Social anxiety disorder is sometimes called social phobia. Social anxiety disorder is not just shyness; it is more severe than this. With social anxiety disorder you become very anxious about what other people may think of you, or how they may judge you. As a result you have great difficulty in social situations, which can affect your day-to-day life.
- A marked fear or dread of social situations. You fear that you will act in an embarrassing or humiliating way and that other people will think you are stupid, inadequate, foolish, etc:
- In some cases the fear is only for certain situations where you will be looked at by others, even if they are known to you. For example, you become very anxious if you have to 'perform' in some way, such as giving a talk or presentation, taking part in a discussion at work or school, etc. However, you are OK in informal social gatherings.
- In other cases the fear occurs for most social situations where you may meet strangers. This can even include eating in public places, as you fear you may act in an embarrassing way.
- You may have weeks of anxiety prior to a social event or an event where you have to 'perform'.
- You avoid such situations as much as possible.
- If you go to the feared situation:
- You become very anxious and distressed.
- You may develop some physical symptoms of anxiety. These may include:
- A fast heart rate.
- The sensation of having a 'thumping heart' (palpitations).
- Shaking (tremor).
- Feeling sick (nausea).
- Chest pain.
- Stomach pains.
- A 'knot in the stomach'.
- Fast breathing.
- Blushing easily.
- You may have an intense desire to get away from the situation.
- You may even have a panic attack. Read more about panic attack and panic disorder.
- However, you will usually know that your fear and anxiety are excessive and unreasonable.
Social anxiety disorder can greatly affect your life. You may not do as well at school or work as you might have done, as you tend to avoid any group work, discussions, etc. You may find it hard to obtain, or keep, a job. This may be because you feel unable to cope with the social aspects needed for many jobs, such as meeting with people. You may become socially isolated and find it difficult to make friends.
Who has social anxiety disorder?
It is one of the most common mental health conditions. As many as 1 in 10 adults have social anxiety disorder to some degree. It usually develops in the teenage years and is usually a lifelong problem unless treated. Just over twice as many women as men are affected.
What causes social anxiety disorder?
The cause is probably a combination of bad experiences as a child and your genetic 'makeup' which makes you more prone to this condition. In one study about half of affected people said their phobia began after one memorable embarrassing experience. The other half said it had been present for 'as long as they could remember'.
How is it diagnosed?
You must have three features to be diagnosed with social anxiety disorder:
- Your symptoms must not be the result of some other mental health condition (for example, a delusion).
- You feel anxious entirely or mostly in social situations.
- One of your main symptoms will be the avoidance of social situations.
As well as discussing your problems your doctor or practice nurse may use a short questionnaire to obtain extra information on how severely you are affected.
What are the treatment options for social anxiety disorder?
Cognitive and behavioural therapies
Cognitive behavioural therapy (CBT) is a type of therapy that deals with your current thought processes and/or behaviours and aims to change them by creating strategies to overcome negative thought patterns, which may help you to manage your social anxiety. See separate leaflet called Cognitive Behavioural Therapy (CBT) for more details.
You can obtain leaflets, books, CDs, DVDs or MP3s, etc, on how to relax and how to combat anxiety. They teach simple deep-breathing techniques and other measures to relieve stress and anxiety.
Medicines for social anxiety
Although mainly prescribed for the treatment of depression, they can also lessen the symptoms of anxiety. They interfere with brain chemicals (also called neurotransmitters) such as serotonin, which are thought to cause anxiety symptoms. There are lots of different antidepressants, but selective serotonin reuptake inhibitors (SSRIs) seem best for anxiety disorders. Escitalopram and sertraline are two SSRIs commonly prescribed..
Benzodiazepines such as diazepam used to be the most commonly prescribed medicines for anxiety. They were known as the minor tranquilisers but they do have some serious known side-effects. They often work well to ease symptoms. The problem is they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Now they are not used much for persistent anxiety conditions. A short course of up to two weeks may be an option for:
- Anxiety which is very severe and short-term; or
- 'Now and then' treatment to help you over a bad spell if you have persistent anxiety symptoms.
A beta-blocker (for example, propranolol) can ease some of the physical symptoms such as trembling and the sensation of having a 'thumping heart' (palpitations). They do not directly affect the mental symptoms such as worry. However, some people relax more easily if their physical symptoms are eased. These tend to work best in short-lived (acute) anxiety. For example, if you become more anxious before performing in a concert then a beta-blocker may help to ease 'the shakes'.
In some cases a combination of treatments such as cognitive therapy and an antidepressant may work better than either treatment alone.
Social anxiety and alcohol
Although alcohol may ease symptoms in the short term, don't be fooled that drinking helps to cure social anxiety. In the long run, it does not. Drinking alcohol to 'calm nerves' can lead to problem drinking and may make problems with social anxiety (and the depression that often accompanies it) worse in the long term. See a doctor if you are drinking alcohol (or taking street drugs) to ease social anxiety.
What is the outlook for social anxiety disorder?
Not much is known about the natural progress of the condition. However, with treatment there is a good chance that symptoms can be greatly improved. Without treatment, social phobia can be associated with depression in later life.
Further reading and references
Social anxiety disorder: recognition assessment and treatment; NICE Clinical Guideline (May 2013)
Anxiety disorders; NICE Quality Standards, Feb 2014
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