6.9 Social Anxiety

Weight discrimination and the stigma associated with being overweight can be deeply distressing, contributing to the development of anxiety disorders [76]. With respect to health, it’s long been established that the negative effects of social discrimination are more significant and distressing for women. This is particularly true when there’s a diagnosis of PTSD, or factors such as low social support, fewer social networks, and lower socioeconomic status [77, 78, 79].

Body image dissatisfaction significantly contributes to social anxiety disorder (SAD) and those with SAD are more likely to have a lifetime history of eating disorders [79]. Preoperative studies of patients screened for bariatric surgery have found that anxiety disorders are the most prevalent class of disorders [79].

Recognition: Describe any discrimination, teasing, or bullying you’ve experienced because of your weight or other attributes.

Many BT course participants share feelings of anxiety in social settings. This anxiety can range from mild apprehension to paralyzing fear and for some, agoraphobia. Some are comfortable with crowds for a while; others would rather scale Mt. Everest. Typically social apprehension doesn’t meet the threshold for a disorder but as we discussed earlier, it can become increasingly ingrained and debilitating. We may want to make friends and fit in (feel a part of) but at the same, we’re afraid to approach or be approached by others (feeling apart from). Often underlying this anxiety are past social experiences that were painful. Possibly, because of family circumstances (alcoholism) or restrictions on activities, we may lack social experience. We fear the unknown, certain of rejection, humiliation, or dismissal.

Core fears and the anticipation (or projection) of rejection, disapproval, or judgment are at the heart of understanding social apprehension. Unfortunately, these fears and our projections produce intense awareness and hypervigilance of other people’s criticism, emotional states, facial expressions, mannerisms, and presence. This unrelenting vigilance is physically and emotionally exhausting. In this state, we can easily overlook our exhaustion and convince ourselves that crowded venues are “unsafe”. Being around crowds is overwhelming, we’re likely to experience “panic, and it’s safer to stay home. Remember, our brain only knows and responds to what it’s experienced in the past, and what we tell it. If we tell ourselves “we’re not safe” our brain responds by increasing the production of cortisol and energizes our adrenal survival-driven “flight” responses.

 To appreciate social hypervigilance, another factor is mirror neurons and their role in the brain. The function of mirror neurons, located in the frontal cortex is that subconsciously they help us connect to another’s emotional state with understanding. However, these same neurons unknowingly can also leave us vulnerable to the mood states of others.

As apprehension escalates, WE usually experience tension and the onset of a variety of physical symptoms, such as elevated heart rate, muscle tension, sweating, stomach upset, and more.  When fear-based emotions hijack our mind (US) we may feel paralyzed, unable to connect thoughts to words. It’s situations like these where we can shift from past to present and develop our emotional resistance and resilience to triggers. 

Deep-seated triggers are difficult to eliminate, so we need to learn to work with them to maintain our peace of mind. Triggers may remain for a lifetime but we can change how we react, and what happens next. Once triggered, first we stop and remind ourselves we are safe, and that anxiety is based on perception, old thoughts, and the projection of past fears. Here is when we talk to our brain. When you feel the first flush of apprehension or flooding say: “The past has no bearing on now.”  

When WE exert control from the deeper place of an authentic self, negative energy will dissipate and slip away. We don’t have to do anything but be exactly where we are at this moment and do what’s needed. As mentioned earlier, when we’re present, deconstructed fears are nothing more than a task list; they’re not a reflection of our character! We can feel fully alive when we bring ourselves to where our feet are at this moment. When we face old fears of judgment or rejection, it’s then we realize that when we advocate for ourselves or our values; all we’re losing is someone else’s opinion of us. If they’re strangers…then why the heck should we care about the opinion of someone who doesn’t even know us? Another train the brain: “That’s their stuff…not mine!”

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