Social Anxiety Disorder / Social Phobia

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What is Social Anxiety Disorder?

Social anxiety disorder (SAD) or social phobia is a common mental health problem (third most common) that makes a person feel extremely uncomfortable and anxious about social situations and meeting other people. The anxiety stems from a fear of being negatively judged and embarrassing themselves in front of others.

The disorder may be severe enough for the person to avoid social situations or events that may bring on the anxiety, affecting their daily activities as a result.

Although this is a chronic condition, it is treatable; learning coping skills, psychotherapy (cognitive behavioral therapy) and medications, if required, can help in the alleviation of symptoms and improve the ability to face social situations normally.

What are the Causes and Risk Factors for Social Anxiety Disorder?

Social anxiety disorder can be caused by an interplay of genetic and environmental factors. These include:
  • Familial - Anxiety disorders can run in families. However, it is difficult to say precisely how much of it is inherited (genetics) and how much is due to environmental influences.
  • Brain structure - When a brain structure called amygdala that is associated with the fear response is overactive, it can lead to the disorder.
  • Environment -Parents who control their children or who create anxious behavior in them in social situations or following an embarrassing or unpleasant incident.

Risk Factors of Social Anxiety Disorder?

Although there may be individual variations in response to a given situation, there are certain risk factors that might trigger social anxiety disorder
  • Family history of anxiety disorder in parents or siblings
  • Negative or traumatic experience, e.g., bullying at school
  • Temperamentally shy and timid, and socially withdrawn
  • Medical conditions such as stuttering, cosmetic disfiguration or tremors of hand
  • Social demands such as public speaking, meeting new persons at work
Risk Factors of Social Anxiety Disorder

What are the Symptoms of Social Anxiety Disorder?

Social anxiety disorder is an exaggerated fear and anxiety in social situations, unlike shyness or nervousness in a social situation which is normal. The features of social anxiety disorder include the following:
Physical signs and symptomsBehavioral signs and symptomsEmotional symptoms
  • Shaking or trembling
  • Inability to speak
  • Feeling faint
  • Sweating and hot flushes
  • Rapid heartbeat
  • Breathlessness
  • Nausea, stomach upset
  • Afraid of venturing out alone; need to have someone accompany them
  • Drinking before social occasions
  • Avoiding the situation altogether
  • Hiding in the background to escape notice
  • Unnatural fear and anxiety of being watched and judged by others
  • Excessive self-consciousness and assuming the worst
  • Fear of embarrassing oneself publicly
  • Excessive worrying for days or weeks before the event
Presence of insight - An important feature of SAD is that the person is aware that his fear and anxiety are irrational and make no sense but is unable to shake off the negative thoughts or assumes that the worst is going to happen.

Symptoms of Social Anxiety Disorder

Some situations that can trigger social anxiety
  • Public speaking
  • Meeting and talking to strangers
  • Performing in front of an audience
  • Being teased or criticized
  • Exam fear
  • Going to parties or other social gatherings
  • Speaking to a figure of authority
  • Using public restrooms

What are the Complications of Social Anxiety Disorder?

Unfortunately, if neglected or left untreated, SAD can affect relationships at home, workplace or school and give rise to complications such as:
  • Poor social skills
  • Alcohol or other substance abuse
  • Isolation and difficult relationships
  • Overreaction to criticism
  • Negative thoughts and assertions
  • Low achievement in school and work
  • Suicide attempts or suicide risk
  • Occurrence of other mental health disorders such as depression, anxiety disorder, and substance abuse
Complications of Social Anxiety Disorder

How do you Diagnose Social Anxiety Disorder?

Diagnosis of social anxiety disorder requires a complete history and thorough physical examination to ensure there are no identifiable causes for the condition and to rule out the presence of any other concurrent mental health disorder along with social anxiety.

DSM-5 criteria for social anxiety disorder include:
  • Excessive anxiety entirely out of proportion to the situation
  • Anxiety disrupting normal life activities
  • Avoidance of stressful social situations or undergoing them with untold fear and anxiety
  • Absence of an identifiable medical condition, or substance abuse to account for the symptoms
  • Persistent fear about situations because of fear of being judged, embarrassed or humiliated

How do you Treat Social Anxiety Disorder?

Management of social anxiety disorder depends on the severity of symptoms. The two most commonly employed forms of treatment include psychotherapy and medication therapy. Self-help therapy can also help.

Psychotherapy

In psychotherapy, patients are taught to recognize negative thoughts and feelings and to gain coping skills to overcome social anxiety.

Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy and can be done as individual or group therapy.

In exposure-based cognitive behavioral therapy, the patient is gradually exposed to social situations they fear and then trained to develop coping skills and to improve confidence and dispel negative thoughts and assertions.

Role-playing sessions can also help develop and practice social skills to gain comfort and confidence relating to others.

Cognitive Behavioral Therapy Can Help Patient's with Social Anxiety Disorders

Self-help therapy

Books, leaflets, or audio tapes or CDs teaching deep breathing and relaxation techniques and other measures to relieve stress and anxiety may be of added benefit.

Medications

Selective serotonin reuptake inhibitors (SSRIs) are often the first type of drugs employed for persistent symptoms of social anxiety. The serotonin and norepinephrine reuptake inhibitor (SNRI), venlafaxine (Effexor XR) may also be tried for social anxiety disorder. The drugs interfere with brain chemicals (also called neurotransmitters) such as serotonin, believed to affect emotions. Typically treatment will be started at a low dose to reduce side effects and gradually increased. It may take several weeks for a noticeable response.

Anxiolytics - Benzodiazepines can also reduce anxiety. They often work quickly but can be sedating and addictive, and so they are prescribed only for short-term use.

Beta-blockers - These medications can reduce some of the physical symptoms of SAD such as thumping of the heart and trembling, and work by blocking the stimulating effect of epinephrine (adrenaline). They are not recommended as first-line treatment of social anxiety disorder but infrequently used before certain anxiety-inducing situations such as public speaking or concerts.

How do you Prevent and Manage Social Anxiety Disorder?

Social anxiety episodes can be prevented by reducing anxiety levels and learning to cope with situations that produce anxiety.

Lifestyle changes to reduce anxiety
  • Learn and practice stress-reducing techniques such as meditation and deep breathing
  • Be physically active and exercise on a regular basis
  • Get enough sleep
  • Eat a healthy, well-balanced diet
  • Avoid smoking and alcohol
  • Limit or avoid caffeinated drinks such as coffee and tea
  • Chamomile, valerian, kava root, and passion flower are sedative herbs that have been known to exert a calming effect
  • Take part in social events and spend time with persons with whom you feel comfortable
Lifestyle Changes That Can Help Reduce Anxiety

Gearing up and developing skills to face social situations
  • Start with small steps setting small goals in the beginning and gradually increasing the targets at your comfort level. Practise these regularly
  • Do not avoid feared situations
  • Challenge negative thoughts that come to the mind and snuff them out
  • Volunteer to take part in some enjoyable activity
  • Reach out to family members
  • Join a support group or enroll in a social skills training class
  • Focus on others instead of yourself

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