Social Anxiety Disorder

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Social anxiety disorder, also called social phobia, is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations. Anxiety (intense nervousness) and self-consciousness arise from a fear of being closely watched, judged and criticized by others.

A person with social anxiety disorder is afraid that he or she will make mistakes and be embarrassed or humiliated in front of others. The fear may be made worse by a lack of social skills or experience in social situations. The anxiety can build into a panic attack. As a result of the fear, the person endures certain social situations in extreme distress or may avoid them altogether. In addition, people with social anxiety disorder often suffer "anticipatory" anxiety -- the fear of a situation before it even happens -- for days or weeks before the event. In many cases, the person is aware that the fear is unreasonable, yet is unable to overcome it.

People with social anxiety disorder suffer from distorted thinking, including false beliefs about social situations and the negative opinions of others. Without treatment, social anxiety disorder can negatively interfere with the person's normal daily routine, including school, work, social activities and relationships.

People with social anxiety disorder may be afraid of a specific situation, such as speaking in public. However, most people with social anxiety disorder fear more than one social situation. Other situations that commonly provoke anxiety include:

Eating or drinking in front of others

Writing or working in front of others

Being the center of attention

Interacting with people, including dating or going to parties

Asking questions or giving reports in groups

Using public toilets

Talking on the telephone

Social anxiety disorder may be linked to other mental illnesses, such as panic disorder, obsessive-compulsive disorder and depression. In fact, many people with social anxiety disorder initially see the doctor with complaints related to these disorders, not because of social anxiety symptoms.

What Are the Symptoms of Social Anxiety Disorder?

Many people with social anxiety disorder feel that there is "something wrong," but don't recognize their feeling as a sign of illness. Symptoms of social anxiety disorder include:

Intense anxiety in social situations

Avoidance of social situations

Physical symptoms of anxiety, including confusion, pounding heart, sweating, shaking, blushing, muscle tension, upset stomach and diarrhea

Children with this disorder may express their anxiety by crying, clinging to a parent or throwing a tantrum.

How Common Is Social Anxiety Disorder?

Social anxiety disorder is the most common anxiety disorder and the third most common mental disorder in the U.S., after depression and alcohol dependence. It is estimated that anywhere from 3%-13% of the population suffers from social anxiety disorder. In any year, at least 5.3 million Americans have social anxiety disorder. The disorder most often surfaces in adolescence or early adulthood, but can occur at any time, including early childhood. It is more common in women than in men.

What Causes Social Anxiety Disorder?

There is no single known cause of social anxiety disorder, but research suggests that biological, psychological and environmental factors may play a role in its development.

Biological: Social anxiety disorder may be related to an imbalance of the neurotransmitter serotonin. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell in the brain. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts to stressful situations, leading to anxiety. In addition, social anxiety disorder appears to run in families. This means that the disorder may be passed on in families through genes, the material that contains instructions for the function of each cell in the body.

Psychological: The development of social anxiety disorder may stem from an embarrassing or humiliating experience at a social event in the past.

Environmental: People with social anxiety disorder may develop their fear from observing the behavior of others or seeing what happened to someone else as the result of their behavior (such as being laughed at or made fun of). Further, children who are sheltered or overprotected by their parents may not learn good social skills as part of their normal development.

How Is Social Anxiety Disorder Diagnosed?

If symptoms are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical examination. Although there are no laboratory tests to specifically diagnose social anxiety disorder, the doctor may use various tests to make sure that a physical illness isn't the cause of the symptoms.

If no physical illness is found, you may be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for an anxiety disorder. The doctor bases his or her diagnosis of social anxiety disorder on reports of the intensity and duration of symptoms, including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate social anxiety disorder.

How Is Social Anxiety Disorder Treated?

The most effective therapy currently available is cognitive-behavior therapy (CBT). In some cases, medication may also be used to help ease the symptoms of social anxiety disorder so that CBT is more effective.

Cognitive-behavior therapy: The goal of CBT is to guide the person's thoughts in a more rational direction and help the person stop avoiding situations that once caused anxiety. It teaches people to react differently to the situations that trigger their anxiety symptoms. Therapy may include systematic desensitization or real life exposure to the feared situation. With systematic desensitization, the person imagines the frightening situation and works through his or her fears in a safe and relaxed environment, such as the therapist's office. Real life exposure gradually exposes the person to the situation but with the support of the therapist.

Medication: There are several different types of medications used to treat social anxiety disorder, including: antidepressants, like Paxil and monoamine oxidase inhibitors (MAOIs); Tranquilizers (benzodiazepines), such as Xanax, Librium, Valium, and Ativan; Beta-blockers, often used to treat heart conditions, may also be used to minimize certain physical symptoms of anxiety, such as shaking and rapid heartbeat.

Counseling to improve self-esteem and social skills, as well as relaxation techniques, such as deep breathing, may also help a person deal with social anxiety disorder.

What Is the Outlook for People With Social Anxiety Disorder?

The outlook is generally good with treatment. Many people recover and enjoy more productive lives. According to the National Institute of Mental Health, 80% of people with social anxiety disorder will find relief from medication, CBT or both.

Can Social Anxiety Disorder Be Prevented?

Unfortunately, social anxiety disorder cannot be prevented, but seeking help as soon as symptoms surface can help make treatment more effective.