Social Phobia/Social Anxiety Disorder

Social phobia, also be called social anxiety disorder or social anxiety, is a diagnosis within psychiatry and other mental health professions referring to excessive anxiety in social situations causing relatively extreme distress and impaired ability to function in at least some areas of daily life. Generalized social anxiety disorder typically involves a persistent, intense, and chronic fear of being judged by others and of potentially being embarrassed or humiliated by their own actions. These fears can be triggered by perceived or actual scrutiny by others. While the fear of social interaction may be recognized by the person as excessive or unreasonable, considerable difficulty can be encountered overcoming it.

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. 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. Approximately 13.3 percent of the general population may meet criteria for social anxiety disorder at some point in their lifetime, according to the highest survey estimate, with the male to female ratio being 1:1.5.

 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.

 Signs and symptoms

An early diagnosis may help in minimizing the symptoms and the development of additional problems such as depression. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. Social anxiety disorder can have emotional, behavioral and physical signs and symptoms.

Emotional and behavioral signs and symptoms of social anxiety disorder include:

  • Intense fear of being in situations in which you don't know people
  • Fear of situations in which you may be judged
  • Worrying about embarrassing or humiliating yourself
  • Fear that others will notice that you look anxious
  • Anxiety that disrupts your daily routine, work, school or other activities
  • Avoiding doing things or speaking to people out of fear of embarrassment
  • Avoiding situations where you might be the center of attention

Physical signs and symptoms of social anxiety disorder include:

  • Blushing
  • Profuse sweating
  • Trembling or shaking
  • Nausea
  • Stomach upset
  • Difficulty talking
  • Shaky voice
  • Muscle tension
  • Confusion
  • Palpitations
  • Diarrhea
  • Cold, clammy hands
  • Difficulty making eye contact

 Screening and diagnosis

There is no laboratory test to diagnose social anxiety disorder, however. Dr. Tapp or a mental health provider will ask you to describe your signs and symptoms, how often they occur and in what situations. He or she may review a list of situations to see if they make you anxious or have you fill out psychological questionnaires or self-assessments to help pinpoint a diagnosis.

To be diagnosed with social anxiety disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

 How Is Social Anxiety Disorder Treated?

The most effective therapy currently available is cognitive-behavior therapy (CBT). Medication may also be used to help ease the symptoms of social anxiety disorder so that CBT is more effective. Medication 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 medications used to treat social anxiety disorder, including: antidepressants, tranquilizers, and 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.

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The information contained on this site is not intended to be a substitute for professional medical advice. Please visit Dr. Tapp prior to starting any new treatment or with any questions you may have regarding a medical condition or concern. Any duplication or distribution of the information contained herein is strictly prohibited.

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