Social Anxiety Disorder

Social anxiety disorder, previously called social phobia, is a mental disorder. People with social anxiety disorder frequently feel nervous, afraid, or embarrassed when around other people in social situations. They constantly worry that other people are judging or criticizing them for how they look, what they say, or how they act. They may worry that other people might reject them because of their appearance or behavior.

Social anxiety disorder is more than just occasional shyness or self-consciousness. It can cause severe emotional distress. It can interfere with daily life activities. Social anxiety disorder also may lead to excessive alcohol or drug use and even suicide.

Social anxiety disorder is actually one of the most common mental disorders. It can develop at any time but usually starts in the teenage years. Women are more commonly affected than men. Social anxiety disorder is also more common in people who have family members with anxiety disorders. It also is more common in people who have physical deformities or conditions with characteristics that are obvious to others, such as stuttered speech or movement abnormalities (Parkinson disease).

SYMPTOMS

In addition to feeling anxious or fearful in social situations, people with social anxiety disorder frequently have physical symptoms. Examples include:

  • Red face (blushing).

  • Racing heart.

  • Sweating.

  • Shaky hands or voice.

  • Confusion.

  • Lightheadedness.

  • Upset stomach and diarrhea.

DIAGNOSIS

Social anxiety disorder is diagnosed through an assessment by your caregiver. Your caregiver will ask you questions about your mood, thoughts, and reactions in social situations. Your caregiver may ask you about your medical history and use of alcohol or drugs, including prescription medications. Certain medical conditions and the use of certain substances, including caffeine, can cause symptoms similar to social anxiety disorder. Your caregiver may refer you to a mental health specialist for further evaluation or treatment.

The criteria for diagnosis of social anxiety disorder are:

  • Marked fear or anxiety in one or more social situations in which you may be closely watched or studied by others. Examples of such situations include:

  • Interacting socially (having a conversation with others, going to a party, or meeting strangers).

  • Being observed (eating or drinking in public or being called on in class).

  • Performing in front of others (giving a speech).

  • The social situations of concern almost always cause fear or anxiety, not just occasionally.

  • People with social anxiety disorder fear that they will be viewed negatively in a way that will be embarrassing, will lead to rejection, or will offend others. This fear is out of proportion to the actual threat posed by the social situation.

  • Often the triggering social situations are avoided, or they are endured with intense fear or anxiety. The fear, anxiety, or avoidance is persistent and lasts for 6 months or longer.

  • The anxiety causes difficulty functioning in at least some parts of your daily life.

TREATMENT

Several types of treatment are available for social anxiety disorder. These treatments are often used in combination and include:

  • Talk therapy. Group talk therapy allows you to see that you are not alone with these problems. Individual talk therapy helps you address your specific anxiety issues with a caring professional. The most effective forms of talk therapy for social anxiety disorder are cognitive–behavioral therapy and exposure therapy. Cognitive–behavioral therapy helps you to identify and change negative thoughts and beliefs that are at the root of the disorder. Exposure therapy allows you to gradually face the situations that you fear most.

  • Relaxation and coping techniques. These include deep breathing, self-talk, meditation, visual imagery, and yoga. Relaxation techniques help to keep you calm in social situations.

  • Social skills training. Social skills can be learned on your own or with the help of a talk therapist. They can help you feel more confident and comfortable in social situations.

  • Medication. For anxiety limited to performance situations (performance anxiety), medication called beta blockers can help by reducing or preventing the physical symptoms of social anxiety disorder. For more persistent and generalized social anxiety, antidepressant medication may be prescribed to help control symptoms. In severe cases of social anxiety disorder, strong antianxiety medication, called benzodiazepines, may be prescribed on a limited basis and for a short time.