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Social anxiety disorder

Definition

Social anxiety disorder is a persistent and irrational fear of situations that may involve scrutiny or judgment by others, such as at parties and other social events.

Alternative Names

Phobia - social

Causes

People with social anxiety disorder fear and avoid situations in which they may be judged by others. It may begin in adolescence and may have to do with overprotective parents or limited social opportunities. Males and females are affected equally with this disorder.

People with social phobia are at high risk for alcohol or other drug use. This is because they may come to rely on alcohol or drugs to relax in social situations.

Symptoms

People with social anxiety become very anxious and self-conscious in everyday social situations. They have an intense, persistent, and chronic fear of being watched and judged by others, and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends.

Social anxiety can be limited to one situation (such as talking to people, eating or drinking, or writing on a blackboard in front of others). Or, it may be so broad that the person experiences anxiety around almost everyone other than family members.

Physical symptoms that often occur include:

  • Blushing
  • Difficulty talking
  • Nausea
  • Profuse sweating
  • Trembling

Social anxiety disorder is different from shyness. Shy people are able to participate in social functions. Social anxiety disorder affects the ability to function in work and relationships.

Some of the most common fears of people with this disorder include:

  • Attending parties and other social occasions
  • Eating, drinking, and writing in public
  • Meeting new people
  • Speaking in public
  • Using public restrooms

Exams and Tests

The health care provider will look at your history of social anxiety and will get a description of the behavior from you, your family, and friends.

Treatment

The goal of treatment is to help you function effectively. The success of the treatment usually depends on the severity of the phobia.

Anti-anxiety and antidepressant medications are sometimes used to help relieve the symptoms. See: Panic Disorder for more information about medications.

Behavioral treatment may have long-lasting benefits:

  • Cognitive behavioral therapy helps you understand and change the thoughts that are causing your condition, as well as learn to recognize and replace panic-causing thoughts.
  • Systematic desensitization or exposure therapy may be used. You are asked to relax, then imagine the situations that cause the anxiety, working from the least fearful to the most fearful. Gradual exposure to the real-life situation has also been used with success to help people overcome their fears.
  • Social skills training may involve social contact in a group therapy situation to practice social skills. Role playing and modeling are techniques used to help you become more comfortable relating to others in a social situation.

Lifestyle changes may help reduce how often the attacks occur.

  • Get regular exercise, enough sleep, and regularly scheduled meals.
  • Reduce or avoid the use of caffeine, some over-the-counter cold medicines, and other stimulants.

Outlook (Prognosis)

The outcome is often good with treatment. Antidepressant medications can also be effective.

Possible Complications

  • Alcohol use to combat anxiety
  • Alcohol or other drug dependence
  • Loneliness and social isolation

When to Contact a Medical Professional

Call your health care provider or mental health professional if fear is affecting your work and relationships with others.

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, Va: American Psychiatric Publishing. 2013.

Stein MB, Stein DJ. Social anxiety disorder. Lancet. 2008;371:1115-1125.

Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders: Panic, social anxiety, and generalized anxiety. In: Stern TA, Rosenbaum JF, Fava M, et al, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Elsevier Mosby; 2008:chap 32.


Review Date: 3/10/2014
Reviewed By: Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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