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Social Anxiety Disorder

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Iqra Mazhar

Overview

Social anxiety disorder (previously known as social phobia) is a medical condition that causes disproportionate <a href="https://merisehat.pk/disease/anxiety">anxiety </a>and fear in social circumstances. 
Social anxiety disorder is characterized by strong anxiety that interferes with a job or personal life and lasts for at least six months.

&nbsp;

It&#39;s normal to occasionally experience shyness, nervousness, or self-consciousness in public. Most individuals make it through these times when they must. However, the anxiety that comes with being shy or self-conscious can be quite severe for certain people such that it keeps them from speaking up or interacting with others the majority of the time. This is social anxiety.

Some anxiety is common in social circumstances like making presentations or going for an interview. However,&nbsp;social anxiety disorder occurs when an individual is extremely anxious about how other people perceive them in a social setup.

According to the National Institute of Mental Health, around 12.1% of American adults have a social anxiety disorder at&nbsp;some point in their lives<a href="#accordion">[1]</a>. It is the third most prevalent mental ailment, after severe depression and alcoholism, according to data from the National Comorbidity Survey<a href="#accordion">[2]</a>. Also, males are less likely to experience it than females<a href="#accordion">[1]</a>.

Reportedly, it has a lifetime prevalence rate of up to 12%, compared to estimates of 6% lifetime prevalence for generalized anxiety disorder, 5% lifetime prevalence for panic disorder, 7% lifetime prevalence for post-traumatic stress disorder, and 2% lifetime prevalence for obsessive-compulsive disorder<a href="#accordion">[2]</a>. 
&nbsp;

The three types of social anxiety are measures of the severity of the condition.

<ol>
	<li>Mild Social Anxiety - A person with mild social anxiety engages in or tolerates social events despite experiencing its physical and psychological symptoms. Additionally, they only exhibit symptoms in particular social settings. 
	&nbsp;</li>
	<li>Moderate Social Anxiety - A person who has moderate social anxiety exhibits physical and psychological symptoms. They will only engage in certain social activities while avoiding others. 
	&nbsp;</li>
	<li>Extreme Social Anxiety - In social circumstances, a person with extreme social anxiety will have more severe symptoms of the condition, such as a panic attack. As a result, they will typically steer clear of social situations at all costs<a href="#accordion">[3]</a>. 
	&nbsp;</li>
</ol>

Signs and Symptoms

Various personality attributes and life experiences affect social comfort levels. Some people are extroverts by nature, while others are more reserved. The onset of social anxiety disorder often occurs between the early and mid-teens; however, it can also occur in childhood or adulthood. 
&nbsp;

<h5>Behavioral And Emotional Symptoms</h5>

<ul>
	<li>Fear of encounters where they receive unfavorable judgment</li>
	<li>Worry about humiliating oneself</li>
	<li>Severe nervousness while engaging or conversing with strangers</li>
	<li>Fear that people may notice the social anxiety</li>
	<li>Fear of experiencing humiliating physical side effects, such as sweating, blushing, shaking, or having a quivering voice</li>
	<li>Avoid situations or interactions with individuals out of shame</li>
	<li>Avoid being the focus of attention on any occasion</li>
	<li>Fear of a dreaded activity or event-related anxiety</li>
	<li>Severe anxiety or fear in social settings</li>
	<li>Always evaluate their own performance after a social event and look for weaknesses in the interactions</li>
	<li>Anticipate the worst potential outcomes as a result of a bad social encounter</li>
	<li>Low self-esteem, sensitivity to criticism, and negative self-talk 
	&nbsp;</li>
</ul>

<h5>Physical Signs</h5>

<ul>
	<li>Racing heart</li>
	<li>Sweating</li>
	<li>Blushing</li>
	<li>Trembling</li>
	<li>Nausea or upset stomach</li>
	<li>Feeling breathless</li>
	<li>Feeling lightheaded or dizzy</li>
	<li>Mind goes blank</li>
	<li>Tense muscles 
	&nbsp;</li>
</ul>

<h5>Concerning Social Situations</h5>

Experiences such as the following become tough to endure due to social anxiety:

<ul>
	<li>Interacting with strangers</li>
	<li>Going to events or gatherings even with friends</li>
	<li>Attending a class or working</li>
	<li>Initiating&nbsp;discussions</li>
	<li>Maintaining eye contact</li>
	<li>Entering a room where others are already seated</li>
	<li>Making a shop return</li>
	<li>Having a meal in public</li>
	<li>Using a public toilet 
	&nbsp;</li>
</ul>

<h5>Signs And Symptoms In Children</h5>

<ul>
	<li>Throwing temper tantrums</li>
	<li>Crying</li>
	<li>Freezing and not being able to speak in social situations</li>
	<li>Being clingy with the caregiver 
	&nbsp;</li>
</ul>

The signs of social anxiety disorder evolve. They tend to flare up if the person is dealing with a lot of changes or stress. Even though&nbsp;avoiding anxiety-provoking circumstances can help the individual feel better in the short term, it&rsquo;s important to receive therapy to ensure their anxiety doesn&rsquo;t persist in the long run<a href="#accordion">[4]</a>. 
&nbsp;

