A Christmas Concern – Social Anxiety Disorder
Although the condition of Seasonal Affective Disorder is increasingly well known there is another form of emotional dysfunction which shares the same acronym. This version of SAD is Social Anxiety Disorder which is also very prevalent at this time of year.
The condition is just as the words suggest. Sufferers have a heightened sense of anxiety at the prospect of being faced with meeting and interacting with other people in a social situation. The intensity of feeling can range from a slight sense of unease to an overwhelming panic.
This condition can blight lives at any time but comes very much to the fore around Christmas and the New Year period when there are likely to be many social gatherings. There is considerable pressure on the Social Anxiety Disorder (SAD) sufferer to participate in social events over the holiday period. The expectations of others from partners to family and friends can also add to the level of discomfort endured by those with SAD.
SAD can be exacerbated by a number of factors. If the social gathering involves strangers the fear factor is likely to rise. If the gathering is in a new place, if the structure is unknown and if there are concerns around judgement the anxiety level may increase remorselessly.
As a result sufferers introduce avoidant behaviours reflected in the myriad of excuses which are used to keep the dreaded social event at bay. Illness and tiredness are the most obvious examples but there are other increasingly desperate reasons given ranging from the legendary “I have nothing suitable to wear” to “I have to stay behind to look after child, dog or guinea pig”. Sometimes sheer desperation will result an angry outburst. “I just don’t like them so why don’t you go on your own” is a refrain which when repeated too often can explain the increase in couple counselling referrals in January!
For many SAD sufferers home can be a safe place if not invaded by too many strangers.But for the most acute SAD sufferer, home can also become a prison. If SAD takes too firm a grip the door out from home may shut so firmly that it becomes difficult to prise open even when the symptoms diminish.
Just as with Seasonal Affective Disorder this second form of SAD is very real to those who are affected.Yet it is a phenomena which others particularly those who are the outgoing, extraverts in life will struggle to understand. As a result SAD can create tension and difficulties in relationships which just serves to intensify the discomfort of those affected.
For example the fact that for most this SAD phenomena focuses on social life rather than work can seem puzzling.This can exacerbate misunderstandings if one partner cannot understand the nature of the challenges faced by the SAD sufferer. The individual who quails at the prospect of going to the neighbours for a drink on New Year’s Eve can still look forward in the New Year to making a presentation to a large number of colleagues at a business convention. Just how is that possible? This may in turn give rise to accusations that one is being unsociable, awkward or even selfish. “You know I want to go; why can’t you just do this for me?” may be a refrain from the frustrated partner.
Although the causes of SAD are unique to each individual there are some common explanations. The puzzlement over that work/social split is relatively easy to resolve. Within the work role there is likely to be a clear identity. The work role is acknowledged and accepted. The behaviours to be exhibited are understood and the language to be used is shared. There is opportunity for preparation and rehearsal. There is the known and control.
Within the fluid social gathering things are very different particularly for those who prefer a controlled environment. Those with a more fragile sense of self may experience uncertainty. The internal challenges may include a lingering fear of being ‘found out’. A self-perceived shallowness exists to be exposed and there is something scary around feelings of not belonging, of being ridiculed and excluded.
Away from those deep rooted internal insecurities there may also be more straightforward issues of skills and competencies. Those brought up in larger family units with a constant interplay of different personalities may be more at ease in gatherings as social skills are developed at an early age.
Conversely those who grew up in a quiet household perhaps even as an only child may not have experienced the easy flow of language which others use to ease into social groupings. It is likely that this chid will not have the same social skills or interactive competence levels as their more gregarious counterpart. The quiet child who is then teased, bullied or ridiculed at an early age perhaps at school is likely to carry that sense of insecurity into adulthood. That may inhibit spontaneous verbal engagement which leaves the individual on the outside looking in with an increasing sense of concern and anxiety
Perhaps this view of those with SAD explains the behaviour of those colleagues who will readily contribute in the monthly meeting, engage in work reviews and climb the career ladder whilst being simultaneously reluctant to join others for a drink after work or disconcerted by the prospect of the impending Christmas social.
So what is the cure for SAD? Does there even need to be one? Is this an actual condition or just an aspect of personality which is unique to each individual? Perhaps the answer lies in the degree of distress. If the result of SAD is an adverse impact on relationships, a limiting factor in the sheer enjoyment of life and a restriction on the development of friendship networks then it may be helpful to at least try to ease the influence of the SAD condition.
And how to do this? CBT and related behavioural techniques can be helpful. If individuals are able to find sufficient motivation to break through the fear barrier and participate, the result is usually a positive one. From my experience it is commonplace for clients to report on an event saying “I was not looking forward to it but afterwards I was glad I went”. CBT or a behavioural focussed set of strategies can sometimes help client to endure challenging social situations.
Another complementary approach is for the individual wrestling with SAD to develop an enhanced self-awareness of just why the anxiety has taken hold. If a deeper understanding can be achieved this may help to normalise the condition. This may lessen the stigma and that accompanying sense of guilt which if left unchecked can deepen the internal malaise.
Support from others can also be extremely beneficial. If partners and friend can demonstrate understanding and appreciation of the condition, that is likely to be of very real help to the individual concerned. Sometimes however that assistance is not always be forthcoming and it may be then that work with a counsellor or therapist may be particularly helpful.
In Chichester and West Sussex where my practice is based many local counsellors will have experience of working with clients presenting with SAD related issues including both Social Anxiety Disorder and Seasonal Affective Disorder.
Counselling work does not have to be focussed on completely removing SAD. That may not be a realistic aim. Instead an acceptable outcome may be to just contain the anxiety to the extent that the sufferer is able to experiment, to try some initial engagements and to venture out into the social world. If the individual can be helped by friends or partners to tolerate a degree of uncomfortableness the eventual rewards may be considerable
The festive period can be a worrying time for Social Anxiety Disorder sufferers. Yet for those who do want to tackle their anxiety perhaps this time can also present a real opportunity for change. It may be the occasion to take a deep breath, find some professional support and look to walk out through the door. The outcome may be life enhancing and eventually life changing!