'Tis the season to be jolly, and for most people, this means attending an array of gatherings with family, friends and work colleagues. But while many of us look forward to such festivities, it is a different story for people with social anxiety disorder.
"Social anxiety disorder is characterized by the presence of fear or anxiety about social or performance situations in which the person is exposed to possible scrutiny by others," Dr. Kalina Michalska, a research fellow in the Section on Developmental and Affective Neuroscience at the National Institute of Mental Health (NIMH), told Medical News Today.
"The individual overestimates their likelihood of being rejected and frequently fears that he or she will act in a way that will be embarrassing and humiliating," she added.
Of course, all of us have experienced shyness or nervousness in certain situations - when having to make a presentation to colleagues at work, for example, or when meeting people for the first time.
However, people with social anxiety disorder - also referred to as social phobia - worry so much about communal situations that the condition can become disabling, severely affecting their work, social life and relationships.
The symptoms and causes of social anxiety
Social anxiety disorder affects more than 15 million adults in the US, and onset is most common during early adolescence.
Symptoms of the condition include anxiousness around other people, the inability to talk to others, self-consciousness, fear that others will judge them, and severe anxiousness days or weeks prior to a social event.
"If you experience social anxiety, you might also avoid situations that could trigger your anxiety, such as meeting up with friends, going out shopping or even answering the phone," he added.
The severity of social anxiety disorder varies; some people with the condition may fear specific social situations, such as speaking or eating in public, while others may have a phobia of all social situations, even experiencing intense anxiety around close family members.
If an individual experiences symptoms of social anxiety for 6 months or more, this usually leads to a diagnosis of social anxiety disorder. But according to the Anxiety and Depression Association of America (ADAA), around 36% of individuals with social anxiety disorder report having symptoms for 10 years or more before seeking help.
"Many people wait too long before seeing their general practitioner, discounting social anxiety as just day-to-day stress," Challis noted. "But it's not the same as being 'a bit shy,' and it's important to seek help as soon as possible if you feel like your anxiety is interfering with your ability to do the things you normally would."
The exact causes of the disorder are unclear, although past research has suggested that people with a family history of social anxiety may be at higher risk. It is unknown whether this is down to genetics, however, or a result of learned behavior.
Other studies have indicated the disorder may be triggered by overactivity in a brain structure called the amygdala, which plays a role in regulating fear response.
Social anxiety often 'overlooked' as a mental illness
But despite around 7% of the US population living with social anxiety disorder, many health care professionals believe the condition is often surpassed as a mental health problem.
"Socially anxious people are often discounted as merely being shy or introverted. Other times, their behavior can be misinterpreted as aloof or uninterested," Dr. Michalska told MNT, adding:
"Because most of us feel shy or even moderately socially anxious in certain situations, social anxiety can sometimes be overlooked as a mental illness.
Even though it is commonly perceived as less severe than other forms of psychopathology, such as schizophrenia or psychosis, research shows that it is associated with a variety of serious adverse outcomes, including development of other psychiatric disorders such as major depression and suicide."
Social anxiety disorder has also been linked to increased risk of substance abuse - particularly excessive alcohol consumption. According to the ADAA, around 20% of people with social anxiety disorder are alcohol dependent, using alcohol as a tool to cope with their symptoms and relax in social situations.
Dr. Michalska told us there needs to be increased awareness surrounding the seriousness of social anxiety disorder.
"Ironically," she said, "people with social anxiety are less likely to speak about their anxieties in public, but giving them more of a public voice - potentially in writing - will help others understand and empathize with how debilitating this illness can be."
The social challenges of the festive season
Although people with social anxiety disorder can find social situations difficult at any time of year, the festive season is particularly challenging.
"People with social anxiety disorder have difficulty in any large groups, which tend to be a staple of the holiday season," explained Dr. Michalska. "It is also a time when people are expected to be with family and friends."
She added that people with social anxiety disorder tend to avoid socializing in large groups during the festive period out of fear that they will humiliate themselves or be judged by others, but that bypassing such situations only fuels their anxiety further.
