Overview

Feeling nervous in certain social situations is a common experience for many individuals. However, for those with social anxiety disorder, also known as social phobia, everyday interactions can trigger significant anxiety, self-consciousness, and embarrassment due to the fear of being negatively judged or scrutinized by others.

Social anxiety disorder can lead to avoidance behaviors that disrupt various aspects of life. The severe stress caused by this condition can impact relationships, daily routines, work, school, and other activities.

While social anxiety disorder can be a chronic mental health condition, learning coping skills through psychotherapy and taking medications can help individuals gain confidence and improve their ability to interact with others.

Symptoms

Feelings of shyness or discomfort in certain situations aren’t necessarily signs of social anxiety disorder, particularly in children. Social anxiety disorder includes fear, anxiety, and avoidance that interfere with relationships, daily routines, work, school, or other activities. Common emotional and behavioral symptoms include:

  • Fear of being judged negatively
  • Worry about embarrassing oneself
  • Intense fear of interacting with strangers
  • Fear of physical symptoms causing embarrassment, such as blushing or sweating
  • Avoidance of situations due to fear of embarrassment
  • Anxiety in anticipation of feared activities or events
  • Intense fear or anxiety during social situations
  • Self-analysis and identification of flaws in interactions after social situations
  • Expectation of the worst possible consequences from negative experiences during social situations

Physical symptoms such as blushing, fast heartbeat, trembling, and upset stomach can accompany social anxiety disorder.

Causes

Social anxiety disorder likely arises from a complex interaction of biological and environmental factors. Possible causes include inherited traits, brain structure, and learned behavior from negative social experiences or parental influence.

Several factors can increase the risk of developing social anxiety disorder, including a family history of the condition, negative life experiences, temperament, new social or work demands, and having an appearance or condition that draws attention.

Complications

Left untreated, social anxiety disorder can control one’s life and lead to low self-esteem, difficulty being assertive, negative self-talk, hypersensitivity to criticism, poor social skills, isolation, and substance abuse. Other anxiety disorders and certain mental health conditions often occur with social anxiety disorder.

Prevention

While there’s no way to predict who will develop an anxiety disorder, individuals can take steps to reduce the impact of symptoms:

  • Seek help early if experiencing anxiety
  • Keep a journal to identify stress triggers and coping strategies
  • Set priorities and manage time and energy
  • Avoid unhealthy substance use

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Diagnosis

To determine whether you have social anxiety disorder or if other conditions may be causing your anxiety, your health care provider will conduct a thorough evaluation. The diagnosis may involve:

  • Physical exam to assess any medical conditions or medications that may trigger anxiety symptoms
  • Discussion of your symptoms and their frequency and triggers
  • Review of situations that make you anxious
  • Self-report questionnaires about social anxiety symptoms
  • Assessment based on the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

DSM-5 criteria for social anxiety disorder include persistent, intense fear or anxiety in specific social situations, avoidance of anxiety-producing social situations, excessive anxiety disproportionate to the situation, interference with daily living, and anxiety not better explained by medical conditions, medication, or substance abuse.

Treatment

The treatment for social anxiety disorder depends on how significantly it affects your daily functioning. The most common treatment options include psychotherapy, medication, or a combination of both.

Psychotherapy

Psychotherapy, particularly cognitive-behavioral therapy (CBT), is effective in improving social anxiety symptoms. CBT helps you recognize and challenge negative thoughts about yourself, develop coping skills, and build confidence in social situations. Exposure-based CBT involves gradually facing feared situations to improve coping skills and gain confidence.

Medication

Selective serotonin reuptake inhibitors (SSRIs) are often the first-choice medications for social anxiety disorder. Medications like paroxetine (Paxil) or sertraline (Zoloft) may be prescribed. Venlafaxine (Effexor XR), a serotonin and norepinephrine reuptake inhibitor (SNRI), can also be an option. Other medications like antidepressants and anti-anxiety medications may be considered based on individual responses.

Stick with It

It’s essential to be patient with treatment, as progress may take time. Learning new skills and finding the right medication may require some trial and error. Stick with your medical or therapy appointments, set goals to approach anxiety-inducing situations, take medications as directed, and communicate any changes in your condition to your health care provider.

Alternative Medicine

While some herbal remedies have been studied for anxiety, results are mixed. Consult your health care team before trying any herbal remedies or supplements to ensure their safety and possible interactions with medications.

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