With Treatment, People Suffering From Social Phobia Need Not Be SAD by Gina Shaw Imagine winning a Nobel Prize and missing out on the ceremony honoring you for this singular achievementóall because of a crippling fear of interacting socially. Thatís the dilemma facing Elfriede Jelinek, the Austrian author who received the 2004 Nobel Prize for literature. On Dec. 10, the other Nobel laureates will gather at the awards ceremony in Stockholm, but Jelinek will not be there. Instead, the 58-year-old author recorded a speech from her home in Vienna to be broadcast at the ceremony. "I did this because I cannot go to Sweden because of my ësocial phobia.í I cannot stand crowds," she told Bahrainís Gulf Daily News in early November. Most people suffering from social phobia, or social anxiety disorder (SAD), donít miss out on international awards ceremonies, but their overwhelming anxiety and self-consciousness in everyday social situations can hold them back at work and at school, stifle their relationships, and even lead to alcohol and substance abuse as they attempt to "self-medicate" their fears away. According to the Anxiety Disorders Association of America, 5.3 million Americans, o r nearly 4 percent of the population, have some form of social anxiety disorder. Itís the most common anxiety disorder and the third most common psychiatric disorder in the United States, after depression and alcoholism. And a new Canadian study reports that the rate may be higher: Slightly more than 2 million people, or about 8 percent of Canadaís population, reported a "lifetime history" of social anxiety disorder in a report from Statistics Canada released in October. Wait a minuteówhatís the difference between SAD and ordinary shyness? After all, from time to time most of us have faced the fears that characterize SAD, such as the fear that all eyes are on you, fear that youíll make a mistake and everyone will notice and judge you, and fear that youíll embarrass yourself in public. The difference, say experts, is one of degree. If youíre nervous about getting up to speak at your office staff meeting, and find yourself a little sweaty and flushed, youíre feeling shy. If youíre so overwhelmed by fear at the thought of speaking at that staff meetingóso much so that you literally canít stand up or you turn down an opportunity to work on a career-advancing project because youíll have to speak at that staff meetingóthen you might have social anxiety disorder. Being shy can make your life a bit more difficult, while having SAD can bring it to a screeching halt. (You can take a social anxiety disorder self-test online at www.adaa.org/Public/selftest_socialpho.htm.) Unlike two other common psychiatric disorders, panic disorder and depression, which tend to begin in a personís mid-20s, SAD often sets in during childhood. The Canadian study found that symptoms of SAD began at an average age of 13, and according to "Shy Children, Phobic Adults: Nature and Treatment of Social Phobia," published by the American Psychological Association, some 5 percent of children suffer from social phobia. That might sound familiar to Heisman Trophy-winning running back Ricky Williams, who told Ebony magazine two years ago that painful shyness had dictated his life for as long as he could remember. For Williams, SAD became so overwhelming that people began to whisper that he was crazy, hiding in restrooms and insisting on doing interviews with his helmet on to shield him from reporters. And like most other people with SAD, it took Williams years to recognize that he had a problem and seek help. Only 37 percent of people with SAD in the Canadian study had sought treatment, and other studies have found that as little as 1 percent of SAD cases are properly diagnosed and treated. Thatís unfortunate because effective treatments are available, and they can literally change a personís life. There are two approaches to treatment: therapy and medication. Most experts advocate a combined approach, using drugs approved to treat SAD (such as Effexor and Paxil) along with cognitive behavioral therapy, which involves confronting a patientís fears. Medication combats that initial surge of anxiety when a patient enters a social situationóthe flushed face, the shaking hands, the sweatinessóand if those early triggers can be short-circuited, the person may find it easier to "practice" interacting socially during therapy. "From what we know now, combined treatment is more effective than either one alone. Cognitive behavioral therapy is very effective in directly attacking the thoughts and feelings that go with social anxiety," said Dr. Sy Atezaz Saeed, professor and chair of psychiatric medicine at the Brody School of Medicine at East Carolina University. "Itís also highly effective in preventing relapses. But there are people who cannot really get back to a good level of functioning without medication. Typically what ends up happening is that you start someone with a combination of medication and therapy, and then gradually take them off the medication once theyíre responding." Later on, the patient can also taper off the behavioral therapy. Not all kinds of cognitive behavioral therapy are the same, however. "For social anxiety, itís a very specific type of therapy," Saeed said, adding that people with SAD should be careful to seek out a therapist who has specific experience with social phobia. In a large city such as Washington, that may be easier than in a small town. The Anxiety Disorders Association of America can help you find a treatment provider near you, either using their online search tool (www.adaa.org/Public/Find.cfm) or by calling them at (240) 485-1001. (There are also therapists who specifically treat children with SAD.) In addition, there are several good books aimed at helping people with social anxiety disorder, including "The Hidden Face of Shyness: Understanding and Overcoming Social Anxiety," by Franklin Schneier and Lawrence Welkowitz, and "Overcoming Shyness and Social Phobia: A Step-by-Step Guide," by Ronald Rapee. Be patient: If youíve spent a lifetime avoiding social situations, youíre not going to be the life of the neighborhood holiday party or the leader of the next company retreat after a month of treatment. Social anxiety disorder wonít go away overnightóespecially if itís a problem that has gone untreated for years. But whether itís receiving your own Nobel Prize (hey, it could happen) or just taking a bow for your hard work during the annual report at the next office staff meeting, you donít have to let SAD stand in the way of the rest of your life. Gina Shaw is the medical writer for The Washington Diplomat.