Causes

Social anxiety disorder most likely results from a complex mix of biological and environmental variables, similar to many other mental health diseases. 
&nbsp;

<ul>
	<li>Genetics - There is a familial tendency for anxiety problems. It is unclear, though, how much of this may be inherited and how much is the result of learned behavior. 
	&nbsp;</li>
	<li>Structure Of The Brain - The amygdala in the brain is involved in regulating the fear response. People with an overactive amygdala have a more intense fear reaction, which would make them more anxious in social circumstances. 
	&nbsp;</li>
	<li>Environment - Some people have severe anxiety after being in an uncomfortable or embarrassing social setting, suggesting that social anxiety disorder is a learned behavior. 
	&nbsp;</li>
</ul>

Additionally, there seems to be a link between social anxiety disorder and parents who are either more controlling or overprotective of their kids or who exhibit anxious behavior in social circumstances. Anxiety disorders are more likely to develop in the presence of stressful or traumatic situations, such as abuse, violence, the death of a loved one, or a chronic illness. A history of rejection, humiliation, or bullying can further increase the risk<a href="#accordion">[4]</a>. 
&nbsp;

Diagnosis

There is no medical test to diagnose social anxiety disorder. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criterion is used to determine whether or not a patient has the condition. 
&nbsp;

The doctor will first&nbsp; check the physical signs caused by the disorder, after which they will ask the patient about:

<ul>
	<li>Their family history</li>
	<li>Any other health conditions they may have</li>
</ul>

Based on this information, the doctor will rule out other conditions, such as personality disorder, substance abuse, or if the fear or anxiety is related to something different, like physical appearance (e.g., obesity or face burn). 
&nbsp;

The DSM-5 criteria include:

<ul>
	<li>A phobia of one or more social settings where other people can observe them</li>
	<li>Dread acting in a way that will be perceived negatively by others, that would enrage or offend people</li>
	<li>A certain circumstance that&nbsp;almost always causes dread or anxiety</li>
	<li>Either avoids the situation or attends it with great fear or worry</li>
	<li>Excessive fear compared to the actual danger</li>
	<li>Continuous fear or worry that typically lasts six months or longer</li>
	<li>Dread or worry disrupts daily life</li>
	<li>The fear and anxiety cannot be explained by other symptoms or medical disorders<a href="#accordion">[5]</a>. 
	&nbsp;</li>
</ul>

Treatment

People with social anxiety disorder can control their symptoms, develop confidence, and conquer their anxiety with the use of a variety of therapy approaches.&nbsp;However, without therapy, social anxiety disorder is likely to persist throughout life, even if it occasionally seems better.&nbsp;Typically, medical experts advise treatment that includes psychotherapy, medication, or both. 
&nbsp;

Trials comparing pharmacotherapy and psychotherapy show that while CBT has more long-lasting benefits, medicine has speedier effects<a href="#accordion">[7]</a>. 
&nbsp;

<h5>Counseling</h5>

A session can be one-on-one or in a group. The appointments can be provided in person or online. 
&nbsp;

<ul>
	<li>Cognitive Behavioral Therapy (CBT) - CBT teaches coping mechanisms for anxiety, such as how to replace negative ideas with optimistic ones. 
	&nbsp;</li>
	<li>Acceptance And Commitment Therapy (ACT) - In the ACT, people discover how to be more present and determine how to lead a value-based life despite unpleasant feelings by using mindfulness, acceptance, and behavioral methods. 
	&nbsp;</li>
	<li>Support Group Or Group Therapy - This helps develop the desired social skills. Working in a group enables the patient to role-play workable answers and learn that they&rsquo;re not alone. 
	&nbsp;</li>
	<li>Exposure Therapy - A healthcare expert will help the patient confront social situations in a safe environment rather than avoid them<a href="#accordion">[5]</a>. 
	&nbsp;</li>
</ul>

<h5>Medication</h5>

There are a variety of drugs that can control the symptoms of social anxiety disorder. Usually, the doctor will prescribe beta-blockers, antidepressants, and anxiety medicines to deal with it<a href="#accordion">[1]</a>. 
&nbsp;

Antidepressants - The symptoms of social anxiety disorder can be treated with selective serotonin reuptake inhibitors (SSRIs), which are often used as antidepressants. They can take weeks or months to start working. For example

<ul>
	<li>Sertraline</li>
	<li>Paroxetine</li>
	<li>Fluoxetine 
	&nbsp;</li>
</ul>

Also, serotonin-norepinephrine reuptake inhibitors (SNRIs) that can help are:

<ul>
	<li>Desvenlafaxine</li>
	<li>Venlafaxine</li>
	<li>Duloxetine 
	&nbsp;</li>
</ul>

Anti-Anxiety Medications - Anti-anxiety drugs work immediately to lessen anxiety symptoms, but physicians often only advise using them temporarily since they can lead to dependence.

