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

Social anxiety disorder is much more severe than shyness. It can interfere with work, school, or other situations, as well as cause physical symptoms.

Physical Reactions of Anxiety

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Causes

The exact cause is unknown. Possible causes include:

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

Risk Factors

Social anxiety disorder is most common in adolescence and early adulthood. It is almost twice as common in women than in men. Other factors that may increase your chance of social anxiety disorder include:

• Family history of social anxiety
• Other psychiatric disorders, such as anxiety, bipolar disorder, depression, or substance abuse

Symptoms

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

Symptoms during these social interactions may include:

• Blushing
• Excessive sweating
• Trembling
• Dry throat and mouth
• Muscle twitches
• Rapid heart beat
• Lightheadness

Diagnosis

You will be asked about your fears and symptoms. A physical exam may be done. You may be referred to a mental health specialist. A psychiatric evaluation may be done.

Treatment

Treatments may include:

Cognitive-Behavioral Therapy

During cognitive-behavioral therapy (CBT), the therapist may:

• Help you change your negative thought patterns and behaviors
• Teach you techniques to help you control anxiety symptoms, such as deep breathing, visualization, and meditation
• Suggest changes to your social environment to minimize stress
• Gradually expose you to feared situations in a controlled environment

A support group may also be part of your treatment.

Medication

The following medications may be used to help control symptoms:

• Selective serotonin reuptake inhibitors (SSRIs) or other antidepressants—to help relieve symptoms of anxiety and depression
• Beta-blockers—to stop the physical symptoms of panic and anxiety (has been used to relieve the performance anxiety that often occurs with social anxiety disorder)

Other medications may include:

• Benzodiazepines
• Anticonvulsants

Prevention

There are no guidelines to prevent social anxiety disorder. However, early diagnosis and treatment can prevent complications, such as:

• Substance abuse
• Depression
• Difficulties at school, work, or in your personal life