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Overview of Social Anxiety Disorder

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Updated May 16, 2014

BUSINESS WOMAN AT SOCIAL RECEPTION
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What is Social Anxiety Disorder?

People with social anxiety disorder (SAD) have an irrational fear of being watched, judged or evaluated, or of embarrassing or humiliating themselves. The anxiety and discomfort becomes so extreme that it interferes with daily functioning. SAD is one of the most common mental disorders with up to 13% of the general population experiencing symptoms at some point in their life. With proper treatment, symptoms can be managed and quality of life can greatly improve.

Symptoms of SAD

The difference between normal shyness and SAD relates to the severity and persistence of the symptoms that are experienced. People with SAD have both emotional and physical symptoms.

Some of the emotional symptoms include:

  • intense fear of situations where you don't know other people
  • fear of situations where you will be judged
  • anxiety about being embarrassed or humiliated
  • fear that others will notice your anxiety
  • fear and dread of upcoming events weeks in advance

Examples of physical symptoms include:

  • blushing
  • profuse sweating
  • trembling hands
  • muscle tension
  • racing heart

People with SAD know that their fear is out of proportion to the actual situation, but are still unable to control their anxiety. The anxiety may be specific to one type of social or performance situation (known as specific SAD) or it may be in all situations (generalized SAD). Some of the situations that are common triggers include interacting with strangers, making eye contact, and initiating conversations.

Causes of SAD

The disorder usually begins in the teenage years although it may start in childhood. It is believed that SAD is the result of a combination of factors, both genetic and environmental.

Genetics, Biochemistry and Brain Structure

Researchers are working to determine whether specific genes are linked to anxiety and fearfulness. Because SAD tends to run in families, it is likely that part of the underlying cause of the disorder is genetic.

Imbalances in brain chemistry have been linked to SAD. For example, an imbalance in the neurotransmitter serotonin, a brain chemical that regulates mood and emotions, may play a role in the development of SAD. The use of medication in treating SAD is based on the notion that chemicals in the brain need to be regulated.

A structure in the brain called the amygdala has been linked to the fear response. It is believed that people with SAD may be predisposed to an exaggerated fear response, and in turn increased anxiety, because of an overactive amygdala.

Environmental Risk Factors

Several environmental factors may increase your risk of developing SAD. These include but are not limited to:

  • having an overly critical, controlling or protective parent
  • being bullied or teased as a child
  • family conflict or sexual abuse
  • a shy, timid or withdrawn temperament as a child

Diagnosis of SAD

A medical professional may complete a physical examination first to make sure that you don't have an underlying medical condition that could be responsible for your symptoms. As part of the psychological evaluation you will be asked a number of questions about your symptoms. In order to receive a diagnosis, you must meet a number of specific diagnostic criteria.

Treatments for SAD

The most effective treatment options for SAD are medication and cognitive-behavioral therapy (CBT). Often these two forms of treatment will be used together for optimal results.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy of SAD consists of three main components: exposure, cognitive restructuring and social skills training. Exposure involves gradually facing feared situations to develop confidence while cognitive restructuring works to change maladaptive thought patterns that contribute to the symptoms of anxiety. Although not necessary for everyone, social skills training can be helpful for those who lack specific social skills.

Medication

Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line of treatment of SAD. Monoamine Oxidase Inhibitors (MAOIs) are sometimes prescribed for SAD but have potential serious side effects and strict dietary requirements. Benzodiazepines and beta blockers are generally prescribed for short-term relief of anxiety in specific situations (e.g., public speaking) and are not appropriate for those with generalized SAD (fear of most social and performance situations). It is usually a process of trial and error in order to find the best medication for your particular situation. Although some people may find that their symptoms improve over a short period of treatment, others may need to take medication for several years to avoid relapse.

Coping with SAD

In addition to receiving professional treatment, you can do a number of things to help cope with SAD. Some of these include practicing relaxation exercises, getting enough sleep, and eating a well-balanced diet. It is important not to avoid the situations that make you anxious. Although in the short term, avoidance may reduce your anxiety, in the long term it will make things worse. If you find yourself feeling anxious it may help to remind yourself that you can get through the situation, that your anxiety is usually short-lived, and that your worst fears are not likely to come true.

It is important to remember that feeling anxious and nervous is not a sign of weakness or inferiority. SAD is a real medical condition that requires attention. If left untreated, it can lead to other health problems such as substance abuse or risk of depression or suicide. However, with proper treatment and ongoing care, your quality of life can be much improved.

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