Many people are a little bit shy, but those with social anxiety disorder (also called social phobia) can become overwhelmed with anxiety in simple social situations.
Peter (not his real name) was a smart, savvy businessman with a PhD and a bright future. He had quickly climbed the corporate ladder, but when he was offered another promotion -- one that would put him at the top of his division -- he turned it down, jeopardizing his career. Why? The thought of being the center of attention in a major meeting, required in the new position, threw Peter into a blind, desperate panic, complete with physical symptoms like flushing, sweating, and heart palpitations.
Normal life includes some anxiety and fear. In a stressful situation, your brain triggers a flood of chemicals into the bloodstream. Your heart beats faster; your breath becomes shallow and rapid; muscles tense; your mind goes on full alert. It's all part of the human's innate reaction to a threat: You're ready to flee or fight.
Sometimes anxiety and fear linger on and on. The feelings can be overwhelming. When they interfere with normal activities, there's a problem. Doctors call this kind of problem...
Peter had what psychiatrists call circumscribed social anxiety disorder (SAD) -- an intense, irrational, and persistent fear of being scrutinized or negatively evaluated by other people. People with SAD, also known as social phobia, tend to be sensitive to criticism and rejection, have difficulty asserting themselves, and suffer from low self-esteem. Social anxiety disorder can be "circumscribed," like Peter's (he only feared being scrutinized at work), or "generalized" -- a much more debilitating condition that can make everything from walking to a table at a restaurant to attending your best friend's wedding a cause for sheer terror.
In February, two antidepressant drugs, Effexor and Zoloft, were added to a list of about a dozen approved medications for social anxiety disorder, sparking renewed interest in this little-known condition. Is social anxiety disorder just another name for being really shy?
Putting the Brakes on Life
Not at all, say many leading psychiatrists. "Many people are a little bit shy. If you're shy, you might be somewhat uncomfortable in situations such as going to a party where you don't know anyone, but you do it. You give yourself a push, you go to the party, after a while you relax and talk to people," says Rudolf Hoehn-Saric, MD, who heads the Anxiety Disorders Clinic at Johns Hopkins University School of Medicine. "The social phobic person, at the prospect of the same party, would be overwhelmed by such anxiety that [he or she] would have a physical reaction -- perhaps nausea, sweating, heart racing, dizziness -- and would avoid it if at all possible. It's a matter of degree."