One popular kind of anti-anxiety medication is called benzodiazepines. These include, for instance, alprazolam and clonazepam. The Food and Drug Administration updated its benzodiazepine warning in 2020 that these medicines can cause physical dependence, and that their withdrawal symptoms can be fatal. They can be fatal, too, when the medicine is used with alcohol, painkillers, and other drugs. When utilizing these medications, it is crucial to adhere to the doctor&#39;s recommendations. 
&nbsp;

Beta-Blockers: Beta-blockers can reduce the symptoms of anxiety, such as perspiration, trembling, and an accelerated pulse, by preventing adrenaline&#39;s stimulating effects.&nbsp;These medications are typically prescribed by doctors for certain circumstances, such as needing to deliver a presentation, rather than for continuous care. 
&nbsp;

<h5>Home Remedies</h5>

In addition to the treatment recommended by the doctor, some home remedies can also help manage stress and anxiety, including:

<ul>
	<li>Meditation and mindfulness exercises</li>
	<li>Breathing exercises</li>
	<li>Avoiding caffeine along with other stimulants</li>
	<li>Develop a regular sleep routine</li>
	<li>Educate oneself about anxiety and its effects</li>
	<li>Talk to a trusted individual, i.e., share feelings and thought processes, such as a therapist, family member, or friend, to practice participation in social situations</li>
	<li>Balance diet along with regular exercise to boost the sense of well being<a href="#accordion">[4]</a>. 
	&nbsp;</li>
</ul>

Factors that increase the risk of developing social anxiety include:

<ul>
	<li>Family history</li>
	<li>Temperament</li>
	<li>Negative experiences</li>
	<li>New work or social demands</li>
	<li>Having a condition or appearance that draws attention<a href="#accordion">[4]</a>. 
	&nbsp;</li>
</ul>

Although it&#39;s impossible to foresee what can cause an anxiety disorder, certain steps can help lessen the severity of symptoms: 
&nbsp;

<ul>
	<li>Early Intervention - Social anxiety, like other mental health conditions, can be tougher to treat if the patient avoids early intervention. 
	&nbsp;</li>
	<li>Keep A&nbsp;Journal - The patient and their mental health practitioner can determine the stressors and what seems to make the individual feel better by keeping track of their life. 
	&nbsp;</li>
	<li>Set Goals - If time and energy are properly balanced, it can reduce tension. Also, ensuring that the individual spends time engaging in the activities they like. 
	&nbsp;</li>
	<li>Avoid Unhealthy Consumption Of Alcohol, Cigarettes, And Caffeine - The use&nbsp;of nicotine or caffeine, as well as alcohol and other drugs, can aggravate anxiety. A person who&rsquo;s addicted to these substances and trying to quit will present with withdrawal symptoms. If the patient feels they cannot stop using the substance on their own, then their doctor can suggest a support group or treatment program<a href="#accordion">[4]</a>. 
	&nbsp;</li>
</ul>

A cross-sectional study among medical students in Saudi Arabia classified 20.22% of participants as suffering from mild, 18.32% from moderate, 8.21% from severe, and 4.21% from extremely severe social anxiety disorder according to the Social Phobia Inventory Severity Score. 
&nbsp;

Students of older age were at a lower risk of developing social anxiety disorder. Females, students of private colleges, and colleges implementing non-problem-based learning were at a higher risk. An elevated risk of social anxiety disorder was seen among students who had failed previously or had a lower GPA<a href="#accordion">[6]</a>. 
&nbsp;

Key Points

<ul>
	<li>Social anxiety disorder (previously known as social phobia) is a medical condition that causes disproportionate anxiety and fear in social circumstances.</li>
	<li>Social anxiety disorder is characterized&nbsp;by strong anxiety that interferes with a&nbsp;job or personal life and lasts for at least six months, even though some anxiety is common in social circumstances like making presentations or going for an interview.</li>
	<li>Social anxiety disorder most likely results from a complex mix of biological and environmental variables, similar to many other mental health diseases.</li>
	<li>Usually, the doctor will prescribe beta-blockers, antidepressants, and anxiety medicines to deal with it.</li>
	<li>The use&nbsp;of nicotine or caffeine, as well as alcohol and other drugs, can aggravate anxiety.</li>
	<li>CBT teaches coping mechanisms for anxiety, such as how to replace negative ideas with optimistic ones. 
	&nbsp;</li>
</ul>

[1] Social anxiety disorder: Causes, symptoms, and treatment. Medical News Today.

[2] National Collaborating Centre for Mental Health (UK). Social Anxiety Disorder: Recognition, Assessment and Treatment. Leicester (UK): British Psychological Society (UK); 2013. (NICE Clinical Guidelines, No. 159.) 2, SOCIAL ANXIETY DISORDER.

[3] Social anxiety disorder: Symptoms, tests, causes & treatments. Cleveland Clinic.

[4] Social anxiety disorder (social phobia). Mayo Clinic.

[5] Social anxiety disorder: Causes, symptoms, and diagnosis. Healthline.

[6] Al-Johani WM, AlShamlan NA, AlAmer NA, et al. Social anxiety disorder and its associated factors: A cross-sectional study among medical students, Saudi Arabia - BMC psychiatry. BioMed Central.