Social anxiety disorder is distinct from traits of introversion and shyness.
Social anxiety disorder (SAD), (social phobia) , is an anxiety disorder characterized by fear and anxiety in social situations, causing considerable distress and impairing ability to function in at least some aspects of daily life.
Such fears can be triggered by perceived or actual scrutiny from others.
Individuals with social anxiety disorder fear negative evaluations from other people.
Physical symptoms often include: excessive blushing, excessive sweating, trembling, palpitations, rapid heartbeat, muscle tension, shortness of breath, nausea, stammering may be present, along with rapid speech.
Panic attacks can also occur under intense fear and discomfort, and some affected individuals may use alcohol or other drugs to reduce fears and inhibitions at social events.
This can lead to alcohol use disorder, eating disorders or other kinds of substance use disorders.
SAD is sometimes an illness of lost opportunities where individuals make major life choices to accommodate their illness.
The main diagnostic criteria of social phobia are fear of being the focus of attention, or fear of behaving in a way that will be embarrassing or humiliating, avoidance and anxiety symptoms.
The first line of treatment for social anxiety disorder is cognitive behavioral therapy (CBT).
SSRIs are effective for social phobia, especially paroxetine.
CBT seeks to change thought patterns and physical reactions to anxiety-inducing situations.
Prescribed medications include several classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs).[
Other useful medications include beta blockers and benzodiazepines.
Social anxiety is classified as a mental and behavioral disorder.
Those with social phobias experience dread over how they will present to others, may feel overly self-conscious, pay high self-attention after an activity, or have high performance standards for themselves.
Before the potentially anxiety-provoking social situation, social anxiety patients may review what could go wrong and how to deal with each unexpected case.
After the event, they may have the perception that they performed unsatisfactorily, and will perceive anything that may have possibly been abnormal as embarrassing.
Such thoughts may extend for weeks or longer.
Cognitive distortions are a hallmark, with thoughts that’s are often self-defeating and inaccurate.
Individuals with social phobia tend to interpret neutral or ambiguous conversations with a negative outlook and many studies suggest that socially anxious individuals remember more negative memories than those less distressed.
Social anxiety disorder is a persistent fear of one or more situations in which the person is exposed to possible scrutiny by others and fears that they may do something or act in a way that will be humiliating or embarrassing.
SAD exceeds shynesS as it leads to excessive social avoidance and substantial social or occupational impairment.
Feared activities may include almost any type of social interaction.
Types of activities feared: small groups, dating, parties, talking to strangers, restaurants, and interviews.
Individuals social anxiety disorder fear being judged by others in society.
People with social anxiety are nervous in the presence of people with authority and feel uncomfortable during physical examinations.
People who have this disorder may behave a certain way or say something and then feel embarrassed or humiliated after: they often choose to isolate themselves from society to avoid such situations.
SAD patients may also feel uncomfortable meeting people they do not know and act distant when they are with large groups of people.
In some cases, evidence of this disorder by avoiding eye contact, or blushing when someone is talking to them.
Major avoidance behaviors in SAD could include an almost pathological or compulsive lying behavior to preserve self-image and avoid judgment in front of others.
Minor avoidance behaviors are exposed when a person avoids eye contact and crosses his or her arms to conceal recognizable shaking.
A fight-or-flight response is triggered in such events.
SAD causes a cycle of avoidance that often leads to in isolation and exacerbates symptoms over time, it has a substantial influence on day-to-day living.
People with SAD may avoid networking or public speaking-related jobs and
People with SAD find it difficult to establish or sustain personal relationships because they are afraid of being judged.
SAD avoidance tendencIES exacerbate emotions of loneliness and frustration in addition to limiting their social and professional development.
The discomfort in social situations is exacerbated by common physical symptoms, such as sweating, shaking, or a racing heart, which highlights the need for efficient support and treatment.
Physiological effects, similar to those in other anxiety disorders, are present in social phobias.
Sad may cause tears as well as excessive sweating, nausea, difficulty breathing, shaking, and palpitations as a result of the fight-or-flight response.
A person with SAD may be so worried about how they walk that they may lose balance, especially when passing a group of people.
Blushing is commonly process by individuals with social phobia.
Such visible symptoms further reinforce the anxiety in the presence of others.
The amygdala, part of the limbic system, is hyperactive when SAD patients are shown threatening faces or confronted with frightening situations.
With severe social phobia showed a correlation with increased response in their amygdalae.
People with SAD may avoid looking at other people, their surroundings, to a greater extent than their peers, possibly to decrease the risk of eye contact, which can be interpreted as a nonverbal signal of openness to social interaction.
