Social Anxiety Disorder

What Is Social Anxiety Disorder?

Social anxiety disorder, also called social phobia, is a disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with the condition have a persistent, intense, and chronic fear of being watched and judged by others and of being embarrassed or humiliated by their actions. Their fear may be so severe that it interferes with:

 

While many people with social anxiety disorder recognize that their fear of being around people may be excessive or unreasonable, they are unable to overcome it. They often worry for days or weeks in advance of a dreaded situation.

 

Types of Social Anxiety Disorder

Social anxiety disorder can be limited to only one type of situation, such as a fear of speaking in public or eating or drinking in front of others. In its most severe form, the condition may be so broad that people experience symptoms almost anytime they are around other people.

 

Social anxiety disorder can be debilitating -- it may even keep people from going to work or school on some days. Many people with this illness have a hard time making and keeping friends.

 

What Are the Symptoms?

Physical symptoms often accompany the intense worry associated with social anxiety disorder, such as:

 

These visible symptoms heighten the fear of disapproval, and the symptoms themselves can become an additional focus of fear. Fear of these symptoms can create a vicious cycle: As people with social anxiety disorder worry about experiencing the symptoms, the greater their chances of developing them.

 

This condition often runs in families and may be accompanied by depression or alcohol dependence.

 

Facts on Social Anxiety Disorder

About 3.7 percent of the U.S. population ages 18 to 54 (approximately 5.3 million Americans) has social anxiety disorder in any given year. Women and men are equally likely to develop the condition. The disorder typically begins in childhood or early adolescence and rarely develops after age 25.

 

Possible Causes

Research to define the causes of social anxiety disorder is ongoing. Some researchers believe a small structure in the brain called the amygdala is involved in symptoms of the condition. The amygdala is believed to be a central site in the brain that controls fear responses. Animal studies are adding to the evidence that suggests social anxiety disorder can be inherited.

 

Another area of research is investigating a biochemical basis for the disorder. Scientists are exploring the idea that heightened sensitivity to disapproval may be physiologically or hormonally based.

 

Other researchers are investigating the role of environment on the development of social anxiety disorder. People with the condition may acquire their fear from observing the behavior and consequences of others, a process called observational learning or social modeling.

 

Treating Social Anxiety Disorder

Two effective forms of treatment are available for social anxiety disorder:

 

Medications include antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as well as drugs known as high-potency benzodiazepines.

 

Some people with a form of social anxiety disorder called performance phobia have been helped by beta blockers, which are more commonly used to control high blood pressure.

 

Cognitive behavioral therapy is also useful in treating social anxiety disorder. The central component of this treatment is exposure therapy, which involves helping patients gradually become more comfortable with situations that frighten them. The exposure process often involves three stages. The first involves introducing people to the feared situation. The second is to increase the risk for disapproval in that situation so people build confidence in their ability to handle rejection or criticism. The third stage involves teaching people techniques to cope with disapproval. In this stage, people imagine their worst fear and are encouraged to develop constructive responses to their fear and perceived disapproval.

 

Cognitive behavioral therapy for social anxiety disorder also includes anxiety management training -- for example, teaching people techniques such as deep breathing to control their anxiety. Another important aspect of treatment is called cognitive restructuring, which involves helping individuals identify their misjudgments and develop more realistic expectations of the likelihood of danger in social situations.

 

Supportive therapy, such as group therapy or couples or family therapy to educate significant others about the disorder, is also helpful. Sometimes, people with social anxiety disorder also benefit from social skills training.

 

Social Anxiety Disorder and Other Conditions

Social anxiety disorder can cause lowered self-esteem and depression. To try to reduce their anxiety and alleviate depression, some people with the condition turn to alcohol or other drugs, which can lead to addiction. Some people may also have other anxiety disorders, such as panic disorder and obsessive-compulsive disorder (OCD).