Your Health - Social Anxiety Disorder

Social Anxiety Disorder

(Social Phobia)

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

It is much more severe than shyness. It can interfere with work, school, or other situations. It also carries physical reactions .

Physical Reactions of Anxiety

Causes

The exact cause is unknown. Possible causes include:

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

Risk Factors

Factors that increase your chance for social anxiety disorder include:

Age: adolescence and early adulthood
Other psychiatric disorders (such as anxiety disorders , bipolar disorder , depression , or substance misuse )

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

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

Diagnosis

Your doctor will ask about your fears and symptoms. A physical exam may be done. You may be referred to a mental health professional. They may conduct 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 by methods such as:
- Deep breathing
- Visualization
- Meditation
Suggest changes of your social environment to minimize perceived stress:
- May be helpful in the short term
Gradually expose you to feared situations in a controlled environment

A peer support group may also be helpful.

Medication

Selective serotonin reuptake inhibitors (SSRIs)—relieve symptoms of anxiety and depression
Benzodiazepines, anticonvulsants ( gabapentin , pregabalin ), and monoamine oxidase inhibitors—relieve anxiety and depression
Beta-blockers—stop the physical symptoms of panic and anxiety (used to relieve the performance anxiety that often occurs with social anxiety disorder)

FDA Public Health Advisory for Antidepressants

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.

Although the warning is for all antidepressants, of most concern are the SSRI class such as:

Prozac ( fluoxetine ), Zoloft ( sertraline ), Paxil ( paroxetine ), Luvox ( fluvoxamine ), Celexa ( citalopram ), Lexapro( escitalopram )

For more information, please visit: http://www.fda.gov/cder/drug/antidepressants/

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/

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

References:

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed July 15, 2009.

Ballenger JC, Davidson JRT, Lecrubier Y, et al. Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry. 1998;59:54-60.

Bruce TJ, Saeed SA. Social anxiety disorder: a common, underrecognized mental disorder. Am Fam Physician ; 1999.

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.

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 2009 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.