People with SAD avoid situations that most people consider normal, and may have a hard time understanding how others can handle these situations so easily.
People with SAD avoid all or most social situations and hide from others, which can affect their personal relationships.
Social phobia removes people from social situations due to the irrational fear of these situations.
People with SAD may become addicted to social media networks, have sleep deprivation, and feel good when avoiding human interactions.
SAD lead to lowered self-esteem, negative thoughts, major depressive disorder, sensitivity to criticism, and poor social skills: that do not improve.
People with SAD experience anxiety in a variety of social situations, that range from important, meaningful encounters, to everyday trivial ones.
People with SAD may feel more nervous in job interviews, dates, interactions with authority, or at work.
There is a 75% correlation between internet gaming disorder and social anxiety.
Social networking accounts are significantly associated with higher levels of anxiety symptoms.
Studies investigating social media use and development of psychiatric disorders in childhood and adolescence concluded that a direct association between levels of anxiety, social media addiction behaviors, and nomophobia,
Longitudinal associations between social media use and increased anxiety, that fear of missing out and nomophobia are associated with severity of social media usage, and fear of missing out may trigger social media addiction and that nomophobia appears to mediate social media addiction.
Social anxiety is associated with problematic social media use and that socially anxious persons used social media to seek social support possibly to compensate for a lack of offline social support.
There is a statistically significant correlation between cybervictimization and anxiety with a moderate-to-large effect.
There is a statistically significant association between problematic social media use and anxiety.
There is a significant positive association between social anxiety and mobile phone addiction.
There is a significant association between binge-watching and anxiety.
SAD shows a high degree of co-occurrence with other psychiatric disorders:
SAD often occurs alongside low self-esteem and most commonly clinical depression, perhaps due to a lack of personal relationships and long periods of isolation related to social avoidance.
Clinical depression is 1.49 to 3.5 times more likely to occur in those with SAD.
The presence of social fears as avoiding of participating in small groups are likely to trigger comorbid depressive symptoms.
Anxiety disorders other than SAD are also very common in patients with SAD, in particular generalized anxiety disorder.
Avoidant personality disorder is likewise highly correlated with SAD, with comorbidity rates ranging from 25% to 89%.
In an attempt to reduce their anxiety and alleviate depression, people with social phobia may use alcohol or other drugs, which can lead to substance use disorders.
It is estimated that one-fifth of patients with social anxiety disorder also have alcohol use disorder.
However, some research suggests SAD is unrelated to, or even protective against alcohol-related problems.
Those who have both alcohol use disorder and social anxiety disorder are more likely to avoid group-based treatments and to relapse compared to people who do not have this combination.
Social phobia is not caused by other mental disorders or substances, but genetics can play a part in combination with environmental factors.
Generally, social anxiety begins at a specific point in an individual’s life.
Mild social awkwardness can develop into symptoms of social anxiety or phobia.
There is a two to a threefold greater risk of having social phobia if a first-degree relative also has the disorder: possibly due to genetics and/or due to children acquiring social fears and avoidance through processes of observational learning or parental psychosocial education.
Identical twins brought up in different families have indicated that, if one twin developed social anxiety disorder, then the other was between 30 percent and 50 percent more likely than average to also develop the disorder.
If a parent has any kind of anxiety disorder or clinical depression, then a child is somewhat more likely to develop an anxiety disorder or social phobia.
Parents of those with social anxiety disorder tend to be more socially isolated themselves,and shyness in adoptive parents is significantly correlated with shyness in adopted children.
Growing up with overprotective and hypercritical parents is associated with social anxiety disorder.
Adolescents who were rated as having an insecure attachment with their mother as infants are twice as likely to develop anxiety disorders by late adolescence, including social phobia
A previous negative social experience can be a trigger to social phobia;
For around half of those diagnosed with social anxiety disorder, a specific traumatic or humiliating social event appears to be associated with the onset or worsening of the disorder.
Observing or hearing about the socially negative experiences of others (e.g. or verbal warnings of social problems and dangers, may also make the development of a social anxiety disorder more likely.
Social anxiety disorder may be caused by the longer-term effects of not fitting in, or being bullied, rejected, or ignored.
Shy adolescents or adults have emphasized unpleasant experiences with peers or childhood bullying or harassment.
Popularity has been found to be negatively correlated with social anxiety, and children who were neglected by their peers reported higher social anxiety and fear of negative evaluation than other children.
