Social Anxiety Disorder

1 What is Social Anxiety Disorder (Social Phobia)?

Social anxiety disorder or social phobia is an anxiety disorder characterized by excessive fear of situations or events that involve interaction with other people. The person may be worried about being judged or evaluated negatively by other people. This causes persistent worry and distress during most times of a person’s life.

People with this disorder is often seen as a shy, withdrawn, or a nervous person. But, these people are actually eager to make friends and be involved in groups. They distress about being center of attention, or meeting a person in authority.

Social anxiety can be controlled successfully by psychotherapy and medications.

2 Symptoms

Symptoms of social anxiety disorder (social phobia) usually develop during early teens. In some cases the onset is noticed much earlier or during adulthood. Social anxiety disorder involves both psychological and behavioral symptoms. Social phobia is characterized by:

  • Fear or worry about being introduced to new people
  • Fear of being judged or criticized
  • Anxious about being center of attention
  • Feeling nervous of being watched while doing something
  • Avoiding speaking or doing things in fear of embarrassment
  • Avoiding situations that make you look anxious
  • Extremely anxious about an event or activity
  • Expecting negative or worst consequences during a situation

Children may respond by crying, throwing a temper tantrum, and refusing to speak or perform in a social situation. In addition to the emotional symptoms social phobia is characterized by several physical symptoms like:

People with this disorder try to avoid everyday situations like:

  • eating in front of others
  • making eye contact
  • starting a conversation
  • attending social gatherings
  • entering a room where people are already present
  • returning items at a store
  • going to work or school
  • and meeting strangers
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3 Causes

The exact cause of social anxiety disorder (social phobia) is unknown.

An interaction of genetic and environmental factors is implied in the development of this disorder. It is found to run in families, and hence if there is a close family member with this disorder, the risk of social disorder increases. But it is still not clear to what extent genetics play a role in developing this disorder.

Amygdala in the brain controls fear and related feelings. Increased activity of amygdala result in heightened fear response that lead to anxiety.

Anxiety disorder may also be caused by learning or seeing another person with anxiety. Social anxiety disorder is more commonly seen among children whose parents are more controlling or protective.

The major risk factors for this disorder are

  • Family history
  • Emotional trauma or negative experiences
  • Shy or withdrawn personality
  • Medical condition that attracts attention like stuttering or Parkinson’s disease

4 Making a Diagnosis

The first step in the diagnosis of social anxiety disorder (social phobia) is to rule out chances of other medical conditions that cause similar symptoms. Social anxiety disorder is differentiated from other associated mental disorders.

Physical examination helps to determine the trigger for the symptoms. Review of symptoms, their frequency and situations in which they occur provide important clues to the cause of the disorder. Psychological questionnaires also help to identify the triggers and the cause of symptoms.

Criteria for the diagnosis of this anxiety disorder is given in Diagnostic and Statistical Manual of Mental Disorders (DSM) published by American Psychiatric Association. The criteria for diagnosis are:

  • Symptom of constant fear or worry about social interactions for more than six months.
  • Avoiding social situations that trigger fear
  • Excessive fear or worry about a situation which is disproportional to the impact of the situation
  • Anxiety that affects daily life
  • Fear or worry that cannot be explained with any other medical condition or substance abuse like alcohol

5 Treatment

As in other anxiety disorders, psychotherapy and medications are the most common treatment methods used for social anxiety disorder. It may be used alone or in combination to control the symptoms.

Psychotherapy helps the patient to identify the negative thoughts, change them, and develop a more confident and positive approach to different situations. The most popular form of psychotherapy for treatment is cognitive behavioral therapy. In one form of cognitive behavioral therapy, called exposure-based cognitive behavioral therapy, the person is exposed to the trigger gradually, which helps in facing the situation. This helps the patient to face the situation with more confidence. Skills training and role playing enable learning the much needed social skills.

Selective serotonin reuptake inhibitors (SSRIs) like paroxetine and venlafaxine are commonly used for alleviating the symptoms of social anxiety disorder. Other anti-depressants and anti-anxiety medications are used to reduce excessive anxiety.

Beta blockers help to reduce the physical symptoms like rapid heartbeat, blood pressure, and shaking. These medications are particularly useful before a stressful situation like a speech.

The right kind of medication for a person may depend on several factors and is often recommended after trial and error. Being consistent with psychotherapy and medications is very important for successful treatment of the disorder.

6 Prevention

There is no standard preventive measure for social anxiety disorder (social phobia) as the actual cause of the disease is not known. The impact of symptoms can be reduced by early treatment and keeping a journal of the trigger for anxiety attack.

Carefully planning and managing activities help to reduce anxiety. Avoid substance abuse like alcohol and drugs as these worsen the symptoms of social anxiety disorder.

7 Alternative and Homeopathic Remedies

Herbal remedies are usually used as alternative medicine in treating anxiety. Herbal supplements of kava, valerian, passionflower, and theanine control excessive worry.

In homeopathy, lycopodium is used to reduce anxiety caused by poor self-esteem.

Gelsemium is recommended for chronic anxiety.

Evening primrose oil is considered to be useful against different forms of anxiety.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with social anxiety disorder (social phobia).

Self-management helps to control the responses during exposure to triggers. Taking help from family and friends to deal with the situation provides good support during triggers.

Regular practice, good sleep, well-balanced diet, and avoiding alcohol help to improve the mood and keep them mentally active. Preparing well for any social interaction helps to cope with the situation comfortably.

9 Risks and Complications

Social anxiety disorder (social phobia) may result in complications like:

  • low self-esteem,
  • negative self-image,
  • hypersensitivity,
  • poor social skills,
  • trouble in social relationships,
  • self-harm,
  • substance abuse.
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