Every day is a struggle for Siyabonga*. After many months of suspecting something was wrong, social anxiety disorder (SAD) ticked all the boxes. 

The 29-year-old is a copywriter for an advertising agency based in Cape Town. His job demands a lot of time, energy and creative thinking.

However, one of the key components in his position is communication, both verbal and non-verbal. Though never diagnosed, Siyabonga believes he may have a social anxiety disorder.

“Last year in June, I started researching social anxiety disorder after my partner suggested that that’s what I may be struggling with,” said Siyabonga.

“She was the extrovert of the relationship; more outgoing, could easily start conversations and never had problems with making new friends and socialising. After attending a social interaction or event together, I’d always over analyse everything and think back to something I may have said or done that could be considered embarrassing or stupid,” he said. 

Siyabonga shared how his heart beat faster when trying to speak to people at social gatherings. He said his girlfriend always reassured him that no one was looking at him or judging him.

Siyabonga loves his job. However, he usually keeps to himself. 

More than just being an introvert

“Both my colleagues and family think I’m extremely introverted and shy. Even my high school teachers thought so. But ever since I started researching social anxiety disorder, I felt that it’s more than that,” he explained. 

“I avoid most work gatherings and don’t interact with my colleagues after work. It’s because I just feel like I will end up humiliating myself. I don’t mind making calls or communicating via email, but in person, it is something different now,” he said.

The possibility of being diagnosed with a social anxiety disorder is something that Siyabonga finds hard to accept.

“Hearing that I might have a mental health disorder doesn’t sit well with me. That’s why I’ve never gone to a doctor to confirm it”, he said.

During Siyabonga’s last review at work, his line manager mentioned that his performance had dropped. He realised it might be due to his day-to-day struggles with social anxiety.  

“I haven’t mentioned this to anyone at work. My family recommended that I first find out if I have it before I say anything. Even if I do, I don’t even know how to start that conversation”, says Siyabonga.

When it comes to the reality of Mental Health and how it can greatly affect an individual's behaviour. Read the following article by @IOL in the link below about the importance of addressing Mental Health early. https://t.co/3Sg050VzFX #WorldMentalHealthMonth pic.twitter.com/A7CSU01wrb

— SADAG (@TheSADAG) October 29, 2022

Explaining social anxiety disorder

Dr Colinda Linde, a clinical psychologist and South African Depression and Anxiety Group (SADAG)  board member, further explained how social anxiety disorder impacts the day-to-day life of an individual.

“Anxiety has a genetic base and is very common. The best way to address anxiety is early identification so that treatment intervention can happen early”, she said. 

According to Linde, social anxiety is not related to trauma in the way PTSD is. However, when you have a social anxiety disorder (SAD), it can be very challenging to perform at school and in social situations. This includes speeches and school plays and meeting new people.  

Anxiety is normal

“It’s normal to feel nervous in some social situations. For example, going on a date or giving a presentation may cause that feeling of butterflies in your stomach,” said Linde. 

But with social anxiety disorder, also called social phobia, everyday interactions cause significant anxiety, self-consciousness and embarrassment because you fear being scrutinised or judged negatively by others”, she said.

Linde said the condition causes fear and anxiety, which leads to avoidance. Severe stress can affect your relationships, daily routines, work, school or other activities.

SAD vs shyness

“Introversion and extroversion are personalities we are born with, and introverts tend to be labelled as ‘shy’ as they take time to ‘warm up’ (be comfortable) in a new social situation,” said Linde.

Introverts do not have as much of a need to connect socially as extroverts do, but do have connections with others”, says Linde. 

She also said that social anxiety is where you want to be able to connect, but the extreme fear of being evaluated gets in the way of even trying.

Signs and symptoms 

“Social anxiety disorder typically begins in the early to mid-teens, though it can sometimes start in younger children or adults”, says Linde.

Symptoms of social anxiety disorder are categorised into emotional, behavioural and physical symptoms. These include:

• Fear of situations in which you may be judged negatively
• Worry about embarrassing or humiliating yourself
• Intense fear of interacting or talking with strangers; and
• Fear that others will notice that you look anxious.

Others include fear of physical symptoms that may cause embarrassment, avoidance of situations where you might be the centre of attention and anxiety in anticipation of a feared activity or event.

Intense fear or anxiety during social situations, analysis of your performance and identification of flaws in your interactions after a social situation are also signs to look out for.

Physical symptoms include:

• Blushing
• Fast heartbeat eat
• Trembling
• Sweating
• Upset stomach or nausea
• Trouble catching your breath
• Dizziness or lightheadedness
• Feeling that your mind has gone blank; and
• Muscle tension.

