Topic Overview
What is social anxiety disorder?
People with
social anxiety disorder (or social phobia) are extremely anxious about what
they will say or do in front of other people. This includes public speaking and
day-to-day social situations. But it is more than just being shy or nervous
before public speaking. The fear can begin weeks or months before an event. It
can cause a fast heartbeat and make it hard to focus.
Some people
fear only one or a few types of social situations. For other people, many
situations cause stress. This problem affects your daily life. You may be so
stressed or afraid that you avoid public situations, including missing work and
school.
What causes social anxiety disorder?
Doctors don't
know what causes social anxiety disorder. They think it may run in families. But they are not sure if it's because of
genetics or a response to a traumatic situation.
What are the symptoms?
Social anxiety disorder
causes both emotional and physical symptoms:
- It can make you nervous, sad, or easily upset
before or during a social event. You may worry a lot or be afraid that
something bad will happen.
- The anxiety can cause you to blush,
sweat, and feel shaky. Your heart may beat faster than normal, and you may have
a hard time focusing.
How is social anxiety disorder diagnosed?
To
diagnose social anxiety disorder, your doctor will examine you and ask about
your symptoms. He or she may ask other questions to see how you are doing
emotionally. This is called a mental health assessment.
Your
doctor may also do blood or urine tests to rule out other conditions, such as
thyroid problems that can cause similar symptoms.
How is it treated?
Treatment of social anxiety
disorder includes counseling and sometimes medicine, such as antidepressants.
Whether you need medicine depends on how much the problem affects your daily
life. If you already feel anxious around other people, it may be hard to ask
for help. But treatment for social anxiety disorder works for many people.
Some people with social anxiety disorder turn to alcohol or drugs
to help them relax. This can lead to
addiction problems. They may also have
depression. It is important to treat these issues
too.
Frequently Asked Questions
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Learning about social anxiety disorder:
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Being diagnosed:
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Getting treatment:
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Ongoing concerns:
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Symptoms
Social anxiety disorder causes unreasonable,
debilitating fear of being judged or publicly humiliated. You may avoid or
severely limit encounters with other people—which can keep you from daily
activities. You may develop physical symptoms such as a rapid heartbeat,
shortness of breath, or tightness in your chest when faced with a feared social
situation.
When you have social anxiety disorder, common social
situations—such as eating in public, writing in front of other people, using a
public restroom, or speaking in front of others—can cause overwhelming fear and
anxiety.
You may be more afraid of people noticing your
anxiety than of the actual feared situation. A vicious
cycle can emerge of avoiding or worrying about the social event (such as
speaking in public) because you are afraid others will see you as weak,
anxious, or foolish—this, in turn, leads to more anxiety. This may lead to
avoiding or limiting contact with other people.
Symptoms of social
anxiety disorder may differ in adults and children.
Adults and teenagers with social anxiety disorder usually
recognize their fears of being publicly humiliated are unreasonable or
excessive. But children who have this disorder may not.
Anxiety in adults
Expressions of anxiety in adults or adolescents
include:1
- Having persistent but unreasonable fear of a
situation that involves unfamiliar people or being judged by others. The fear
is that you will be embarrassed or humiliated by something that you say or
do.
- Developing severe anxiety or
panic attacks when in the feared
situation.
- Recognizing that your fears are excessive or
unreasonable.
- Avoiding social situations that you fear or enduring
them with intense anxiety or distress.
- Avoiding or anxiously
anticipating feared situations so much it interferes with daily activities and
relationships.
- Worrying about being anxious.
Anxiety in children
Expressions of anxiety in children include:1
- Worrying about being embarrassed in front of
their peers but not usually in front of adults or teenagers.
- Expressing
anxiety by frequently crying, throwing tantrums, "freezing" in social
situations, or "shrinking back" from unfamiliar people.
- Denying or
not realizing the fears are excessive or unreasonable.
- Fearing
performance situations, such as having to speak in front of the class. This
fear doesn't come and go. It is continuous and lasts for 6 months or
longer.
People with social anxiety disorder often underachieve at work or
at school to avoid the attention of a promotion or to avoid being forced to
participate in a group. They tend to have few friendships and have trouble
dating or developing relationships. In prolonged or severe cases, many people
develop other psychological conditions (such as
depression or
substance abuse).
Social anxiety disorder
is among several types of
phobias that many people experience, such as
agoraphobia or
a specific phobia (fearing an object, like a spider, or
a frightening situation, such as being stuck in an elevator).
Treatment Overview
Treatment for
social anxiety disorder involves psychological
counseling and sometimes medicines (such as antidepressants) to reduce
related anxiety and depression.
A
combination of medicines and professional counseling may be effective for
long-term treatment for people who have generalized anxiety and fear over many social
situations.2 For those who fear only one or a few social situations (such as
public speaking or eating in front of others), professional counseling to
overcome the fear may be all that is needed.
Unfortunately, many
people don't seek treatment for anxiety disorders. You may not seek treatment
because you think the symptoms are not bad enough or that you can work things
out on your own. But getting treatment is important.
