Overview

Social anxiety disorder, also known as social phobia, is characterized by significant anxiety, self-consciousness, and embarrassment in everyday social situations. The fear of being judged negatively by others leads to avoidance behaviors that can disrupt one’s life. While feeling nervous in social situations is normal, social anxiety disorder causes more severe distress and interference with daily activities.

Symptoms

Signs and symptoms of social anxiety disorder may include:

  • Fear of being judged negatively
  • Worry about embarrassing oneself
  • Fear of interacting with strangers
  • Concern about appearing anxious
  • Fear of physical symptoms like blushing or sweating
  • Avoidance of social situations or activities
  • Anticipation of anxiety in social events
  • Intense fear or anxiety during social situations
  • Overanalyzing social interactions
  • Expecting negative consequences from social experiences

Physical symptoms that may accompany social anxiety disorder include blushing, fast heartbeat, trembling, sweating, upset stomach, dizziness, and muscle tension.

Common social situations that may be challenging for individuals with social anxiety disorder include interacting with strangers, attending social gatherings, starting conversations, making eye contact, dating, and eating in front of others.

When to See a Doctor

If fear and avoidance of normal social situations cause embarrassment, worry, or panic, it’s essential to see a doctor or a mental health professional for evaluation and potential treatment.

Causes

Social anxiety disorder likely arises from a combination of biological and environmental factors, such as inherited traits, brain structure affecting fear responses, and learned behaviors from negative social experiences or parental influences.

Risk Factors

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

Complications

Left untreated, social anxiety disorder can significantly impact one’s life, leading to low self-esteem, poor social skills, isolation, substance abuse, and even suicidal tendencies. It can also co-occur with other mental health disorders, like major depressive disorder and substance abuse.

Prevention

While it’s challenging to predict anxiety disorder development, some preventive steps include seeking help early, keeping a journal to identify stress triggers and coping strategies, setting priorities in life to manage time and energy, and avoiding unhealthy substance use.

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Diagnosis

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

  • Physical exam to rule out medical conditions or medications triggering anxiety symptoms
  • Discussion of your symptoms, frequency, and triggers
  • Review of situations that cause anxiety
  • Completion of self-report questionnaires to assess symptoms of social anxiety
  • Evaluation 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 and intense fear or anxiety in specific social situations due to the fear of being judged or humiliated
  • Avoidance of anxiety-provoking social situations or enduring them with intense fear or anxiety
  • Anxiety that is out of proportion to the situation
  • Anxiety that interferes with daily life
  • Fear or anxiety not explained by medical conditions, medications, or substance abuse

Treatment

The most common treatments for social anxiety disorder include psychotherapy (talk therapy) and medications.

Psychotherapy

Psychotherapy, especially cognitive-behavioral therapy (CBT), is effective in improving symptoms in most individuals with social anxiety disorder. Exposure-based CBT involves gradually facing feared situations to develop coping skills and gain confidence in social settings.

Medications

Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) or sertraline (Zoloft), are often the first-choice medications for persistent social anxiety symptoms. Venlafaxine (Effexor XR) may also be an option.

Other medications, like other antidepressants, anti-anxiety medications (benzodiazepines), and beta blockers, may also be prescribed.

It’s essential to stick with the treatment plan even if the results are not immediate. Psychotherapy and medication may take time to show noticeable improvement.

Alternative Medicine

Some herbal remedies have been studied as potential treatments for anxiety, but the results are mixed. Consult your health care provider before taking any herbal supplements to ensure they are safe and won’t interact with other medications.

Lifestyle and Home Remedies

While social anxiety disorder often requires professional help, some techniques may help manage anxiety symptoms:

  • Learn stress-reduction skills
  • Stay physically active
  • Get enough sleep
  • Eat a healthy diet
  • Avoid alcohol and limit caffeine
  • Participate in social situations with people you feel comfortable with

Practice in small steps by setting achievable goals in less overwhelming situations to build coping skills gradually.

Coping and Support

Routinely reach out to friends and family, join support groups, or groups that promote communication skills to manage social anxiety. Engage in pleasurable and relaxing activities to control symptoms and prevent relapse over time.

Preparing for Your Appointment

Before your appointment, make a list of situations you’ve been avoiding, symptoms you’ve experienced, medical history, and any medications you’re taking. If possible, have a trusted family member or friend accompany you to help remember key information.

Prepare questions for your health care provider, such as possible causes, treatment options, and the likelihood of symptom improvement.

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