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Social Anxiety Disorder Symptoms, Causes & Treatment Options

Learn about Social Anxiety Disorder, including symptoms, causes, treatment options, and when to seek consultation. Or take a quiz to get a second opinion on your Social Anxiety Disorder from our A.I. health assistant.

Social Anxiety Disorder Symptom Checker

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What Is Social Anxiety Disorder?

Summary

Social anxiety disorder is a psychiatric condition affecting both males and females of all ages. This condition is characterized by fear of judgment by others in social situations such as parties, speaking in public, or using public restrooms [1]. Other symptoms include anxiety, blushing, palpitations, sweating, trembling, shortness of breath, and nausea. Treatment options include cognitive behavioral therapy and medications.

Recommended care

You should visit your primary care physician, who can diagnose you based on an interview. He/she can refer you to a psychiatrist or psychologist for cognitive behavioral therapy (CBT). Medications may also be appropriate.

How common is Social Anxiety Disorder?

Common

Must-symptoms

Symptoms that always occur with Social Anxiety Disorder:

  • Anxiety when doing something in front of a group
  • Impaired social or occupational functioning

Social Anxiety Disorder is also known as

  • Social phobia

Social Anxiety Disorder Symptoms

Main symptoms

The main symptoms of social anxiety disorder include the following.

  • Excessive fear of scrutiny: People with social anxiety disorder often feel scrutinized or intensely watched in everyday social situations.
  • Anxiety
  • Blushing
  • Avoidance: People with social anxiety disorder may isolate themselves or avoid day-to-day activities in an effort to not experience symptoms.
  • Palpitations
  • Sweating
  • Difficulty speaking in public
  • Trembling
  • Nausea
  • Shortness of breath
  • Postural rigidity: When in social situations, people with social anxiety disorder may feel like they have difficulty moving their limbs.

Diagnosis

The diagnosis of social anxiety disorder is based on meeting the criteria detailed in DSM-IV [2].

  • Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
  • The patient fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated.
  • Social situations almost always provoke fear or anxiety.
  • Social situations are avoided or endured with intense fear or anxiety.
  • The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
  • The fear, anxiety, or avoidance is persistent, typically lasting for six months or more.
  • The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., an abused drug or medication) or another medical condition.
  • The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
  • Fear or anxiety cannot be due to another medical disorder.

Comorbidities

People with social anxiety disorder commonly present with other psychiatric conditions as well [3,4]. The following are the most common comorbidities:

  • Other anxiety disorders (49%)
  • Affective disorder (38%)
  • Alcohol dependence (9%)
  • Eating disorders
  • Schizophrenia

Social Anxiety Disorder Causes

While social anxiety disorder may present as early as elementary school age, it usually first presents in the mid-teen years. It is uncommon for social anxiety to present for the first time after age 30. Social anxiety disorder is thought to be caused by a mix of social and genetic factors [5]. While specific genes have not yet been identified, the areas of the brain thought to be most implicated are the insula, prefrontal cortex, and amygdala [6]. Many people with social anxiety disorder experience an alleviation of symptoms with the class of drugs called selective serotonin reuptake inhibitors (SSRIs), which increase the amount of available serotonin. The improvement in the condition with this medication suggests that a biological decrease in serotonin levels may play a role in the development of this disorder.

Social Anxiety Disorder Symptom Checker

Take a quiz to find out if your symptoms point to Social Anxiety Disorder

Treatment Options and Prevention

Treatment

The treatment course for social anxiety disorder is aimed at both symptom management and using tools to measure continued response to pharmacologic or therapy-based treatment regimens.

  • Cognitive behavioral therapy (CBT): CBT has been proven to be equally effective as pharmacotherapy in treating social anxiety disorder [7]. This method of therapy involves identifying errors or unhelpful patterns in thinking processes.
  • Selective serotonin reuptake inhibitors (SSRIs): These drugs increases the amount of serotonin available within the brain. In trials comparing SSRIs to placebo, the treatment group showed significant improvement compared to the control group [8].
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs): This class of drugs increases the amount of serotonin and norepinephrine available for the brain to use. The SNRI drug venlafaxine has been proven to be equally effective for the treatment of social anxiety disorder as SSRIs [9].
  • Monoamine oxidase inhibitors and benzodiazepines: These pharmacotherapies were historically used for the treatment of social anxiety disorder. However, given their extensive side effect profiles, they are now largely reserved for conditions refractory to other treatments.

Prevention

Currently, no preventable risk factors for social anxiety disorder have been identified. There have been reports indicating that a highly-observed social situation (e.g. public speaking) followed by criticism can condition an individual to feel social anxiety when being in similar situations in the future. Therefore, prevention can in part be managed by those in educating roles (teachers, parents, etc.) to provide feedback that is not overly harsh or critical.

When to Seek Further Consultation

Anyone experiencing persistence of the symptoms listed above for greater than six months should consult his or her physician.

Questions Your Doctor May Ask to Diagnose

To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.

  • A panic attack is a sudden surge of intense fear combined with other symptoms that peaks quickly and then is over within minutes. Have you ever experienced a panic attack?
  • Do you have a cough?
  • How severe is your anxiety?
  • Have you ever suffered from a concussion or traumatic brain injury?
  • Are you feeling irritable (easily made upset)?

The above questions are also covered by our A.I. Health Assistant.

Social Anxiety Disorder Symptom Checker

Take a quiz to find out if your symptoms point to Social Anxiety Disorder

References

  1. Berger FK. Social anxiety disorder. U.S. National Library of Medicine: MedlinePlus. Updated December 6, 2018. MedlinePlus Link
  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
  3. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602. PubMed Link
  4. Grant BF, Hasin DS, Blanco C, et al. The epidemiology of social anxiety disorder in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2005;66(11):1351-1361. PubMed Link
  5. Kendler KS, Neale MC, Kessler RC, Heath AC, Eaves LJ. The genetic epidemiology of phobias in women. The interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia. Arch Gen Psychiatry. 1992;49(4):273-281. PubMed Link
  6. Kawaguchi A, Nemoto K, Nakaaki S, et al. Insular Volume Reduction in Patients with Social Anxiety Disorder. Front Psychiatry. 2016;7:3. Published 2016 Jan 21. NCBI Link
  7. Davidson JR, Foa EB, Huppert JD, et al. Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Arch Gen Psychiatry. 2004;61(10):1005-1013. PubMed Link
  8. Stein DJ, Ipser JC, Balkom AJ. Pharmacotherapy for social phobia. Cochrane Database Syst Rev. 2004;(4):CD001206. PubMed Link
  9. Mayo-Wilson E, Dias S, Mavranezouli I, et al. Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry. 2014;1(5):368-376. The Lancet Psychiatry Link