A lot of people are shy, and we all fear public embarrassment. Social convention has such a strong pull on us that we all basically do the same stuff as everyone else most of the time, especially when we’re out in public. Nobody wants to mess up– and you probably know that painful experience of lying awake at night, reflecting on a social blunder you just made. Or maybe one from years back, as if junior high gym class were relevant again.
When social anxiety becomes chronic, though, it starts to shut us down. Joining an intramural sports team? Sharing your opinion with a group? Heading to a party with a few friends? They all sound kind of nice, but there’s way too big of a chance you could do something stupid.
However we label these things, the overlap between worrying excessively about social situations and having constant disturbing thoughts is clear. If you have what psychologists call obsessive-compulsive disorder (OCD), you get intrusive thoughts, images, and urges and deal with them by repeatedly doing specific things that make you feel temporarily better. People with Social Anxiety Disorder (SAD) feel so much fear of being judged by others, even though they usually know it’s irrational, that they might avoid social gatherings altogether.
According to Healthline, SAD has a number of common physical symptoms:
These physical symptoms (prompted by extreme worry) and the worry itself work together to make social situations feel so unbearable that people start to avoid restaurants, public restrooms, conversations with strangers, shopping in person, and anything else that involves risk of embarrassment.
People with OCD are more prone to having SAD than the general population, and vice versa. Even though scientists don’t know the exact reason, we can begin to understand how closely linked the two conditions are. In both, persistent worry prompts intense physiological reactions and psychological distress; these lead to behaviors that help someone feel better for a while and are therefore reinforced. In the case of both OCD and SAD, one of the more common behaviors is avoidance.
Luckily, both OCD and SAD are treatable with SSRI medication, cognitive-behavioral therapy, or a combination. Exposure therapy can be particularly helpful for both conditions, because getting used to all of that worry tends to require putting oneself in the situations that cause them.
Many people deal with both SAD and OCD, and working with your clinician to identify what’s going on can help you decide on a treatment plan. The good news is that both conditions can usually be treated at the same time.