Social Anxiety Disorder

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 criticised by others.

A person with a social phobia is afraid that he or she will make mistakes 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 phobias 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 centre 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 recognise 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 diarrhoea.
  • Children with this disorder may express their anxiety by crying, clinging to a parent or throwing a tantrum.


How common is social anxiety disorder?

The Royal College of Psychiatrists says 5% of people have some degree of social phobia, with women two or three times more likely to be affected. 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 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 behaviour of others or seeing what happened to someone else as the result of their behaviour (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, your GP will begin an evaluation by asking questions about your medical history and performing a physical examination. Although there are no laboratory tests to specifically diagnose social anxiety disorder, your GP 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 or psychologist, doctors who are 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 their 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-behaviour therapy (CBT). Medication may also be used to help ease the symptoms of social anxiety disorder so that CBT is more effective. Medicines may also be used alone.

  • Cognitive-behaviour therapy: The aim 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 desensitisation or real life exposure to the feared situation. With systematic desensitisation, the person imagines the frightening situation and works through their 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, tranquillisers (benzodiazepines) and beta-blockers. Beta-blockers, which are often used to treat heart conditions, may also be used to minimise certain physical symptoms of anxiety, such as shaking and rapid heartbeat.
  • Counselling: 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.


Referenced from http://www.webmd.boots.com/anxiety-p...xiety-disorder