Social situations 

According to Linde common, everyday experiences may be hard to endure when you have SAD, including:

• Interacting with unfamiliar people or strangers
• Attending parties or social gatherings
• Going to work or school and starting conversations
• Making eye contact
• Dating
• Entering a room in which people are already seated
• Returning items to a store
• Eating in front of others; and
• Using a public restroom is also difficult.

“Social anxiety disorder symptoms can change over time. They may flare up if you’re facing a lot of changes, stress or demands in your life,” said Linde.

Although avoiding situations that produce anxiety may make you feel better in the short run, it’s likely to continue over the long term if you don’t get treatment”, she said.

She added that if you fear and avoid normal social situations because they cause embarrassment, worry or panic, then you should consider seeing your doctor or a mental health professional.

“Untreated SAD impacts a young person’s ability to engage with their peers and form relationships. It can also make public speaking intensely anxiety-provoking, and so much of schooling involves this.” 

Treatment options

According to Linde, treatment depends on how much SAD affects your ability to function in daily life. 

The most common treatment for social anxiety disorder includes psychotherapy. Cognitive behavioural therapy (CBT) is proven to be the most effective. 

“One of the several goals of CBT is to identify irrational beliefs and thought patterns and replace them with more realistic ones. Your thoughts, emotions, and behaviours are all linked. By identifying unhelpful thoughts, you can then change how you behave,” she said.

As part of the therapy process, you will work on several problem areas, including negative beliefs you may have about your abilities and self-worth, guilt, embarrassment, or anger over past situations.

You will also cover social skills training, tackling perfectionism and being more realistic. Dealing with avoidance related to social anxiety and mistaken beliefs that others are judging you will also be dealt with.

Disclosing your condition

Lesley Burns is an occupational therapist who specialises in workplace mental health. She explains what disclosure of your mental health condition or status to your employer involves. 

According to Burns, it is not legal to be questioned about your mental health during an interview, nor are applicants legally obliged to disclose a mental illness during the process.

“If an employee’s attendance at work becomes erratic, an employer is entitled to ask the employee to provide a reason.  Should a mental health condition be the cause, an employer can ask for more information to see if the employee is capable of remaining employed. Special job accommodation is also an option,” said Burns.

Burns said that the main reason an employee might not want to disclose their mental health condition is due to the stigma attached to mental illness.

“Many employees will fear consequences such as limited progression in the company, exclusion or even losing their job. Mental illness stigma is a big topic and a big problem in workplaces,” she said.

Burns also said that the fear of being judged or considered weak and unsuccessful also plays a role. 

Who to disclose to and when

Burns said there is no rule when choosing who to discuss your mental health condition with. She said some employees might prefer talking to their line manager while others might prefer to talk to someone in HR.  

“If they talk to someone in HR, the line manager needs to know about it,” she advised.

According to Burns, when your condition starts to interfere with your ability to do your job, then you should consider disclosing it.  

“Until this happens, there is no need for disclosure.  But if you are not performing and you don’t disclose, you run the risk of facing disciplinary action,” she said.

Before you choose to disclose, you need to be prepared. Burns shared some ways that could make it easier.

“You need to be sure you understand your condition to explain it.  Try to think about the questions they may ask you so you can prepare your answers.”

She also recommended taking along some articles about your condition that you have read and practising with a mental health professional.  

“If you are in sessions with a psychologist or an occupational therapist, they can assist you with preparation, maybe even through activities such as role-play,” said Burns.

Pros and cons

“Special or reasonable job accommodation can only occur if you disclose your mental health condition. And in the long run, such accommodation can help you keep your job,” said Burns.

A disadvantage would be if the person you disclose to doesn’t understand mental illness and frowns upon you; this is a risk you need to take,” she said.

Burns continued: “This is why I am spending a lot of my time nowadays running training workshops with corporate clients – so they can learn to understand and therefore be empathetic.”

Role of leaders

Burns said employers can support employees by learning about these conditions, therefore, allowing them to demonstrate empathy and implement special accommodations.

Managers can also play a role. 

“First, they need to learn to understand these conditions.  Once that has been achieved, they can schedule short groups on a weekly, bi-weekly or monthly basis to check in on everyone’s mental health. They can also arrange for mental health sessions with service providers and display signage in their work area,” she said.

Where to get help

For people who can’t afford treatment, Linde recommended CBT online resources and her self-help site, which offers free CBT techniques. – Health-e News