Cultural factors related to social anxiety disorder include a society’s attitude towards shyness and avoidance, which then affects the ability to form relationships or access employment or education, and shame.
US children appear more likely to develop social anxiety disorder if their parents emphasize the importance of others’ opinions and use shame as a disciplinary strategy.
The socially anxious person perceive their own social skills to be low.
The increasing need for sophisticated social skills in forming relationships or careers, and an emphasis on assertiveness and competitiveness, is making social anxiety problems more common.
Alcohol initially relieves social phobia, however, excessive alcohol misuse can worsen social phobia symptoms and cause panic disorder to develop or worsen during alcohol intoxication and especially during alcohol withdrawal syndrome.
This effect can also occur with long-term use of drugs that have a similar mechanism of action to alcohol such as the benzodiazepines which are sometimes prescribed as tranquilizers.
There is evidence relating social anxiety disorder to imbalance in some neurochemicals and hyperactivity in some brain areas.
Sociability is closely tied to dopaminergic neurotransmission.
There is a direct relation between social status and binding affinity of dopamine D2/3 receptors in the striatum.
The binding affinity of dopamine D2 receptors in the striatum of people with social anxiety is lower than in controls.
There may be an abnormality in dopamine transporter density in the striatum of those with social anxiety: some researchers have been unable to replicate previous findings of evidence of dopamine abnormality in social anxiety disorder.
Studies have shown high prevalence of social anxiety in Parkinson’s disease and schizophrenia.
Social phobia was diagnosed in 50% of Parkinson’s disease patients in one study.
Social phobia symptoms in patients treated with dopamine antagonists like haloperidol, emphasizing the role of dopamine neurotransmission in social anxiety disorder.
Some evidence social anxiety disorder involves reduced serotonin receptor binding.
Paroxetine, sertraline and fluvoxamine are three SSRIs that have been approved by the FDA to treat social anxiety disorder.
Some researchers believe that SSRIs decrease the activity of the amygdala.
Norepinephrine and glutamate, may be over-active in social anxiety disorder, and the inhibitory transmitter GABA, which may be under-active in the thalamus.
The amygdala is part of the limbic system which is related to fear cognition and emotional learning.
Individuals with social anxiety disorder have been found to have a hypersensitive amygdala.
The anterior cingulate cortex, is involved in the experience of physical pain, also appears to be involved in the experience of social pain.
There is a role of the prefrontal cortex, especially its dorsolateral part, in the maintenance of cognitive biases involved in SAD.
Individuals with social anxiety had hyperactivation in the amygdala and insula areas which are frequently associated with fear and negative emotional processing.
It is defined as social phobia as fear of scrutiny by other people leading to avoidance of social situations.
The anxiety symptoms may present as a complaint of blushing, hand tremor, nausea, or urgency of urination and symptoms may progress to panic attacks.
Standardized rating scales (Social Phobia Inventory, the SPAI-B, Liebowitz Social Anxiety Scale, and the Social Interaction Anxiety Scale) can be used to screen for social anxiety disorder and measure the severity of anxiety.
It is marked, or intense, fear or anxiety of social situations in which the individual may be scrutinized by others.
Examples include: having a conversation, meeting unfamiliar people, being observed eating or drinking, and performing in front of others, icy as giving a speech.
In children, the anxiety must occur in peer settings and not just during interactions with adults.
The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated, that it will be humiliating or embarrassing: will lead to rejection or offend others.
When exposed to such social situations, the individual fears that they will be negatively evaluated.
Individuals are concerned that they will be judged as anxious, weak, crazy, stupid, boring, intimidating, dirty, or unlikable.
The individual fears that they will show anxiety symptoms, such as blushing, trembling, sweating, stumbling over one’s words, or staring, that will be negatively evaluated by others.
Social situations almost always provoke fear or anxiety.
In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
Social situations are avoided, or alternatively the situations are endured with intense fear or anxiety.
The fear or anxiety is out of proportion to the actual threat posed by the social situation.
The fear or anxiety is out of proportion to the actual risk of being negatively evaluated or to the consequences of such negative evaluation.
Sometimes, the anxiety may not be judged to be excessive, as it is related to an actual danger, unchecked as being bullied or tormented by others.
The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more: This duration threshold helps distinguish the disorder from transient social fears that are common, particularly among children and in the community.
The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The fear, anxiety, and avoidance interferes significantly with the individual’s normal routine, occupational or academic functioning, or social activities or relationships, and 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 or another medical condition, or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
If the fear is restricted to speaking or performing in public it is a performance only social anxiety disorder.
