翻译：@阿普-Apgar
想象一下，这是你新工作的第一天 Say it's your first day at a new job.
你战战兢兢 Maybe you're nervous or jittery.
想给别人留下一个好印象 You want to make a good impression.
这些都是非常正常的感觉 Those feelings are pretty normal,
事实上它们还可以让你更加警觉和小心 and may actually help you be more alert and careful.
但几周之后，一旦你习惯了新工作 But after a few weeks, once you're used to the job,
熟悉了新同事 and you know your coworkers,
这种紧张感就会减弱，对吗？ thatnervousness usually diminishes, right?
不过，有些人的初始焦虑会非常严重 Well, for some people that initial anxiety is really high
并且在一段时间内都保持高水平 and stays really high over time.
他们对负面评价的恐惧是如此严重 For those people, the fear of being judged negatively by new people might be so daunting
以至于无法做好自己的工作 that it affects their ability to do their job well.
事实上，仅仅是想到要待在一个可能被别人审视的地方 In fact, even the idea of having to be somewhere where they may be scrutinized by others
就足以让他们放弃工作 might make them not want the job in the first place.
这就是社交焦虑障碍 This describes social anxiety disorder.
目前还不清楚是什么导致了社交焦虑障碍 It's unclear what causes social anxiety disorder,
但人们认为遗传和环境因素都起了作用 but it's thought to be a combination of genetic and environmental factors,
比如近亲中有人患病 like having a close relative with social anxiety disorder
或被忽视和虐待（都可能与发病有关） or being exposed to neglect or abuse.
美国精神疾病诊断与统计手册（DSM-5） The Diagnostic and Statistical Manual of Mental Disorders, or DSM-5,
定义社交焦虑障碍为 defines social anxiety disorder
患者害怕自己的行为受到他人审视 as causing individuals to fear acting in a certain way that might make them get judged,
并感到焦虑，这影响了患者的正常生活和人际关系 and it can cause anxiety that interferes with their normal routine as well as their relationships.
此外，这种害怕和焦虑需要持续达到或超过6个月 What's more, is that the fear or anxiety is persistent, lasting for 6 or more months.
社交焦虑障碍通常使患者 Usually social anxiety disorder
在特定的社交情境中感到苦恼 causes distress for individuals in specific social situationsor circumstances.
举个例子，有些人可能会在和认识的人聊天 For example, one person might get really anxious while making small talk with acquaintances,
或结识新朋友的时候感到非常焦虑 or meeting new people.
另一些人可能在演出时感到焦虑， Whereas another person might get performance anxiety,
觉得自己没办法完成展示 and not feel able to give a presentation,
或没办法在朋友的婚礼上发言 or give a toast at a friend's wedding.
社交焦虑障碍是一种自我失调的状态 Social anxiety disorder is an egodystonic condition,
也就是说患者能意识到自己的焦虑是不合理的 meaning people who have the disorder usually understand that their anxiety is unwarranted.
但不幸的是，这种认识会让患者更加焦虑 But, unfortunately, that awareness can cause more anxiety,
因为他们害怕别人能看出他们的焦虑 because they'll fear otherscan tell how anxious they are.
有时患者会担心自己出现躯体症状 Sometimes individuals might worry that they may be having physical symptoms
比如发抖和脸红 like tremblingor blushing
他们会担心别人注意到这些症状而对自己有看法 that others might notice and judge them for.
有时太严重的焦虑会引起现实解体 Sometimes the anxiety can get so severe that it causes something called derealization,
患者会感到“飘飘然” meaning that a person might feel "spaced out"
不太能认出周围的环境 and be less able to recognize their surroundings.
为了减少自己的社交回避行为 In order to reduce their social inhibitions,
有些患者会借助于药物或酒精 some people with social anxiety use drugs and alcohol,
这可能导致物质依赖和上瘾 and that can lead to dependency and addiction.
DSM-5指出，要诊断社交焦虑障碍 The DSM-5 states that in order to make a diagnosisof social anxiety disorder,
其害怕和回避不能归因于某种药物或其他情况 the fear or avoidance shouldn't be due to the effects of a medication or due to another condition.
这是很重要的一点 That's important because
因为社交焦虑障碍的关键特征与其他情况有所重叠 there are key features of social anxiety disorder that overlap with other conditions.
比如说，广泛性焦虑障碍的患者也有焦虑 For example, in generalized anxiety disorder individuals have anxiety,
但这种焦虑并不局限于在社交情境中被评价 but it's not limited to being judged in a social context.
这种焦虑通常更广泛 The anxiety is usually broader,
包含了非社交性的焦虑 and includes non-social concerns,
比如对如经济和人身安全担忧 like finances or physicalsafety.
另一个例子是广场恐怖症 Another example is agoraphobia
这些患者会避开公共场合 where people avoid public places,
因为他们害怕在不好的事情发生或他们开始恐慌时 for fear of being trapped and not being able to escape,
被困住而不能及时逃脱 just in case something embarrassing happens or they begin to panic.
但广场恐怖症患者的恐惧与他人评价关系不大 But in agoraphobia the fear is less about being judged
更多的是害怕在人群中受困而无法逃离 and more about being trappedin a crowd and not being able to escape.
治疗方法通常是心理治疗、药物治疗或者两者皆有 Treatment usually involves psychotherapy, medication, or a combination of the two.
如果使用心理治疗 If it's psychotherapy,
一般会推荐认知行为疗法 cognitive behavioral therapy is recommended,
因为它可以帮助患者建立 since it teaches a person new ways of
与别人在一起时的思考和行为方式 thinking and behaviors to help in being around others.
抗抑郁药是最常用的药物 Antidepressants are the most common choice of medication,
尤其是选择性5-羟色胺再摄取抑制剂 ( SSRIs ) specifically selective serotonin reuptake inhibitors or SSRIs,
5-羟色胺和去甲肾上腺素再摄取抑制剂 ( SNRIs ) serotonin-norepinephrine reuptake inhibitors or SNRIs,
还有苯二氮䓬类药物和β-受体拮抗剂 as well as benzodiazepines, and beta-blockers.
SSRIs帮助调节大脑中5-羟色胺的水平 SSRIs help regulate serotonin levels in the brain,
而SNRIs帮助调节5-羟色胺 while SNRIs help regulate serotonin,
去甲肾上腺素和多巴胺水平，以调节焦虑 norepinephrine and dopamine, to manage anxiety.
苯二氮䓬类药物是有镇静效果的精神活性药物 Benzodiazepines are psychoactive drugs that have a relaxing effect.
而β-受体拮抗剂可以缓解表现焦虑的躯体症 Beta blockers can help ease the physical symptoms of performance anxiety.
尽管药物治疗能在短时间内起作用 Though medication can be effective in the short term,
认知行为疗法从长远来看更具优势 cognitive behavioral therapy has more advantages in the long term,
因为药物有潜在的不良反应 due to the potential of unwanted side effects.
好的，快速回顾一下 All right, so as a quick recap,
患有社交焦虑障碍的人 people with social anxiety disorder
对自己的某些行为或焦虑表现感到强烈焦虑 have heightened anxiety about acting in a way, or showing symptomsvof anxiety,
因为这些行为可能带来负面评价 that will be negatively scrutinized by others.
仅限于表演状态的焦虑是社交焦虑障碍的一种特殊类型 Anxiety that is restricted only to performance is a specific type of social anxiety.
焦虑几乎总是存在于特定的社交情境中 The anxiety is almost always present in the particular social situation
而且其严重程度足以干扰正常的生活 and is severe enough that it interferes with the normal course of life.