Fear of being judged by others? Here’s how to fight the demons in your head
Ever broken into cold sweat before a making a presentation? Or dry retched in a toilet cubicle before a job interview? Or worse, lost sleep worrying whether your last status update or ‘selfie from paradise’ will be liked by a respectable few or dismissed as yesterday’s news?
If you felt anxious about being judged harshly more than a couple of times, you are likely to have undiagnosed social anxiety disorder (SAD), a medical term for an overwhelming fear of being scrutinised by others. For one in 20 people, the anxiety is so intense that they would rather avoid a stressful situation than risk embarrassing themselves.
In some, the apprehension of being judged and laughed at or dismissed is great enough to cause symptoms of palpitation, breathlessness, sweating, stomach cramps and weakening legs. Acute social discomfort makes them forget things, stammer, avoid eye contact and fumble, when it matters the most. This adds to their anxiety, which soon grows to overwhelm their personal, social and professional life.
Social anxiety usually begins in adolescence, with the first signs appearing around 13 years, though they sometimes show early as ages 3 and 4. In very young children, the symptoms swing wildly between clinging behaviour to tantrums and stopping to talk altogether among people outside the immediate family. In adolescents and teens, signs include avoiding eye contact, mumbling, shunning school activities and social withdrawal. The condition is seldom diagnosed because children quickly teach themselves to sidestep attention and avoid trouble and group activities.
Anxious, not shy
More often than not, it gets dismissed as shyness, which is more about people taking longer to open up than about being terrified of rejection. Since adolescence and teenage years are also the time when most young people withdraw into a shell that excludes adult intrusion, social anxiety also tends to be confused as teenage angst.
Studies show that social anxiety is independent of shyness. A US survey of more than 10,000 13-18 year olds shows that while half of the teens identified surveyed themselves as shy, only 12% of the shy youth met the criterion for social phobia. And amongst those who did not think of themselves as shy, 5% had social anxiety, which shows shyness and social phobia are not directly related.
It causes agonising mental pressure that leads to children with social anxiety more likely than their peers to be depressed by age 15. They also have higher chances of abusing tobacco, alcohol and drugs by age 17. Psychologists say that increasing online scrutiny with constant notification alerts from the ever-expanding and intrusive world make the social pressure real-time, making teenagers constantly struggling to be socially accepted or die – strictly metaphorically -- trying.
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The number of people in India seeking help of social anxiety has doubled over the past decade, say psychiatrists, with young people in their 20s and early-30s accounting for almost all of the cases. The reason for people seeking treatment in India is almost always professional because there are very few jobs for professionals now that do not require making a presentation or speaking to strangers.
Happily, social phobia is a physiological condition clearly linked to an imbalance in serotonin, a chemical in the brain that helps regulate mood. Low levels of this chemical cause depression. Since SAD has a physical cause, it can be very easily treated with antidepressant medicines and/or counselling, including cognitive-behavioural therapy.
The medicines prescribed to treat social anxiety in adults include the widely-used anti-depressants SRRIs (selective serotonin reuptake inhibitors), which is used increase serotonin activity in the brain, and norepinephrine.
For those who want to work on the problem on their own, there’s always the relaxation response technique, developed in the 1970s at Harvard Medical School by cardiologist Dr Herbert Benson. To counter the stress response caused by the anticipation of an anxious situation, he proposed achieving a state of profound rest through progressive muscle relaxation, meditation and exercises such as yoga. In simple words, you train your body to calm down physically by evoking a restful situation, such as thinking of things that make you happy or simply imagining the people you’re petrified of speaking before dressed in clown suits several sizes too large or small.
Much like for a headache, the cure for 90% of the cases is as simple as having a pill a day. Walking away from social anxiety may seem like an easier option, but overcoming has bigger payoffs, emotionally, socially and professionally.
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