Overview
Social anxiety disorder (social phobia) is a mental health condition characterized by persistent fear, anxiety, and avoidance of social situations due to concerns about being judged or viewed negatively by others. This can lead to significant distress and impact daily activities, relationships, and overall functioning. Symptoms typically begin in early to mid-teens, but can also start in younger children or adults. Social anxiety disorder is distinct from occasional shyness or discomfort in social situations and involves more severe fear and avoidance. Treatment options include psychotherapy and medications to help individuals manage their symptoms and improve their ability to interact with others.
Understanding the disease
Symptoms
The symptoms of social anxiety disorder include constant fear of situations in which you may be judged negatively, worry about embarrassing or humiliating yourself, intense fear of interacting or talking with strangers, and fear that others will notice that you look anxious. Physical symptoms may also accompany social anxiety disorder and may include blushing, fast heartbeat, trembling, sweating, upset stomach or nausea, trouble catching your breath, dizziness or lightheadedness, feeling that your mind has gone blank, and muscle tension. Children may express anxiety about interacting with adults or peers through crying, having temper tantrums, clinging to parents, or refusing to speak in social situations. Untreated social anxiety disorder can lead to complications such as low self-esteem, trouble being assertive, negative self-talk, hypersensitivity to criticism, poor social skills, isolation, difficult social relationships, low academic and employment achievement, substance abuse, and suicide or suicide attempts.
Risk Factors
The risk factors for developing social anxiety disorder include family history, negative experiences such as teasing or bullying, temperament, and new social or work demands. Individuals with a family history of anxiety disorders or those who have experienced negative events in their lives may be more prone to developing social anxiety disorder. Children who are naturally shy, timid, or withdrawn may also be at a greater risk. Finally, meeting new people, giving speeches, or making important work presentations can trigger symptoms for the first time.
Development
Social anxiety disorder can develop due to a complex interaction of biological and environmental factors. It tends to run in families, and children who experience teasing, bullying, rejection, or other negative events may be more prone to developing social anxiety disorder. Those who are naturally shy, timid, or withdrawn in new situations or around people may also be at greater risk. Meeting new people, giving public speeches, or facing new social or work demands can trigger symptoms for the first time. The condition typically starts in the early to mid-teens but can sometimes begin in younger children or adults.
Assessment and Diagnosis
Triage
You should see a doctor or mental health professional if you fear and avoid normal social situations because they cause embarrassment, worry, or panic. This is a key symptom of social anxiety disorder, and seeking professional help can help you manage the condition effectively.
Diagnosis
To diagnose social anxiety disorder, a health care provider will typically evaluate the patient based on a physical exam, discussion of symptoms, a review of situations that trigger anxiety, self-report questionnaires, and criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. The DSM-5 criteria include persistent, intense fear or anxiety about specific social situations, avoidance of these situations or enduring them with intense fear or anxiety, excessive anxiety that's out of proportion to the situation, anxiety or distress that interferes with daily living, and fear or anxiety not better explained by a medical condition, medication, or substance abuse.
Management and Treatment
Complications
Complications of untreated social anxiety disorder may include:
- Low self-esteem
- Difficulty being assertive
- Negative self-talk
- Hypersensitivity to criticism
- Poor social skills
- Isolation and challenging social relationships
- Low academic and employment achievement
- Substance abuse, such as excessive alcohol consumption
- Suicide or suicide attempts Social anxiety disorder may also co-occur with other anxiety disorders, major depressive disorder, and substance abuse problems.
Treatment
The treatments for social anxiety disorder include learning coping skills in psychotherapy and taking medications. Psychotherapy and medications can help individuals with social anxiety disorder gain confidence and improve their ability to interact with others. It's important to seek help from a mental health professional if you fear and avoid normal social situations due to embarrassment, worry, or panic.
Preparing for medical consultation
To prepare for an appointment for social anxiety disorder, make a list of:
- Your social anxiety symptoms: Note when they occur, how they affect your day-to-day activities and interactions, and whether any situations or factors seem to worsen your anxiety.
- Situations you've been avoiding: Identify situations that trigger social anxiety, especially those that are important to your functioning.
- Any other mental health problems: Discuss any other mental health issues you may be experiencing or have experienced in the past.
- Any physical health problems: Mention any physical health issues you have, as these may also impact your social anxiety.
- Medications and supplements: Include any medications, vitamins, herbs, or other supplements you're taking, along with their doses.
- Questions to ask your doctor: Prepare a list of questions to ask your healthcare provider during the appointment, such as:
- What treatment options are available for my social anxiety disorder?
- How long will it take for the treatment to be effective?
- Are there any lifestyle changes I can make to help manage my social anxiety?
- Are there any support groups or resources available for individuals with social anxiety disorder?
- Key personal information: Be prepared to share any significant events or changes in your life that may have contributed to your social anxiety. Remember to be honest and open with your healthcare provider about your symptoms and concerns. This information will help them better understand your situation and provide appropriate guidance and treatment.