“What is the matter with you!” Judy says to her friend Brittney. “I take you to Red Bank for lunch with some friends from school and you don’t say a word all afternoon. I feel like whenever I go out with you if other people are around I have to be the one to make all of the conversation. “ 
Judy may sound angry, but in fact, she is worried about her friend. They are entering high school and Judy wants to widen her social circle but does not want to leave Brittney behind. But no matter who it is or where they are, Brittney is a silent presence in the room, only talking when someone asks her a direct question.
Everyone has times when they are uncomfortable in a social setting, whether it is walking into a party where most present are strangers, or having to talk to a teacher while the rest of the class is listening in. Anyone can feel butterflies in their stomach in a new situation.
But Social Anxiety Disorder is a more pervasive form of worry, where the fear of scrutiny or judgment by others can leave people paralyzed by anxiety or cause them to avoid situations so often that it disrupts their life. It is the second most commonly diagnosed anxiety disorder and affects over 15 million Americans.
Consider the following examples:
• Jason is a hardworking and successful student, who almost always aces his tests, writes terrific papers, and is a rising star on the track team. But he rarely raises his hand in class, much to the dismay of his teachers, who consider class participation part of the grade. Even the sport he has chosen does not require a lot of interaction with others, and his few close friends are the only ones he is comfortable “being himself” with.
• Marcel is an employee of a local tech company, He loves computer work and shines when it comes to individual projects. But he gets so upset at the thought of talking to others that his career has been affected. At one point, his boss was considering him for a promotion, but when he made Marcel aware of the possibility, Marcel told him that he was not interested. The thought of having to manage others or talk to peer managers felt overwhelming to him.
• Suzie is an eighth grader who is well liked by her classmates. But she suffers every day with worry about what people think of her. A simple conversation in the hallway or locker room can give her physical anxiety symptoms, and often, in the middle of saying something to a friend, she will say to herself “I bet she thinks this is a stupid story.” Her constant worry about being humiliated or embarrassed keeps her up at night and gets in the way of her ability to enjoy everyday situations. Recently, things have gotten so bad that she has begun to avoid social gatherings.
Each of these individuals suffers from Social Anxiety Disorder, formerly called Social Phobia. Children who struggle with Social Anxiety Disorder often fall behind in class because they are afraid to ask questions, and have trouble fitting in conversationally with friends because they are sure that they will be embarrassed.
How do you know whether you or someone you love struggles with this debilitating form of anxiety?
* The person has marked fear or anxiety about social settings where others may be scrutinizing what they say or do. This can include having conversations, meeting new people, performing in front of others (e.g. giving a talk in class). In children, this anxiety is especially severe in front of their peers. Some people are even anxious if others are watching while they eat or drink. Most people with Social Anxiety Disorder do not like to be the center of attention, even on happy occasions such as birthdays or graduations.
* The person is afraid that they will show their anxiety symptoms to others, especially physical symptoms such as blushing, shaking, or not speaking in a clear voice. He or she may also be afraid of being judged in some negative way, and end up humiliated or embarrassed. They may also fear offending others or of being excluded, because of their anxiety.
* The individual experiences intense fear during social situations, or may decide to avoid them altogether. After participating in a social situation, the person may also be hard on himself and find many flaws in how he handled the social interaction. Some people may even fear talking to others on the phone or buying something in the store and interacting with a salesperson.
* The persistent anxiety must go on for at least six months to be diagnosed and can get in the way of social, academic or occupational success. It is sometimes called a silent disorder because children can suffer from it for years before a diagnosis is made. This can happen because they are usually comfortable and interactive at home, and are rarely behavior problems.
* Adults may recognize that the anxiety is out of proportion to the actual situation, but feel powerless to change their behavior. Children may not be old enough to have that insight and may react by school refusal, being mute in social situations, clinging to a parent, refusing to make eye contact, or becoming tearful. Teens may withdraw and become isolated.
What Social Anxiety Disorder Is Not
It is important to differentiate between Social Anxiety Disorder and everyday nervousness. Peoples comfort in social situations can vary based on their personality, their experiences, and their social support system. Some people are just shy or introverted. They may prefer one-on-one interaction or individual activities, but not necessarily be overcome with nervousness when in a social setting. In fact, many introverts have successfully taught themselves to be extroverted when the situation calls for it.
How is Social Anxiety Disorder Treated?
There are many Cognitive-Behavioral approaches to treating Social Anxiety Disorder. Some deal with the physical symptoms that may occur with the worry, while others may focus on the maladaptive thoughts that intrude when the person is in a social situation.
Relaxation techniques can be used to deal with anticipatory anxiety and with many of the physical symptoms that accompany extreme nervousness. Along with these, techniques such as imagery and visualization can also be helpful.
Cognitive restructuring is a range of techniques that can help a person get rid of negative self-talk and eliminate the kind of thinking that leads to anxiety or depression. Black and white thinking (“I never say the right thing”) or generalization (“That happens whenever I am in a group”) are examples of the kind of thinking that are maladaptive.
Acceptance therapy can help people come to terms with anxiety and see it as part of life that needs to be coped with. When a socially anxious person starts to avoid situations, the avoidance can become as much of a problem as the anxiety itself.
If Social Anxiety Disorder is left untreated it can lead to chronic low self-esteem and poor social skills. Risks of depression, drug use to self-medicate for the anxiety, and poor achievement academically or occupationally can also occur.
All of the above techniques can be used with children, teens and adults. It is important for adults to recognize when they are suffering from Social Anxiety disorder, not only to get help for themselves but so that they do not model anxious or avoidant behavior for their children. While there is no quick fix, Social Anxiety Disorder responds well to Cognitive-Behavioral therapy and people can begin to enjoy everyday social situations once they have some basic skills in their anti-anxiety toolkit.