A common feature associated with post-traumatic stress disorder is social discomfort. That’s not a discrete psychiatric diagnosis, but it does cause significant distress for a number of service members and veterans suffering from PTSD.
And if severe enough, it makes recovering from PTSD more difficult.
A number of symptoms and behaviors are associated with social discomfort. Most notably, the person displays a consistent pattern of social anxiety, shyness, or apprehension around others. The person also exhibits a hypersensitivity to disapproval or criticism by others. In essence, not only is the person uncomfortable in public settings, but is worried about being harshly judged by others.
A person experiencing extreme social discomfort associated with PTSD may have no close friends or social support system outside immediate family. They avoid situations that require interpersonal contact, worry about doing something foolish in public and are overly concerned that they will not live up to others’ expectations.
Physical symptoms include a racing heart, sweating, dry mouth, muscle tension, and shakiness in the body and voice. These symptoms are often serious enough to make others around the person aware that something is wrong.
The first step in gaining control of social discomfort associated with PTSD is effectively treating the PTSD. In most cases, once the trauma issues are resolved, the social discomfort will be as well. The most effective treatments for PTSD include various cognitive and behavioral psychotherapies such as Prolonged Exposure and Cognitive Processing Therapy. Medication can be helpful, but is generally less effective than talk therapy.
For those who continue to experience social discomfort following successful treatment of PTSD, more targeted interventions are warranted. One simple approach is education; understanding how the cycle of social anxiety and avoidance works is key to recovery.
Learning to manage one’s self-talk is also critical. Anxious people tend to generate self-defeating, one-sided conversations. Identifying, challenging and replacing biased, fearful self-talk with reality-based, positive self-talk is important.
If you struggle with social discomfort, it’s important to force yourself to go to the mall, hang out with friends, or take in a ball game. The longer you can make yourself stay in these types of situations, the more your anxiety will ease over time.
Social discomfort does not have to keep you from enjoying life. If you think your anxiety is too high in public, make an appointment with your health care provider.
Bret A. Moore, Psy.D., is a board-certified clinical psychologist who served two tours in Iraq. Email him at kevlarforthemind@ militarytimes.com. This column is for informational purposes only and is not intended to convey specific psychological or medical guidance.
