Social Anxiety: Navigating Fear and Isolation

Social anxiety and anxiety?

Hello, doctor.
I might be having some negative and selfish thoughts...
I have unknowingly developed social anxiety.
Although I haven't reached the point of not being able to make friends, I feel very nervous about interacting with strangers, especially men.
Even just sitting next to someone makes me hesitant to move; I dread being on stage or being watched.
Just thinking about it makes me want to escape, and I feel scared and experience chest tightness.
It seems to be getting worse.
I didn't feel this way when I was younger.
When I talk to my mom about it, she tells me that I'm too introverted and need to try more.
My friends say they feel the same way, but to me, they seem to easily make friends and get along well with boys, and they don't fear talking to teachers.
I can't help but wonder if I'm really the same as them.

I once went on a school trip to Japan for a few days with two friends.
I thought it would be fine since I was with them, but they ended up getting close to other classmates, and I couldn't connect with them.
Eventually, they started hanging out together, and I felt scared and avoided them because being with them made me feel too uncomfortable.
I secretly slipped away.
The hardest part was when I was invited to their hotel room at night.
Not wanting to be seen as too reclusive or rejected, I went, but later I didn't know how to leave.
I was on the verge of tears...
Recently, there's something that's been causing me constant anxiety, and I don't know how to handle it, which is what I mainly want to consult about.
My sister returned from the U.S.
for a few days of vacation.
We used to have a good relationship, and we had verbally agreed to go to the gym together.
Later, she suggested going to the park to skateboard, but I didn't want to be around crowds, so I reminded her that we had agreed to go to the gym.
She got upset (not in a furious way, but she seemed indifferent), and since then, she has ignored me.
We haven't spoken a word to each other, not even a single letter.
I realize it's not just her being sulky; it feels like I no longer exist in her eyes.
She avoids me, yet she remains cheerful and affectionate with our parents and even strangers.
When she wants to give me something, she just leaves it at my door.
I don't know what I did wrong.
This has never happened before, and it coincided with a family trip, which made things worse.

On the first day of the trip, I couldn't stop crying, and I just let the tears flow.
The saddest part is that I feel like I need her, but she no longer needs me.
I can't give her anything; I never have.
Without me, she can still do well, and the only one feeling hurt is me.
I always thought home was the one place where I could feel safe and relaxed, but now, even when I'm alone in my room, I still feel a twinge of pain.
I don't know how to handle my emotions anymore.
I've always been hesitant to seek advice or talk to others because my feelings fluctuate so much.
Sometimes I'm very happy, but when I'm in pain, it's overwhelming...
In the end, I find myself back at square one, unsure of what's real or if I'm just trying to shape a version of myself that seems pitiful.

Niming, 10~19 year old female. Ask Date: 2015/12/30

Dr. Ding Shuyan reply Psychiatry

Social anxiety is quite common among us Easterners, though the severity varies.
Those who do not experience this issue may perceive us as overthinking or find it difficult to engage in social activities, lacking assertiveness.
Your sister's reaction seems to reflect a similar misunderstanding of our psychological distress.
It appears that managing your current symptoms on your own may not be easy, so seeking medical help would be a better option.
The doctor will likely prescribe two different types of medications: one that addresses the immediate symptoms, which should significantly reduce your anxiety and alleviate suffering, and another antidepressant that will gradually provide a more fundamental treatment effect.
Medication can be very effective and works faster than psychotherapy, so you might consider having your parents take you to see a doctor.
In the long term, when it comes to relationships, practice not focusing too much on yourself, cultivate genuine interest and concern for others, and recognize that everyone is busy with their own lives, and no one is constantly paying attention to us.
This approach should help gradually alleviate the issue.
Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2015/12/30

More Info

Social anxiety is a common issue that many people face, and it can manifest in various ways, including fear of judgment, avoidance of social situations, and feelings of isolation. Your experiences reflect a deep-seated struggle with these feelings, and it’s important to recognize that you are not alone in this. Many individuals experience similar challenges, and understanding how to navigate these feelings can be a crucial step toward improvement.

Firstly, it’s essential to acknowledge that social anxiety can stem from various factors, including past experiences, personality traits, and even biological predispositions. The feelings of nervousness and fear you experience when interacting with strangers, particularly men, or when faced with public speaking are common symptoms of social anxiety disorder (SAD). This condition can lead to significant distress and avoidance behaviors, as you described in your experiences during the school trip and interactions with your sister.

Your feelings of isolation, particularly regarding your sister’s reaction, highlight a critical aspect of social anxiety: the fear of rejection and the impact of perceived social failures. When you felt that your sister was ignoring you, it likely intensified your feelings of loneliness and anxiety. It’s important to remember that relationships can be complex, and misunderstandings can occur, especially when emotions are running high. Open communication with your sister, when you feel ready, might help clarify the situation and alleviate some of your distress.

In terms of coping strategies, here are several approaches that may help you manage your social anxiety:
1. Cognitive Behavioral Therapy (CBT): This is a highly effective treatment for social anxiety. CBT helps individuals identify and challenge negative thought patterns and beliefs that contribute to anxiety. Working with a therapist can provide you with tools to reframe your thoughts and reduce anxiety in social situations.

2. Gradual Exposure: Gradually exposing yourself to social situations can help desensitize your anxiety response. Start with less intimidating scenarios, such as greeting a neighbor or engaging in small talk with a cashier, and gradually work your way up to more challenging situations.

3. Mindfulness and Relaxation Techniques: Practicing mindfulness can help you stay grounded in the present moment and reduce anxiety. Techniques such as deep breathing, progressive muscle relaxation, or meditation can help calm your mind and body before entering social situations.

4. Building Social Skills: Sometimes, social anxiety is exacerbated by a lack of confidence in social skills. Consider joining a group or class that focuses on social skills development. This can provide a supportive environment to practice and improve your interactions with others.

5. Medication: In some cases, medication may be necessary to help manage symptoms of social anxiety. Consult with a mental health professional to discuss whether this is an appropriate option for you.

6. Support Networks: Connecting with others who understand what you’re going through can be incredibly beneficial. Consider joining a support group for individuals with social anxiety, where you can share experiences and coping strategies in a safe environment.

7. Self-Compassion: Be kind to yourself. Understand that overcoming social anxiety is a process that takes time. Celebrate small victories and recognize that setbacks are a normal part of the journey.

Lastly, it’s crucial to seek professional help if you haven’t already. A mental health professional can provide personalized guidance and support tailored to your specific needs. Remember, you don’t have to navigate this alone, and reaching out for help is a sign of strength, not weakness.

In conclusion, social anxiety can be a challenging experience, but with the right strategies and support, it is possible to manage and overcome these feelings. Take small steps, be patient with yourself, and remember that improvement is a journey. You are not alone in this, and there are resources available to help you navigate your social anxiety effectively.

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