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Just Shy or Social Anxiety Disorder

Is social anxiety disorder just another name for being really shy?

More Common Than You Think

How common is social anxiety disorder? Figures vary, but according to the most recent studies, about 8% of the population experiences social phobia in a given year -- making it the third most common psychiatric disorder, trailing only major depression and substance abuse. It's also widely underdiagnosed, says Saeed. "In one study, less than 1% of the patients with SAD were diagnosed and treated."

Part of the problem: SAD often accompanies major depression, in a which-came-first cocktail of mental health conditions, so psychiatrists may diagnose and treat the depression without taking note of the social anxiety disorder.

When it is diagnosed and treated, though, people with social anxiety disorder can look forward to major improvements in their lives. Saeed's patient, Peter, has seen his career take off after treatment for SAD. Hoehn-Saric describes a high school student whose social phobias were so great that he couldn't even enter the cafeteria at school; after struggling at several colleges, with treatment he found a small New England institution that understood his needs and is excelling academically and socially.

Most experts advocate a combined approach, using both approved medications and what's called cognitive behavioral therapy, to treat SAD. "Medication does decrease the general anxiety and also the depression that is frequently present in people who don't function so well socially," says Hoehn-Saric. "It can combat the surge of anxiety when you go into a social situation, and if you can diminish the initial responses -- chin quivering, hands shaking and sweating, face flushing -- if you take away those triggers, the person doesn't get into a vicious cycle of embarrassment."

But that's usually not enough. Cognitive behavioral therapy for social anxiety disorder usually involves "exposure" -- confronting the patient's fears. "First, people imagine the situation, and look at it as an outsider. How realistic are their fears? They're taught to reorganize their thinking, and then they expose themselves to social situations to decrease their anxiety," says Hoehn-Saric.

Group therapy often works particularly well for social anxiety disorder, since people with SAD are usually uncomfortable in groups and being exposed to other people. "They see that other people are like them, and they're doing better now, so there's some hope for them too. And as they start to feel more comfortable in a therapeutic group setting, they can transfer that to other social situations."

It's a long process. Don't expect social anxiety disorder to disappear after eight weeks of treatment, says Saeed -- closer to eight months or a year may be more realistic. "One of the difficulties with SAD is that since people have had it for so long, they've had to start avoiding things," he says. "Even when the symptoms are under control, unless you go out and engage in the activities you've been fearing, you won't know what your response is. So ultimately you have to face your fears."

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