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Understanding Social Anxiety, Social Phobia, and PMS & PMDD Social Withdrawal
by Dr. Daniel J. Heller
When you don’t feel well, naturally, it’s harder to be around people and to put on your best face—that’s human nature. Especially when you’re in a bad mood or a funk, it’s normal to want to avoid being around both familiar people and strangers. It’s no wonder, then, that one of the typical symptoms of PMS and PMDD is called social withdrawal, and that before your period you may go through hours or days of feeling like you want to crawl into bed, turn off the lights, and not have to deal with anyone or anything.
The social withdrawal of PMS and PMDD is similar to, but different from, the better known conditions social anxiety and social phobia. Millions of people experience fear and anxiety in social situations, and around people, not just at certain times of the month but at any time, or even all the time. So what is social anxiety? Social anxiety disorder and social phobia disorder are part of the spectrum of psychological conditions that include generalized anxiety disorder and depression. Those who’ve struggled with depression or with social anxiety or social phobia will recognize the deep desire to retreat from people and social contact that women with PMS or PMDD social withdrawal experience monthly.
What Social Anxiety and Social Phobia Feel Like
- Do you fear and retreat from social situations? These fears and tendencies plague individuals with social anxiety and social phobia:
- Fear of being negatively evaluated, judged, scrutinized criticized, or treated hostilely.
- Fear of receiving any kind of evaluation by others, even positive evaluation.Fear of making a bad impression.
- Fear you might act in a way that would be embarrassing.
- Fear that signs of anxiety such as blushing and trembling will be apparent, and that you will be judged negatively because of that.
- A fearful or anxious reaction to inner sensations, thoughts, or feelings of anxiety that arise in social situations. Avoidance of situations that make you anxious, in order to avoid situations that evoke anxious feelings.
- Fear of uncertain situations, and fear of being judged negatively for feeling and being uncertain.
- Fear that appearing in less than perfect control reflects poorly on your competence.
In our previous article on anxiety, we pointed out that women are up to 200% more likely to suffer from anxiety than are men; meaning women are also more likely to experience social anxiety and social phobia. Women also have more social anxiety disorder symptoms during the second half of their menstrual cycle, the premenstrual phase.
One possible reason for the increased tendency to anxiety in women may simply be that women have, in general, greater sensitivity than men. In the case of withdrawing from people, women are more sensitive to the inner sensations, feelings, and thoughts that arise at the same time as anxious feelings. This may sound strange, but it means that while everyone experiences anxiety, it is when women have anxiety about anxiety that it causes a problem. Some people are able to ignore, or barely even notice, sensations like trembling, rapid heart rate, and blushing; fearful emotions; and negative thoughts that accompany feeling anxious. Women with anxiety sensitivity become more anxious when they have these thoughts, feelings, and sensations. This reaction is increased before the period, and that can cause even more anxiety, and contribute to the feeling of wanting to withdraw and retreat from people and social situations.
Determine Your Social Anxiety or Social Phobia
Rate yourself on the following 12 statements to assess your own tendency to social anxiety and social phobia. The more statements you agree with, and the stronger your agreement, the more likely you are to have social anxiety or social phobia. Please note: everyone has these thoughts, to different degrees, from time to time—they’re normal. However, if these thoughts significantly impair your life, your relationships, and your ability to function socially, you may have a tendency towards social anxiety or social phobia.
- I worry about what people will think of me even when I know it doesn’t make any difference.
- I am unconcerned even if I know people are forming an unfavorable impression of me.*
- I am frequently afraid of other people noticing my shortcomings.
- I rarely worry about what kind of impression I am making on someone.*
- I am afraid that others will not approve of me.
- I am afraid that others will not approve of me.
- Other people’s opinions of me do not bother me. *
- When I am talking with someone, I worry about what they may be thinking about me.
- I am usually worried about what kind of impression I make.
- If I know someone is judging me, it has little effect on me.*
- Sometimes I think I am too concerned with what other people think of me.
- I often worry that I will say or do the wrong things.
*These statements are reverse-wording and are scored opposite. For these statements, more agreement means less social anxiety.
From Leary MR, 1983. See references for details.
Another factor in both anxiety and depression is called intolerance of uncertainty. This characteristic, too, may be present in women more than in men. Uncertainty intolerance means that some people find insecure and uncertain situations more upsetting and anxiety-producing. Of course, insecurity and uncertainty are part of life, and if you are uncomfortable with feelings of uncertainty, many different types of situations may upset you. This could include new and unfamiliar situations as well as familiar ones. Of course, if your very hormones and biochemistry are uncertain hour to hour, day to day, and week to week, it’s easy to see how PMS and PMDD could compound these feelings, and with them generalized anxiety, social anxiety, social phobia, depression, and a withdrawal from people and social situations.
Other important factors that contribute to social anxiety and social phobia are low self-esteem; perfectionism; and a tendency to worry excessively. We’ve noticed that PMS and PMDD themselves often contribute to, or exacerbate, low self-esteem—and of course, symptoms like bloating, acne, and depression can make it hard to feel good about yourself.
Women with PMS and PMDD social withdrawal, and anyone with social anxiety, social phobia, generalized anxiety disorder, or post-traumatic stress disorder, can feel like the world at large, and social interactions specifically, are threatening and unsafe. From this perspective, a reaction of holing up and isolating oneself is a perfectly reasonable reaction: in the short run, it feels and appears to create a sense of safety and comfort.
Anxiety, Insecurity, and Uncertainty
Everyone has a different degree of tolerance for feelings of uncertainty: those who are more upset by uncertainty are more susceptible to anxiety. Individuals with generalized anxiety disorder, social anxiety, social phobia, and post-traumatic stress disorder tend to have less tolerance for uncertainty. Rate yourself on the following scale to see if you have anxiety about uncertainty.
Anxiety From Anticipating the Future
Anxiety that Prevents You from Acting
These personal issues are often complex and deeply-rooted, and help, treatment, or cure of social anxiety and social phobia usually requires effort, trial and error, help from a professional, and a willingness to experience or to "lean into" discomfort to break out of established thought and behavior patterns. We recommend you start by browsing our articles on anxiety, on on stress, and on depression: we have plenty of ideas and suggestions that will help you get healthy and feel better, and that leads to more energy and more confidence—and that will help you overcome social anxiety and social phobia. Another excellent first step is to review our diet section: food is so crucial to mood and brain function. We have expert advice on healthy diet; what not to eat; blood sugar balance, and food allergies.
Addressing PMS and PMDD social withdrawal begins by dealing with the underlying hormonal and mood imbalances that cause the problem. This whole website is full of practical ways to get a handle on your monthly cycle and PMS and PMDD symptoms, so look around and you’re sure to find something that will help you get on the right path.