A good example of this is given in an article from BBC News last December, in which a 38-year-old woman with social anxiety disorder said: "Most years, I buy a ticket for the work [party]. I actually buy the ticket, knowing full well I won't go. I buy [it] to make sure people don't think I'm tight-fisted, or that I hate Christmas, or that I don't like their company."
Others with social anxiety disorder may even avoid spending the holidays with their own families. "People can suffer with social anxiety in the family unit," Dr. Gillian Butler, a consultant clinical psychologist in the UK and author of the book Overcoming Social Anxiety and Shyness, told BBC News. "You may, as an older person, feel a real fool talking to the children. It can bring back memories of adolescence and embarrassing times in the past."
Tips to reduce social anxiety during the holiday season
There are, however, a number of strategies that may help people with social anxiety disorder better cope with social challenges during the holiday season.
Dr. Michalska told MNT that anticipating what social events may arise that trigger social anxiety and planning how to deal with such situations in advance could reduce anxiousness.
"For instance," she added, "at an office holiday party, a socially anxious person might consider inviting a friend for support or letting one trusted person know how difficult it is to interact in social situations and asking them for emotional support. That person might then help buffer interactions with a particularly difficult individual. Most people are honored to be a source of comfort and feel affinity to those they help out."
Challis said it is also wise to talk about any anxiousness with friends or family:
"It's key not to take too much on and to be honest with people close to you if you are finding it difficult to cope. Keeping anxiety bottled up can make things worse, so find someone you can confide in and let them know that you need some support."
Dr. Michalska told us that people with social anxiety should try to focus on external areas of a social event, rather than how they feel about it personally. For example, she said that if an event is being hosted at a friend's home, they could ask whether they can do anything to help - such as prepare a dessert.
"If they can explain that having something to do is more comfortable for them, most people will be more than happy to accommodate - and have an extra pair of hands to help!" she said. "The key is for the person to not stay at home, even if they are anxious. Avoidance of social situations only leads to more anxiety."
Challis said it is also important that people with social anxiety are healthy over the holiday season. "Festive fare is notoriously high in sugar, fat, caffeine and alcohol, all of which can impact on energy and anxiety levels," he added. "Even making small changes to your diet, such as having a breakfast of porridge, which releases energy more slowly, can help keep anxiety levels in check."
How friends and family can help
Unsurprisingly, many people with social anxiety disorder will not talk about their worries with others out of fear that they will provoke a negative reaction.
As such, it is important that friends and family of those with the condition recognize the symptoms and encourage them to seek help. "One important step is to learn about what social anxiety disorder is and the strategies that are helpful in the long run, including seeking out treatment," said Dr. Michalska.
Treatment for the condition may involve cognitive behavioral therapy (CBT), which teaches a person how to think, behave and react in various social situations in order to reduce anxiety. Medications such as anti-anxiety drugs and antidepressants may also be used to treat social anxiety disorder.
One of the most important things a friend or family member can do to help a person with social anxiety is offer support. Challis told MNT that you do not need to be a mental health expert to do this:
"Simply asking them how they're feeling and listening non-judgementally can make a big difference, as does reassuring them that it will pass and that you're there for them. If someone is obviously very anxious in a situation, it can help to find a quiet place for them to be until their anxiety eases.
Being supportive in the long term can be a question of finding the right balance. You need to accept the person as they are and not push them into situations that are beyond them. Yet, at the same time, it can be helpful to encourage them to overcome small challenges. In this way, they can build up their self-confidence and feel in control."
Although social anxiety disorder can be an isolating illness, Louisa Hatton, of Social Anxiety UK (SAUK), told BBC News it is important that people with the condition remember they are "absolutely not alone."
SAUK run a social anxiety forum, in which individuals with social phobia can openly talk to other people with the condition and get information and advice. Social Anxiety Support and anxietytribe.com also run similar forums.
Our Knowledge Center article provides further information about social anxiety disorder.