An individual cannot receive a diagnosis of social anxiety disorder if their symptoms are better accounted for by one of the autism spectrum disorders such as autism and Asperger syndrome.
Social anxiety disorder is often linked to bipolar disorder and attention deficit hyperactivity disorder: they share an underlying cyclothymic-anxious-sensitive disposition.
The first-line treatment for social anxiety disorder is cognitive behavioral therapy (CBT), with medications such as selective serotonin reuptake inhibitors (SSRIs) used only in those who are not interested in therapy.
Combining the use of CBT with escitalopram reduced anticipatory speech-state anxiety and increased reductions of social anxiety symptoms, revealing the potential of combining various treatment methods.
Acceptance and commitment therapy (ACT) in the treatment of social anxiety disorder, an offshoot of traditional CBT, and emphasizes accepting unpleasant symptoms rather than fighting against them, and provides psychological flexibility with the ability to adapt to changing situational demands, to shift one’s perspective, and to balance competing desires.
Social skills training (SST) with social anxiety include: initiating conversations, establishing friendships, interacting with members of the preferred sex, constructing a speech and assertiveness skills.
However, it is not clear whether specific social skills techniques and training are required, rather than just support with general social functioning and exposure to social situations.
Expressive therapies (painting, drawing or musical therapy) can be effective for treating social anxiety disorder in certain contexts.
Social anxiety disorder may predict subsequent development of other psychiatric disorders such as depression, and therefore early diagnosis and treatment is important.
Social anxiety disorder remains under-recognized with patients often presenting for treatment only after the onset of complications such as clinical depression or substance use disorders.
Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, are the first choice of medication for generalized social phobia.
Paroxetine and paroxetine CR, sertraline, escitalopram, venlafaxine XR and fluvoxamine CR are all approved for SAD and are all effective agents, especially paroxetine.
All SSRIs are somewhat effective for social anxiety except fluoxetine which was equivalent to placebo in all clinical trials.
Paroxetine changes personality and significantly increase extraversion: the SSRI paroxetine was shown to result in clinically meaningful improvement in 55% of patients with generalized social anxiety disorder, compared with 23.9% of those taking placebo.
Other SSRIs like fluvoxamine, escitalopram and sertraline showed reduction of social anxiety symptoms, including anxiety, sensitivity to rejection and hostility.
Before SSRIs, monoamine oxidase inhibitors (MAOIs) were frequently used in the treatment of social anxiety.
MAOIs are effective in the treatment and management of social anxiety disorder: generally now only as a last resort medication, owing to concerns about dietary restrictions, possible adverse drug interactions and a recommendation of multiple doses per day.
Benzodiazepines are an alternative to SSRIs for short time usage for relief.
Benzodiazepines be considered only for individuals who fail to respond to other medications.
Benzodiazepines augment the action of GABA, the major inhibitory neurotransmitter in the brain; effects usually begin to appear within minutes or hours. In most patients, tolerance rapidly develops to the sedative effects of benzodiazepines, but not to the anxiolytic effects.
Long-term use of a benzodiazepine may result in physical dependence.
Their abrupt discontinuation of the drug has a high potential for withdrawal symptoms.
Certain anticonvulsant drugs such as gabapentin and pregabalin are effective in social anxiety disorder.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine have shown similar effectiveness to the SSRIs.
Some people with a form of social phobia called performance phobia have been helped by beta-blockers.
A combination of acute dosing of d-cycloserine (DCS) with exposure therapy facilitates the effects of exposure therapy of social phobia.
Prevalence in the United States 2–7%.
Social anxiety disorder is known to appear at an early age in most cases.
Fifty percent of those who develop this disorder have developed it by the age of 11, and 80% have developed it by age 20.
The early age of onset may lead to people with social anxiety disorder being particularly vulnerable to depressive illnesses, substance use, and other psychological conflicts.
The National Comorbidity Survey revealed 12-month and lifetime prevalence rates of 7.9 percent and 13.3 percent, respectively; this makes it the third most prevalent psychiatric disorder after depression and alcohol use disorder, and the most common of the anxiety disorders.
Data from the National Institute of Mental Health: social phobia affects 15 million adult Americans in any given year.
The mean onset of social phobia is 10 to 13 years.
Onset after age 25 is rare and is typically preceded by panic disorder or major depression.
Social anxiety disorder occurs more often in females than males.
The prevalence of social phobia appears to be increasing among white, married, and well-educated individuals.
As a group, individuals with generalized social phobia are less likely to graduate from high school and are more likely to rely on government financial assistance or have poverty-level salaries.