Social Anxiety Disorder (Social Phobia) Causes, Symptoms, Diagnosis, Treatment, Prevention

Social Anxiety Disorder (Social Phobia) Causes, Symptoms, Diagnosis, Treatment, Prevention


What is Social Anxiety Disorder (Social Phobia)?


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 criticized by others.

A person with social anxiety disorder is afraid that he or she will make mistakes, look bad, 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.

Social Anxiety Disorder (Social Phobia) Causes, Symptoms, Diagnosis, Treatment, Prevention
Social Anxiety Disorder (Social Phobia) 


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.

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 Causes Social Anxiety Disorder (Social Phobia)?


Research to define causes of Social anxiety disorder (Social Phobia) is ongoing.

  • Some investigations implicate a small structure in the brain called the amygdala in the symptoms of social phobia. 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 phobia can be inherited. In fact, researchers recently identified the site of a gene in mice that affects learned fearfulness.
  • One line 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 environment's influence on the development of social phobia. People with social phobia may acquire their fear from observing the behavior and consequences of others, a process called observational learning or social modeling.

Symptoms of Social Anxiety Disorder (Social Phobia)


Social anxiety disorder affects your emotions and behavior. It can also cause significant physical symptoms.

Emotional and behavioral social anxiety disorder signs and symptoms include:


  • Intense fear of interacting with strangers
  • Fear of situations in which you may be judged
  • Worrying about embarrassing or humiliating yourself
  • Fear that others will notice that you look anxious
  • Anxiety that disrupts your daily routine, work, school or other activities
  • Avoiding doing things or speaking to people out of fear of embarrassment
  • Avoiding situations where you might be the center of attention
  • Difficulty making eye contact
  • Difficulty talking
Social Anxiety Disorder (Social Phobia) Causes, Symptoms, Diagnosis, Treatment, Prevention
Social Anxiety Disorder (Social Phobia) Symptoms

Physical social anxiety disorder signs and symptoms include:


  • Blushing
  • Sweating
  • Trembling or shaking
  • Fast heartbeat
  • Upset stomach
  • Nausea
  • Shaky voice
  • Muscle tension
  • Confusion
  • Diarrhea
  • Cold, clammy hands

Worrying about having symptoms of Social anxiety disorder (Social Phobia)


When you have social anxiety disorder, you realize that your anxiety or fear is out of proportion to the situation. Yet you're so worried about developing social anxiety disorder symptoms that you avoid situations that may trigger them. This type of worrying creates a vicious cycle that can make symptoms worse.

Social anxiety disorder can greatly affect your life. You may not do as well at school or work as you might have done, as you tend to avoid any group work, discussions, etc. You may find it hard to get, or keep, a job. This may be because you feel unable to cope with the social aspects needed for many jobs, such as meeting with people. You may become socially isolated and find it difficult to make friends.

When to see a doctor


See your doctor or mental health provider if you fear and avoid normal social situations because they cause embarrassment, worry or panic. If this type of anxiety disrupts your life, causes severe stress and affects your daily activities, you may have social anxiety disorder or another mental health condition that requires treatment to get better.

Feelings of shyness or discomfort in certain situations aren't necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary from individual to individual due to personality traits and life experiences. Some people are naturally reserved and others are more outgoing. What sets social anxiety disorder apart from everyday nervousness is that its symptoms are much more severe, causing you to avoid normal social situations.

Common, everyday experiences that may be difficult to endure when you have social anxiety disorder include:

  • Using a public restroom or telephone
  • Returning items to a store
  • Interacting with strangers
  • Writing in front of others
  • Making eye contact
  • Entering a room in which people are already seated
  • Ordering food in a restaurant
  • Being introduced to strangers
  • Initiating conversations
Social anxiety disorder symptoms can change over time. They may flare up if you're facing a lot of stress or demands. Or if you completely avoid situations that would usually make you anxious, you may not have symptoms. Although avoidance may allow you to feel better in the short term, your anxiety is likely to persist over the long term if you don't get treatment.

How Is Social Anxiety Disorder (Social Phobia) Diagnosed?