If you need
help deciding whether to see your doctor, see
some reasons why people don't get help and how to overcome them.
Initial and ongoing treatment
Initial treatment
of
social anxiety disorder is based on how bad your emotional and physical symptoms are and how able you are to function in daily
activities. People who have social anxiety disorder often have
depression also. They may also have alcohol or
substance abuse problems. Your doctor may
ask you certain questions to see whether you might be drinking too
much or abusing drugs.
Social anxiety disorder often goes
undetected for years before treatment is sought. By that time, you may have
developed behaviors that accommodate the fears. These habits or behaviors must
be overcome to successfully manage social anxiety disorder.
First, your doctor must determine whether you are generally
anxious about all social encounters or whether a specific situation triggers
anxiety.
Treatment with a combination of medicines and
professional counseling is often effective for generalized social anxiety
disorder (fear of most public interaction). Some people need treatment
throughout their lives, while others may recover completely after a period of
treatment with counseling and medicines
Counseling
It is possible to
overcome the fears linked with social anxiety disorder. Working through
fears with a specific type of therapy—cognitive-behavioral therapy that
includes exposure therapy—may be the best approach for treating your anxiety.
It is important to continue professional counseling even if you are taking
medicines to reduce anxiety.
Types of counseling most often used to treat social anxiety
disorder include:
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Cognitive-behavioral therapy
, which helps you identify anxieties and the situations that
provoke the anxiety. At first you may feel uncomfortable while addressing the
feared situations, but it is an important part of your recovery. Several types
of cognitive-behavioral therapy are used to treat social anxiety disorder,
including:
- Exposure therapy.
You will be guided by a professional counselor to imagine you are facing the
feared situation until you no longer fear it, such as eating in public. Next,
you may go with your counselor to a public place and eat until, eventually, you
can eat by yourself in public without fear.
- Social skills training.
This therapy helps you develop the skills you need in social situations through
rehearsing and role-playing. Your anxiety is reduced as you become more
comfortable with and prepared for the feared social
situations.
- Cognitive restructuring. This therapy helps you learn
to identify and improve fearful thinking to help you better handle social
situations.
Stop Negative Thoughts: Getting Started- Anxiety: Stop Negative Thoughts
- Stop Negative Thoughts: Choosing a Healthier Way of Thinking
- Symptom management skills. This therapy
teaches you how to reduce stress by controlling your breathing and other
physical responses to anxiety.
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Supportive therapy. This
can include:
- Education about the
disorder.
- Family therapy, to support loved ones
affected by your condition.
- Group therapy or support groups, to
seek support from others also diagnosed with the disorder.
Medicines
Medicines often used for chronic, severe, or generalized social
anxiety disorder include:
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Selective serotonin reuptake inhibitors (SSRIs), to
relieve anxiety. SSRIs are often the first type of medicine used to treat
generalized social anxiety disorder.3
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Benzodiazepines, to relieve anxiety.
They are fast-acting. But they may be habit-forming and are not generally
used in those who have substance abuse problems.
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Monoamine oxidase inhibitors (MAOIs), to relieve depression and anxiety. MAOIs have
potentially serious side effects when they are taken with certain foods (such
as some cheeses and red wine).
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Beta-blockers, to
reduce anxiety. Beta-blockers are sometimes used to treat physical symptoms of
anxiety (such as
tremors or rapid heart rate).
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Venlafaxine, to help relieve anxiety and depression.
Ongoing treatment of social anxiety disorder usually
includes continuing psychological
counseling and regular checkups to monitor any
medicines you may be taking. If professional counseling alone has not reduced
your anxiety symptoms, medicines may be added to your treatment.
If your anxiety is triggered by many social situations (generalized), you
may need continuous and prolonged treatment with a combination of counseling
and medicines. During this time, your doctor will need to
monitor your medicines. If one medicine doesn't work for you, you and your doctor may decide you should try another.
Treatment if the condition gets worse
With
social anxiety disorder, it is possible to progress
from debilitating fear of one social situation to having anxiety about all
social encounters (generalized). If this occurs, additional treatment is needed
that usually includes adding medicines and increasing the amount of
professional
counseling you receive.
You may also feel
more anxious when you start professional counseling. This is because you are
thinking about the situations that cause you fear and anxiety. After the
situations have been identified, the fears can be addressed through
counseling—especially
cognitive-behavioral therapy which includes
exposure therapy—gradually exposing you to your
fear.
If you are taking medicines to treat social anxiety
disorder, you will need regular checkups to monitor the medicines (such as
selective serotonin reuptake inhibitors) and their
potential side effects. The medicines may cause bothersome side effects that
may make your anxiety worse at first. These side effects may get better over
time. But if they do not, you may need to take a different medicine.
If social anxiety disorder is left untreated or improperly treated, it
can cause debilitating distress that interferes with daily activities. Physical
symptoms such as rapid heart rate, blushing, shortness of breath, and dizziness
can occur and need to be assessed.
