Social Anxiety Disorder

Social anxiety disorder, also called social phobia, is a type of anxiety disorder that causes extreme fear in social settings. People with this disorder have trouble talking to people, meeting new people, and attending social gatherings. They fear being judged or scrutinized by others. They may understand that their fears are irrational or unreasonable, but feel powerless to overcome them.

Social anxiety is different from shyness. Shyness is usually short-term and doesn’t disrupt one’s life. Social anxiety is persistent and debilitating. It can affect one’s ability to:

• work
• attend school
• develop close relationships with people outside of his or her family

Approximately 15 million American adults have social anxiety disorder. According to the Anxiety and Depression Association of America (ADAA), symptoms of this disorder may start around the age of 13 (ADAA, 2012).

The exact cause of social phobia is unknown. However, doctors believe it’s a combination of environmental factors and genetics. Negative experiences also may contribute to this disorder, including:

• bullying
• family conflict
• sexual abuse

Physical abnormalities such as a serotonin imbalance may contribute. Serotonin is a chemical in the brain that helps regulate mood. An overactive amygdala (a structure in the brain that controls fear response and feelings or thoughts of anxiety) may also cause these disorders.

Anxiety disorders can run in families. However, doctors aren’t sure if they’re actually linked to genetic factors (Mayo Clinic, 2011). Learning to react to situations in the same way as other people in your family may cause you to develop a social phobia.

Social interaction may cause the following physical symptoms:

• blushing
• nausea
• excessive sweating
• trembling or shaking
• difficulty speaking
• dizziness or lightheadedness
• rapid heart rate

Psychological symptoms may include:

• worrying intensely about social situations
• worrying for days or weeks before an event
• avoiding social situations or trying to blend into the background if you must attend
• worrying about embarrassing yourself in a social situation
• worrying that other people will notice you are stressed or nervous
• needing a drink to face a social situation
• missing school or work because of anxiety

It is normal to sometimes feel anxious. However, when you have social phobia, you have a constant fear of being judged by others or humiliated in front of them. You may avoid all social situations, including:

• asking a question
• conducting a job interview
• shopping
• using public restrooms
• talking on the phone
• eating in public

Symptoms of social anxiety may not occur in all situations. You can have limited or selective anxiety. For example, symptoms may only occur when you’re eating in front of people or talking to strangers. Symptoms can occur in all social settings if you have a broad or extreme case.

There is no medical test to check for social anxiety disorder. Your doctor will diagnose social phobia from a description of your symptoms. He or she can also diagnose social phobia after examining certain behavioral patterns.

During your appointment, your doctor will ask you to explain your symptoms. He or she will also ask you to talk about situations that cause your symptoms. The criteria for social anxiety disorder includes:

• a constant fear of social situations due to fear of humiliation or embarrassment
• feeling anxious or panicky before a social interaction
• a realization that your fears are unreasonable
• anxiety that disrupts daily living

Several types of treatment are available for social anxiety disorder. Treatment results differ from person to person. Some people only need one type of treatment. However, others may require more than one. Your doctor may start with self-help treatments and therapy before suggesting medication.

Treatment options for social anxiety disorder include:

• cognitive-behavioral therapy: learning how to control anxiety through relaxation and breathing and learning to replace negative thoughts with positive ones
• exposure therapy: learning how to gradually face social situations, rather than avoiding them
• group therapy: learning social skills and techniques to help you interact with people in social settings. Participating in group therapy with others who have the same fears may make you feel less alone. It will give you a chance to practice your new skills through role playing

At-home treatments include:

• avoiding caffeine: foods such as coffee, chocolate, and soda are stimulants and may increase anxiety
• getting plenty of sleep (at least eight hours per night): lack of sleep can increase anxiety and worsen symptoms of social phobia

Your doctor may prescribe medications that treat anxiety and depression if your condition doesn’t improve with therapy and lifestyle changes. These medications do not cure social anxiety disorder. However, they can improve your symptoms and help you function in daily life. Symptoms may take up to three months to improve with medication.

Medications approved by the Food and Drug Administration (FDA) to treat social anxiety disorder include Paxil, Zoloft, and Effexor. Your doctor may start you with a low dose of medication and gradually increase your prescription to avoid side effects.

Common side effects of these medication include:

• insomnia (sleeplessness)
• weight gain
• upset stomach
• lack of sexual desire

Talk to your doctor about the benefits and risks to decide which treatment is right for you.

About 36 percent of people with social anxiety have symptoms for at least 10 years before speaking with a doctor (ADAA, 2012).

People with social phobia may rely on drugs and alcohol to cope with anxiety triggered by social interaction. Left untreated, social phobia can lead to other high-risk behaviors, including:

• alcohol and drug abuse
• loneliness
• thoughts of suicide

The outlook for social anxiety is good with treatment. Therapy, lifestyle changes, and medication can help many people cope with their anxiety and function in social situations.

Social phobia doesn’t have to control your life. Although it may take weeks or months, psychotherapy and/or medication can help you begin to feel calmer and more confident in social situations.

Keep your fears under control by:

• recognizing the triggers that cause you to start feeling nervous or out of control
• practicing relaxation and breathing techniques
• taking your medication as directed