Coping With Social Anxiety Stigma

g-stockstudio/istock

Social anxiety stigma is no different than the stigma surrounding any other mental health disorder. While the stigma may take a slightly different form than, say, that against schizophrenia or borderline personality disorder (BPD), the outcome is the same—people are made to feel shame about a problem over which they have no control.

In the unfortunate case of social anxiety disorder (SAD), the very thing that people fear the most—negative evaluation by others—becomes their reality.

It's not enough that their own minds cause them to worry endlessly about what others think, but now they have confirmation that people do in fact have negative opinions about them.

Even though we live in an age when there are effective treatments for many mental illnesses, social anxiety included, people still go months, years, decades, and even lifetimes without ever receiving treatment. It's an unfortunate situation that will only be turned around by bringing mental health into the forefront of medical care and public perception.

What Is Stigma?

Let's back up a bit. What exactly is stigma? In the simplest sense, stigma refers to devaluing a person based on some characteristic of that person. We typically might think of stigma as related to being of a certain ethnic background or coming from a certain economic class. 

In the case of mental illness, stigma may be present in the general public but also among healthcare professionals.

In this way, if you think of a person with social anxiety disorder, they may face criticism from friends and family members for not measuring up socially, and may face a doctor who misses symptoms or brushes them off.

Stigma can also be thought of as related to the person with the illness or the act of seeking treatment.

A person with SAD may be stigmatized for having symptoms of social anxiety, but also may experience stigma for seeking help for a problem that some may feel is "all in their head" or that everyone deals with.

Social Anxiety Stigma

We've already touched on this a bit, but social anxiety stigma tends to center around the idea that social anxiety is normal and avoidable. It's just shyness after all, right? You may face patronizing attitudes from friends or family who don't believe anxiety is a real problem and that you should be able to "get over it" on your own.

Among children and teenagers, there may even be bullying or cruelty as part of stigma aimed at those with social anxiety. Rather than feeling sympathetic, some may choose to put down kids or teens they view as weak or socially awkward.

What Are the Effects of Stigma?

Unfortunately, the effects of stigma related to social anxiety disorder are numerous. Below is a list of some of the most pressing issues that stigma brings to the forefront.

Problems with self-esteem. People who live with stigma about social anxiety are more likely to experience low self-esteem, self-efficacy, and poorer quality of life, according to a 2015 study in the American Journal of Orthopsychiatry.

Non-evidenced-based treatments. When a disorder is poorly diagnosed or undiagnosed, this can lead a person to seek alternative treatments that may not have scientific backing.

Failure to seek treatment. Most people with social anxiety disorder are afraid to admit they have a problem, and stigma only makes this worse. You may fear effects on your job and relationships as a result of admitting that you have a problem.

Misdiagnosis. Stigma may lead doctors to misdiagnose SAD, particularly if they fail to take symptoms of the disorder seriously, or fail to ask about them at all (after all, what socially anxious patient is likely to bring up the problem on their own)?

Both the public and health professionals may fail to recognize social anxiety as a disorder or believe that it is just normal shyness.

Mismanagement. Stigma may cause a doctor not to fully investigate symptoms or lead to a poor understanding of appropriate treatments. 

Creates barriers to care. External stigma may be internalized in people with social anxiety, making them even less likely to seek treatment. If you start to feel bad about the way you are feeling, you will be less apt to admit you have a problem and try to get help for it.

Creates an unsupportive environment. Mental health issues are best treated within a supportive atmosphere. Stigma creates an environment lacking support, such that it is difficult to reach out for help. If you have a mental health issue, support is key, especially in the early stages. Imagine, as a person with SAD, calling up your doctor and being spoken to in a critical way by the receptionist? 

Suicidal ideation. In a worst-case scenario, a person may feel unable to get help due to stigma and have thoughts of suicide, particularly if SAD is combined with another mental health issue such as depression or bipolar disorder.

Source of Stigma

We can begin to better understand how to counteract stigma by learning what causes it. In general, the main cause of stigma is lack of understanding. This lack of understanding may be because a person has never experienced mental illness themselves or because they are not aware of the types of mental disorders that exist (or that social anxiety disorder is one of them).

How to Reduce Stigma

Now, we get to the most important message—how can we reduce stigma related to social anxiety disorder? It's not going to be a simple fix, unfortunately, and will require changes in attitudes through education. Below are some steps that can be taken by you, the public, and the mental health professions to work towards reducing the impact of stigma:

Public service messages. Yes, that's right—your good old public service messages. Think of these as like commercials for the better good. If they get out there and are heard enough times, the message starts to get across. While in the past these have typically been on television or radio, new media and social media has provided lots of channels to get the message out. When is the last time you shared a mental health post on your Facebook, Twitter, or Instagram account?

Talk about your struggles. Yikes! Sounds scary perhaps, but imagine if everyone with SAD told one other person about something they went through. The elephant in the room might finally go "poof," and the disorder that hides in the shadows might see some light. When is the last time you told a story about your social anxiety? You might be surprised who can relate or who might have a story too.

Encourage people to read books. Yes, it can really be that simple. Encourage your friends, family, colleagues, neighbors to read true stories about mental illness. These books can be eye-opening experiences, particularly for those who have never experienced such things first-hand. If you are a family member of someone with mental illness, read these books yourself.

Share your experience as a celebrity. Thank you Donny Osmond, Barbra Streisand, Zack Greinke, Jonathan Knight and others for your candid sharing of your struggles. If you are a celebrity with social anxiety, tell stories or write a book about what you've been through. People look up to you and you have the chance to help reduce stigma surrounding this disorder.

Be open. This applies to everyone, but let's direct it at the public and the mental health professionals. To the public—be open to the possibility that not everyone experiences life the way you do. Be open to learning about and understanding the struggles of the mentally ill. To the mental health professionals—be open to the possibility that the person sitting in your office may have a problem they are not sharing, no matter how "normal" they seem. Ask questions about social anxiety symptoms and take the answers seriously.

Break the silence. Worldwide, let's work toward breaking the silence about mental health for social anxiety disorder and all mental illness. Let's follow in the footsteps of countries such as Australia and the UK that are working toward integrating mental health care and therapy as part of routine care.

Sources:

Anderson KN, Jeon AB, Blenner JA, Wiener RL, Hope DA. How people evaluate others with social anxiety disorder: A comparison to depression and general mental illness stigma. Am J Orthopsychiatry. 2015;85(2):131-138. doi:10.1037/ort0000046.

Care For Your Mind. Understanding the Unique Barriers for People With Social Anxiety Disorder.

Davies MR. The stigma of anxiety disorders. Int J Clin Pract. 2000;54(1):44-47.

Dinos S, Stevens S, Serfaty M, Weich S, King M. Stigma: the feelings and experiences of 46 people with mental illness. Qualitative study. Br J Psychiatry. 2004;184:176-181.

Rüsch N, Hölzer A, Hermann C, et al. Self-stigma in women with borderline personality disorder and women with social phobia. J Nerv Ment Dis. 2006;194(10):766-773. doi:10.1097/01.nmd.0000239898.48701.dc.

Continue Reading