neural plasticity and affirmations to my understanding promote oxytocin production), See Dr. Jeffrey Schwartz, Brainlock regarding neural plasticity,  Good nutrition see Dr. Mark Hyman, The BloodSugarSolution, The UltraMindSolution, The Omega Diet by Artemis Siimopoulos MD, NIH Chair, Aerobics see Dr. Kenneth Cooper his book Aerobics.  Yes I used these three concepts and got wellness (No meds and No symptoms) within 6-8 months after starting to use them in March 2013.  Also gained wellness from prediabetes, high cholesterol, and sleep apnea.  Also lost over  70 pounds, do need to lose more.  Have a great week, Kurt E. Wilkens

StephenBonin
StephenBonin

Kurt, thank you for posting wellness methods that span the spectrum! I am working that way myself

When I responded to Linda Ferguson, I thought, "Stephen, you could talk about the gamut of wellness approaches; just cite one. " So I did. Again, Kurt, thank you offering a realistic encouragement. Linda, hope you're learning from Kurt!

Incredulous
Incredulous

My disappointment at the number of votes that the person responsible for recognizing the problem is "the person himself or herself" is not without irony because that is how I got better....and recognizing that I am not necessarily inherently that way only took me 50 years. If someone had intervened, I might have gotten better sooner.

T1CAN
T1CAN

@Incredulous I find myself in total agreement at 58 I am finally getting some help and support. It has been a difficult and hard road at times, as it is for most people, but like you, should I have been able to understand or have someone understand and intervene then who knows. It is what it is and much has been learned and 'might have beens' are of little value, but understanding the problem may help others find support and therefore a more tolerable path. Well trained doctors (GPs') in all aspects of mental health are essential and will be more so as time goes on.

StephenBonin
StephenBonin

T1CAN, I glad that for the sake of encouraging Incredulous, you and I are on the same wave. Thank you for writing!

StephenBonin
StephenBonin

Incredulous, like you I felt shocked about the number of votes "person himself or herself" received. As consolation for both of us, a quotation from my friend whose one of several recovery philosophies is: "Resentment is something we in recovery cannot affort." Adding to that, please be encouraged that none of us escapes unscarred. A spiritual battle is constantly raging.

Moreover, none of us--every once in a while at least--reviews the tape in the brain and remarks to self: "Too much bad in my life. Not fair."

Thank you for sharing. If you want to talk, my number is 903-467-4408.