Social Anxiety Disorder
Definition
Social anxiety disorder is the intense fear of social situations. People with social anxiety disorder:
- Avoid interactions with other people
- Are extremely afraid of being judged negatively by others
- Feel humiliated, embarrassed, and inadequate more easily than others
Social anxiety may be:
- Generalized to all social interactions
- Specific to certain social situations, such as public speaking
It is much more severe than shyness. It can interfere with work, school, or other situations. It also carries physical reactions.
Physical Reactions of Anxiety
Causes
The exact cause is unknown. Possible causes include:
- Genetic factors
- Problems with regulation of chemicals in the brain
- Past emotional trauma in social situations
Risk Factors
Factors that increase your chance for social anxiety disorder include:
- Age: adolescence and early adulthood
- Other psychiatric disorders (such as anxiety disorders, bipolar disorder, depression, or substance misuse)
Symptoms
People with social anxiety disorder may have the following symptoms during social interactions:
- Blushing
- Excessive sweating
- Trembling
- Dry throat and mouth
- Muscle twitches
- Intense anxiety
- Rapid heart beat
- Fainting feeling
Symptoms may begin in any public situation such as:
- Being teased or criticized
- Being the center of attention
- Meeting new people
- Interacting with authority figures
- Interacting with members of the opposite sex
- Eating, writing, or speaking in public
- Using public toilets
Diagnosis
Your doctor will ask about your fears and symptoms. A physical exam may be done. You may be referred to a mental health professional. They may conduct a psychiatric evaluation.
Treatment
Treatments include:
Cognitive-behavioral Therapy
With this type of therapy, a therapist may:
- Help you change phobic and other negative thought patterns and behaviors
-
Teach you to control anxiety symptoms by methods such as:
- Deep breathing
- Visualization
- Meditation
-
Suggest changes of your social environment to minimize perceived stress:
- May be helpful in the short term
- Gradually expose you to feared situations in a controlled environment
A peer support group may also be helpful.
Medication
- Selective serotonin reuptake inhibitors (SSRIs)—relieve symptoms of anxiety and depression
- Benzodiazepines, anticonvulsants ( gabapentin, pregabalin), and monoamine oxidase inhibitors—relieve anxiety and depression
- Beta-blockers—stop the physical symptoms of panic and anxiety (used to relieve the performance anxiety that often occurs with social anxiety disorder)
Prevention
There are no guidelines for preventing social anxiety disorder. However, early diagnosis and treatment can prevent complications such as:
- Substance abuse
- Depression
- Dysfunctional school, work, social, and family interactions
Resources:
Anxiety Disorders Association of America
Social Phobia/Social Anxiety Association
Canadian Resources:
Canadian Mental Health Association
Mental Health Canada
References:
Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/Informationby...gClass/UCM096273. Published May 22, 2009. Accessed July 15, 2009.
Ballenger JC, Davidson JRT, Lecrubier Y, et al. Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry. 1998;59:54-60.
Bruce TJ, Saeed SA. Social anxiety disorder: a common, underrecognized mental disorder. Am Fam Physician; 1999.
National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/. Accessed October 12, 2005.
National Mental Health Association website. Available at: http://www.nmha.org/. Accessed October 12, 2005.
Pande AC, Feltner DE, Jefferson JW, et al. Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebo-controlled, multicenter study. J Clin Psychopharmacol. 2004;24:141-149.
Schneier FR. Social anxiety disorder NEJM; 2006;355:1029-1036.
Stein DJ, Ipser JC, van Balkom AJ. Pharmacotherapy for social anxiety disorder. Cochrane Review. Chichester, UK: John Wiley & Sons, Ltd; 2005(3).
Van Ameringen M, Mancini C, Styan G, Donison D. Relationship of social phobia with other psychiatric illness. J Affect Disord. 1991; 21:93-99.
Last reviewed July 2010 by Theodor B. Rais, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.