Social anxiety disorder: Panicked about meeting new people

Dear Reader,

You're certainly not alone, as nearly seven percent of Americans have some form of social anxiety disorder, also known as a social phobia. While everyone experiences nervousness or fear in social situations to a certain extent, those with social anxiety disorder are debilitated by it. They may have a constant, intense, and chronic fear of being watched and judged by others or be terribly afraid of being embarrassed by their own behavior. As you have described, this can prevent people with social anxiety disorder from doing everyday activities, such as going to school or work or socializing with others. 

Social anxiety can come from a number of different places. Researchers are looking into how fear and anxiety work in the brain to understand what may contribute to social anxiety. For some people, the root cause may be a lack of social skills that makes it difficult for them to interpret the social behaviors of others. For others, it may be rooted in fears of rejection or feeling discouraged after a social interaction. Some of the symptoms associated with social anxiety disorder include: 

• Blushing, sweating, trembling
• Feeling nauseous
• Having rigid body posture, difficulty making eye contact
• Being scared to be around other people, especially people they don't know
• Feeling self-conscious in front of other people, feeling embarrassed or awkward
• Being afraid that other people will judge them
• Staying away from places with other people

While everyone may feel some of these feelings at various points in their life, people with social anxiety find that it affects their ability to do everyday tasks. To discover the root of your anxieties, you may also want to discuss your feelings and behaviors with a mental health professional. There are many different types of psychotherapy for anxiety disorders that mental health professionals use, the most common being cognitive behavioral therapy (CBT), but there are a whole host of other approaches. Part of establishing care with a new therapist involves developing a plan that meets your needs and helps you to find ways of managing your fears on a day-to-day basis. You also mentioned that you're potentially interested in anxiety medications. Treatment for social anxiety disorder may involve medications to alleviate symptoms, though these can only be prescribed by a physician or psychiatrist (and not by a counselor or therapist).

When it comes to your parents finding out, it's understandable that you're worried about how they might react to knowing what's been going on for you. Being honest with your parents might help you to feel more at ease; it's possible that they've noticed your behavior and wondered about it or even struggled with similar feelings themselves. There's even some evidence that anxiety disorders may be genetic or run in families — perhaps due to environmental factors and shared interpersonal behaviors. Or you may decide that telling your family and risking their negative reactions is not in your best interest right now. In addition to helping you navigate your social anxiety, a mental health professional could help you decide whether you want to discuss your social anxiety with your family, and if so, strategies for doing this that will be comfortable for you.

Whatever you decide, you can rest assured that any medical provider or mental health professional must adhere to strict standards of confidentiality, meaning that they can’t disclose what you share with them except under very specific and narrow circumstances (usually in the case of immediate danger to yourself or others). You can also work with the reception and billing staff to ensure that you're only contacted in ways that protect your confidentiality (for example, by only calling you on your personal cell phone and not at your parents’ home phone, or by only mailing information to your school mailbox rather than your parents’ address). 

That being said, you mentioned that you're currently on your parents' health insurance plan. If you use this insurance to help cover the cost of a mental health appointment or prescriptions, your parents may find out that you booked an appointment or filled an order at the pharmacy, even if they don’t know what the appointment is about or which prescription it was. This is because insurance offices share a form called the explanation of benefits (EOB) with the plan policyholders (your parents, in your case), which describes the type of care received and who provided that care. The EOB doesn’t disclose the details of the appointment, meaning your parents wouldn’t know the details of your anxiety disorder and treatment plan, but you may want to reflect on whether you are okay with your parents knowing you sought care in general. If you decide that using your parents’ insurance to cover mental health treatment is too risky given the EOB, there are other options available to you, including low-cost options since you indicated that you're currently unemployed. These can include seeking care at your school’s counseling department, mental health clinics funded by teaching hospitals, clinics staffed by graduate students in psychology and social work training programs, and federally funded health centers. Some therapists also accept payments on a sliding scale, meaning that their fees are adjusted based on what you can afford. Check out Finding low-cost counseling for more information. Additionally, some pharmaceutical companies have programs to help low-income patients afford their medications. 

It may not feel like it, but you're by no means the only person who struggles with these issues. While it may feel embarrassing to ask for help, health care and school personnel are trained to help you find the support and resources you need so that you can start feeling better. It takes courage to acknowledge that your anxiety is getting in your way and seek the help you need. You deserve to get assistance in a way that feels safe and comfortable to you, and that allows you to get back to living a full life.

Best to you,