Other psychological conditions
(such as
depression or
substance abuse) may accompany social anxiety
disorder, and these conditions need more treatment.
If
left untreated, the combination of social anxiety disorder and another
psychological condition (such as depression) can increase the risk of attempted
suicide.4
Home Treatment
While counseling and medicines are
the most effective treatments for
social anxiety disorder, you may wish to
reduce your anxiety level at home by practicing a
healthy lifestyle.
If you drink alcohol or use drugs in an attempt to gain confidence
to face feared social situations, it is possible to develop
substance abuse problems in addition to social anxiety
disorder.
For more information, see:
Other Places To Get Help
Organizations
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Anxiety Disorders Association of America
(ADAA)
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| 8730 Georgia Avenue |
| Suite 600 |
| Silver Spring, MD 20910 |
| Phone: |
(240) 485-1001 |
| Fax: |
(240) 485-1035 |
| Web Address: |
www.adaa.org |
| |
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The Anxiety Disorders Association of America (ADAA)
works to improve the lives of people who have anxiety disorders. Members of the
association are not only people who have or are interested in anxiety disorders
but also health professionals who do research and treat people who have anxiety
disorders.
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Healthy Minds. Healthy Lives.American Psychiatric Association
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| 1000 |
| Wilson Boulevard |
| 1825 |
| Arlington, VA 22209 |
| Phone: |
1-888-35-PSYCH
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| Email: |
apa@psych.org |
| Web Address: |
www.healthyminds.org |
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This online resource is provided by the American Psychiatric Association for anyone seeking mental health information. It includes information on many common mental health concerns, including warning signs of mental disorders, treatment options, and preventive measures.
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KidsHealth for Parents, Children, and
Teens
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Nemours Home Office
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| 10140 Centurion Parkway |
| Jacksonville, FL 32256 |
| Phone: |
(904) 697-4100 |
| Web Address: |
www.kidshealth.org |
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This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
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Mental Health America
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| 2000 North Beauregard Street, 6th Floor |
| Alexandria, VA 22311 |
| Phone: |
1-800-969-NMHA (1-800-969-6642) referral service for help with depression
(703) 684-7722 |
| Fax: |
(703) 684-5968 |
| Web Address: |
www.mentalhealthamerica.net |
| |
|
Mental Health America (formerly known as the National
Mental Health Association) is a nonprofit agency devoted to helping people of
all ages live mentally healthier lives. Its website has information about
mental health conditions. It also addresses issues such as grief, stress,
bullying, and more. It includes a confidential depression screening test for
anyone who would like to take it. The short test may help you decide whether
your symptoms are related to depression.
|
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National Institute of Mental Health
(NIMH)
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| 6001 Executive Boulevard |
| Bethesda, MD 20892-9663 |
| Phone: |
1-866-615-6464 toll-free |
| Phone: |
(301) 443-4513 |
| Fax: |
(301) 443-4279 |
| Web Address: |
www.nimh.nih.gov |
| |
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The National Institute of Mental Health (NIMH) provides
information to help people better understand mental health, mental disorders,
and behavioral problems. NIMH does not provide referrals to mental health
professionals or treatment for mental health problems.
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References
Citations
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American Psychiatric Association (2000). Anxiety disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 450–456. Washington, DC: American Psychiatric Association.
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Hollander E, Simeon D (2008). Social phobia (Social anxiety disorder). In RE Hales et al., eds., American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 536–546. Washington, DC: American Psychiatric Publishing.
-
Wagstaff AJ, et al. (2002). Spotlight on paroxetine in psychiatric disorders in adults. Drugs, 62(4): 655–703.
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Schneier FR (2006). Social anxiety disorder. New England Journal of Medicine, 355(10): 1029–1036.
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U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
Other Works Consulted
- Iacoviello BM, Mathew SJ (2010). Anxiety disorder. In EG Nabel, ed., ACP Medicine, section 13, chap. 1. Hamilton, ON: BC Decker.
- Merikangas Kr, Kalaydjian AE (2009). Epidemiology of anxiety disorders. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1856–1864. Philadelphia: Lippincott Williams and Wilkins.
- Zal HM (2003). Social phobia: Treatment issues. Psychiatric Times, 20(6): 80–83.
Credits
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By
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Healthwise Staff |
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Primary Medical Reviewer
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E. Gregory Thompson, MD - Internal Medicine |
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Specialist Medical Reviewer
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Lisa S. Weinstock, MD - Psychiatry |
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Last Revised
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July 11, 2011 |
American Psychiatric Association (2000). Anxiety disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 450–456. Washington, DC: American Psychiatric Association.
Hollander E, Simeon D (2008). Social phobia (Social anxiety disorder). In RE Hales et al., eds., American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 536–546. Washington, DC: American Psychiatric Publishing.
Wagstaff AJ, et al. (2002). Spotlight on paroxetine in psychiatric disorders in adults. Drugs, 62(4): 655–703.
Schneier FR (2006). Social anxiety disorder. New England Journal of Medicine, 355(10): 1029–1036.
U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.