If symptoms of social anxiety disorder are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical exam. Although there are no lab tests to specifically diagnose social anxiety disorder, the doctor 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, mental health professionals 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 his or her 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.

Treatments and drugs for Social Anxiety Disorder (Social Phobia)


The two most common types of treatment for social anxiety disorder are medications and psychological counseling (psychotherapy). These two approaches may be used in combination.

Psychotherapy


Psychological counseling (psychotherapy) improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself. Cognitive behavioral therapy is the most common type of counseling for anxiety. This type of therapy is based on the idea that your own thoughts — not other people or situations — determine how you behave or react. Even if an unwanted situation won't change, you can change the way you think and behave.

Cognitive behavioral therapy may also include exposure therapy. In this type of therapy, you gradually work up to facing the situations you fear most. This allows you to become better skilled at coping with these anxiety-inducing situations and to develop the confidence to face them. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others.

Your mental health professional may help you develop relaxation or stress management techniques.

First choices in medications


Several types of medications are used to treat social anxiety disorder. However, selective serotonin reuptake inhibitors (SSRIs) are often the first type of medication tried for persistent symptoms of social anxiety. SSRIs your doctor may prescribe include:

  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Fluvoxamine (Luvox)
  • Fluoxetine (Prozac, Sarafem, others)
The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) also may be an option for social anxiety disorder.

To reduce the risk of side effects, your doctor will start you at a low dose of medication and gradually increase your prescription to a full dose. It may take up to three months of treatment for your symptoms to noticeably improve.

Other medication options for Social Anxiety Disorder (Social Phobia)


Your doctor or mental health provider may also prescribe other medications for symptoms of social anxiety, including:

  • Other antidepressants. You may have to try several different antidepressants to find which one is the most effective and has the fewest unpleasant side effects.
  • Anti-anxiety medications. A type of anti-anxiety medication called benzodiazepines (ben-zo-di-AZ-uh-peens) may reduce your level of anxiety. Although they often work quickly, they can be habit-forming. Because of that, they're often prescribed for only short-term use. They may also be sedating. If your doctor does prescribe anti-anxiety medications, make sure you try taking them before you're in a social situation so that you know how they will affect you.
  • Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice and limbs. Because of that, they may work best when used infrequently to control symptoms for a particular situation, such as giving a speech. They're not recommended for general treatment of social anxiety disorder. As with anti-anxiety medications, try taking them before you need them to see how they affect you.

Self-help


You can get leaflets, books, tapes, videos, etc, on how to relax and how to combat anxiety. They teach simple deep breathing techniques and other measures to relieve stress and anxiety.

Alcohol and anxiety


Although alcohol may ease symptoms in the short term, don't be fooled that drinking helps to cure anxiety. In the long run, it does not. Drinking alcohol to 'calm nerves' can lead to problem drinking and may make problems with anxiety and depression worse in the long term. See a doctor if you are drinking alcohol (or taking street drugs) to ease anxiety.

Stick with it


Don't give up if treatment doesn't work quickly. You can continue to make strides in psychotherapy over several weeks or months. And finding the right medication for your situation can take some trial and error.

For some people, the symptoms of social anxiety disorder may fade over time, and medication can be discontinued. Others may need to take medication for years to prevent a relapse.

To make the most of treatment, keep your medical or therapy appointments, take medications as directed, and talk to your doctor about any changes in your condition.

Prevention for Social Anxiety Disorder (Social Phobia)


There's no way to predict for certain what will cause someone to develop an anxiety disorder in the first place, but you can take steps to reduce the impact of symptoms if you're anxious:

  • Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
  • Keep a journal. Keeping track of your personal life can help you and your mental health provider identify what's causing you stress and what seems to help you feel better.
  • Prioritize your life. You can reduce anxiety by carefully managing your time and energy.
  • Avoid unhealthy substance use. Alcohol and drug use and even caffeine or nicotine use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a support group to help you.
  • Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.

What Other Illnesses Co-Occur With Social Phobia?


Social phobia can cause lowered self-esteem and depression. To try to reduce their anxiety and alleviate depression, people with social phobia may use alcohol or other drugs, which can lead to addiction. Some people with social phobia may also have other anxiety disorders, such as panic disorder and obsessive-compulsive disorder.