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, look bad, 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 can 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 second most common type of anxiety disorder (after specific phobias) and the third most common mental disorder in the U.S., after depression and alcohol dependence. An estimated 19.2 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 is currently thought to be related to abnormal functioning of brain circuits that regulate emotion and the "fight or flight" response center in the brain. Genetic factors may also contribute, because social anxiety may be somewhat more likely to occur when it is also present in a first-degree relative (parent, sibling, or child).
- Psychological: The development of social anxiety disorder may stem from embarrassing or humiliating social experiences in the past, such as being bullied or neglected by peers.
- 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 of social anxiety disorder are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical exam. Although there are no lab 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, psychologist, or other mental health professional who is 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?
For social anxiety disorder, the most effective treatment currently available is cognitive behavioral therapy (CBT). Medication may also be used to help ease the symptoms of social anxiety disorder so that CBT is more effective. Drugs may also be used alone.
- 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 drugs used to treat social anxiety disorder, including: antidepressants, like Paxil; sedatives (benzodiazepines), such as Klonopin 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 for those with social anxiety disorder is generally good with treatment. Many people improve and enjoy more productive lives.
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.