Social Anxiety Disorder

Definition

Social anxiety disorder is the intense fear of social situations. The condition affects 9% of women and 7% of men within a year period.

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

Social anxiety is much more severe than shyness; it interferes with normal functioning at work, school, or in other situations and carries physical reactions. The fear of social situations is seen by the respective person as being more than it is expected and not within reason, but children may not have this insight about their behavior

Physical Reactions of Anxiety

Physical reaction anxiety

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Causes

The exact cause of social anxiety disorder is unknown. Possible causes include:

  • Genetic factors
  • Problems with regulation of chemicals in the brain
  • Past emotional trauma in social situations

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for social anxiety disorder include:

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

Any public situation, familiar or unfamiliar, can lead to symptoms of social anxiety disorder. Examples include:

  • 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 and may perform a physical exam. You may be referred to a mental health professional for 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 through deep breathing, visualization, and meditation .
  • Suggest changes of your social environment to minimize perceived stress. This may be helpful in the short term, but it is far better to learn to cope with all social situations rather than rely on ways to avoid them.
  • Gradually expose you to feared situations in a controlled environment.

Due to the social nature of this disorder, nonthreatening peer support groups may be helpful in overcoming your phobia.

Medication

  • Selective serotonin reuptake inhibitors (SSRIs) can relieve symptoms of anxiety and the depression that sometimes accompanies social anxiety.

    Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants .

  • Benzodiazepines, anticonvulsants (gabapentin, pregabalin), and monoamine oxidase inhibitors can relieve anxiety and depression.
  • Beta-blockers can 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
http://www.adaa.org

Social Phobia/Social Anxiety Association
http://www.socialphobia.org

CANADIAN RESOURCES:

Canadian Mental Health Association
http://www.ontario.cmha.ca/index.asp

Mental Health Canada
http://www.mentalhealthcanada.com/

References:

Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry . 1998.

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.

Social anxiety disorder: a common, under-recognized mental disorder. Am Fam Physician . 1999.

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 November 2007 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.


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