Social Anxiety Disorder

Social anxiety is the fear of interaction with other people that brings on self-consciousness and feelings of being negatively judged and evaluated. As a result, people with social anxiety have feelings of inadequacy, inferiority, embarrassment, humiliation, and depression and tend to avoid any situation that would bring on these feelings, including going to work or school or engaging in everyday tasks and activities.

Everyone has felt anxious or embarrassed at one time or another. For example, meeting new people or giving a public speech can make anyone nervous, but people with social phobia worry about these and other things for weeks before they happen.

People with social anxiety may become irrationally anxious in social situations, but feel better when they are alone.

Social anxiety can be specific (having anxiety in only some situation) or generalized (having anxiety in almost all situations). A specific social anxiety would be the fear of speaking in front of groups (only), whereas people with generalized social anxiety are anxious, nervous, and uncomfortable in almost all social situations. It is much more common for people with social anxiety to have a generalized type of this disorder, which includes anticipatory anxiety, worry, indecision, depression, embarrassment, feelings of inferiority, and self-blame across most life situations.

People with social phobia are afraid of doing common things in front of other people. For example, they might be afraid to sign a check in front of a cashier at the grocery store, or they might be afraid to eat or drink in front of other people, or use a public restroom. Most people who have social phobia know that they shouldn't be as afraid as they are, but they can't control their fear.

Social phobia usually starts during youth. A doctor can tell that a person has social phobia if the person has had symptoms for at least 6 months. Without treatment, social phobia can last for many years or a lifetime. However, therapy, coping skills, and medicines can help alleviate the symptoms of social anxiety.

Constant, intense anxiety that does not go away is the most common feature of social anxiety disorder.

People with social phobia tend to:

• be very anxious about being with other people and have a hard time talking to them
• be very self-conscious in front of other people and feel embarrassed
• be very afraid that other people will judge them
• worry for days or weeks before an event where other people will be
• stay away from places where there are other people
• have a hard time making friends and keeping friends
• blush, sweat, or tremble around other people
• feel nauseous or sick to their stomach when with other people

People with social anxiety disorder usually experience significant emotional distress in the following situations:

• being introduced to other people
• being teased or criticized
• being the center of attention
• being watched while doing something
• meeting people in authority
• most social encounters, especially with strangers
• going around the room (or table) in a circle and having to say something
• interpersonal relationships, whether friendships or romantic

The physiological manifestations that accompany social anxiety may include

• intense fear
• racing heart
• turning red or blushing
• excessive sweating
• dry throat and mouth
• trembling
• swallowing with difficulty
• muscle twitches, particularly around the face and neck

The exact causes of anxiety disorders are unknown, but areas of the brain that control fear responses may have a role in some anxiety disorders. Anxiety disorders can run in families, which suggests that a combination of genes and environmental stresses can produce the disorders. The role of brain chemistry is also being investigated. In social anxiety disorder, especially, misreading others’ behaviors or body language and weak social skills may contribute to anxiety. Environmental factors, including family characteristics or being around others who have social anxiety, may lead to social anxiety disorder.

To diagnose anxiety disorders, a physical evaluation is recommended to determine whether the anxiety is associated with a physical illness. If anxiety is diagnosed, the pattern of symptoms should be identified, as well as any coexisting conditions, such as depression or substance abuse. These conditions should be treated with appropriate therapies. To diagnose social anxiety disorder, the symptoms of anxiety must have been present for at least 6 months.

With proper treatment, many people with social anxiety disorder lead normal, fulfilling lives. If you think you have social anxiety disorder, seek help from a mental health professional who has particular expertise in diagnosing and treating anxiety.

You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a clinician with whom you are comfortable, you will work together to create an individualized treatment plan for your anxiety disorder.

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Talking with a trusted friend or family member can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician.

Social phobia is generally treated with psychotherapy, medication, or both. Treatment can provide significant relief from symptoms, but it does not always provide a complete cure.
Antidepressants are used to treat depression, but they are also helpful for social phobia. They are probably more commonly prescribed for social phobia than anti-anxiety medications. Common antidepressants prescribed for social anxiety include paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor XR).

Benzodiazepines are anti-anxiety drugs that can be used to treat social anxiety. Common benzodiazepines include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).

A type of antidepressant called monoamine oxidase inhibitors (MAOIs) are especially effective in treating social phobia. However, they are rarely used as a first line of treatment because when MAOIs are combined with certain foods or other medicines, dangerous side effects can occur. Phenelzine (Nardil) and tranylcypromine (Parnate) are common and well-studied MAOIs.

Another type of medication called beta-blockers, which is normally used to treat high blood pressure, can help control some of the physical symptoms of social phobia such as excessive sweating, shaking, or a racing heart. They are most commonly prescribed when the symptoms of social phobia occur in specific situations, such as “stage fright.” Beta-blockers include metoprolol (Toprol XL, Lopressor), carvedilol (Coreg), bisoprolol (Zebeta), betaxolol (Kerlone), nebivolol (Bystolic), and propranolol (Inderal, Pronol).

Psychotherapy involves talking with a trained clinician, such as a psychiatrist, psychologist, social worker, or counselor, to understand the symptoms and triggers of an anxiety disorder and how to manage it. It can be useful in treating anxiety disorders by helping people change the thinking patterns that support the fears and anxieties and changing the way they react to anxiety-provoking situations.

Stress management and relaxation techniques, including meditation, yoga, exercise, and other alternative treatments can help people with anxiety disorders stay calm and may enhance the effects of therapy. Caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, and these substances should be avoided. Check with your physician or pharmacist before taking any additional medications.

Friends and family are an important part of the recovery of a person with an anxiety disorder. The family should be supportive and not help perpetuate their loved one’s symptoms. Family members should not trivialize the disorder or demand improvement without treatment.