Social anxiety disorder (social phobia)
Social anxiety disorder (social phobia)
It's normal to feel nervous in some social situations. Going on a date or giving a presentation may cause that feeling of butterflies in your stomach, for instance. But in social anxiety disorder, also called social phobia, everyday interactions cause irrational anxiety, fear, self-consciousness and embarrassment.
Social anxiety disorder is a chronic mental health condition, but treatment such as psychological counseling, medication and learning coping skills can help you gain confidence and improve your ability to interact with others.
Social anxiety disorder affects your emotions and behavior. It can also cause significant physical symptoms.
Emotional and behavioral social anxiety disorder signs and symptoms include:
Physical social anxiety disorder signs and symptoms include:
Worrying about having symptoms
When to see a doctor
Feelings of shyness or discomfort in certain situations aren't necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary from individual to individual due to personality traits and life experiences. Some people are naturally reserved and others are more outgoing. What sets social anxiety disorder apart from everyday nervousness is that its symptoms are much more severe, causing you to avoid normal social situations.
Common, everyday experiences that may be difficult to endure when you have social anxiety disorder include:
Social anxiety disorder symptoms can change over time. They may flare up if you're facing a lot of stress or demands. Or if you completely avoid situations that would usually make you anxious, you may not have symptoms. Although avoidance may allow you to feel better in the short term, your anxiety is likely to persist over the long term if you don't get treatment.
Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of environment and genes. Possible causes include:
Social anxiety disorder is one of the most common mental disorders. It usually begins in the early to midteens, although it can sometimes begin earlier in childhood or in adulthood.
A number of factors can increase the risk of developing social anxiety disorder, including:
Left untreated, social anxiety disorder can be debilitating. Your anxieties may run your life. They can interfere with work, school, relationships or enjoyment of life. You may be considered an "underachiever," when in reality it's your fears holding you back, not your ability or motivation. In severe cases, you may drop out of school, quit work or lose friendships. Social anxiety disorder can cause:
Social anxiety disorder can also result in:
Preparing for your appointment
You may start by seeing your family doctor. After your initial appointment, your doctor may refer you to a mental health provider who can help make a firm diagnosis and create the right treatment plan for you.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
Questions to ask your doctor at your initial appointment may include:
Questions to ask if you are referred to a mental health provider include:
In addition to the questions that you've prepared in advance, don't hesitate to ask questions at any time during your appointment.
What to expect from your doctor
Tests and diagnosis
When you decide to seek treatment for social anxiety disorder symptoms, you may have a physical exam and your doctor will ask a number of questions. The physical exam can determine if there may be any physical causes triggering your symptoms. Answering questions will help your doctor or mental health provider find out about your psychological state.
There's no laboratory test to diagnose social anxiety disorder, however. Your doctor or mental health provider will ask you to describe your signs and symptoms, how often they occur and in what situations. He or she may review a list of situations to see if they make you anxious or have you fill out psychological questionnaires to help pinpoint a diagnosis.
To be diagnosed with social anxiety disorder, a person must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Criteria for social anxiety disorder to be diagnosed include:
Social anxiety disorder shares symptoms with other psychological disorders, including other anxiety disorders. Your mental health provider will want to determine whether one of these other conditions may be causing your social anxiety, or if you have social anxiety disorder along with another mental health disorder. Often, social anxiety occurs along with other mental health conditions, such as substance abuse problems, depression and body dysmorphic disorder.
Treatments and drugs
The two most common types of treatment for social anxiety disorder are medications and psychological counseling (psychotherapy). These two approaches may be used in combination.
Cognitive behavioral therapy may also include exposure therapy. In this type of therapy, you gradually work up to facing the situations you fear most. This allows you to become better skilled at coping with these anxiety-inducing situations and to develop the confidence to face them. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others.
Your mental health professional may help you develop relaxation or stress management techniques.
First choices in medications
The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) also may be an option for social anxiety disorder.
To reduce the risk of side effects, your doctor will start you at a low dose of medication and gradually increase your prescription to a full dose. It may take up to three months of treatment for your symptoms to noticeably improve.
Other medication options
Stick with it
For some people, the symptoms of social anxiety disorder may fade over time, and medication can be discontinued. Others may need to take medication for years to prevent a relapse.
To make the most of treatment, keep your medical or therapy appointments, take medications as directed, and talk to your doctor about any changes in your condition.
Lifestyle and home remedies
Although social anxiety disorder generally requires help from a medical expert or qualified psychotherapist, you can try some self-help techniques to handle situations likely to trigger your symptoms.
First, consider your fears to identify what situations cause the most anxiety. Then gradually practice these activities until they cause you less anxiety. Begin with small steps in situations that aren't overwhelming.
Situations to practice may include:
At first, being social when you're feeling anxious is challenging. As difficult or painful as it may seem initially, don't avoid situations that trigger your symptoms. By regularly facing these kinds of situations, you'll continue to build and reinforce your coping skills.
The following techniques can help you begin to face situations that make you nervous:
Avoid using alcohol to calm your nerves. It may seem like it helps, but in the long run it can make you feel more anxious.
Certain supplements may help relieve anxiety, although it isn't clear about how much they help or what possible side effects they might have. Some supplements used to treat anxiety include:
Talk to your doctor before taking herbal remedies or supplements to make sure they're safe for you and won't interact with any medications you take.
Coping and support
Some coping methods that may help ease your anxiety include:
Over time, these coping methods can help control your symptoms and prevent a relapse. Remind yourself that you can get through anxious moments, that your anxiety is short-lived, and that the negative consequences you worry about so much rarely come to pass.
There's no way to predict for certain what will cause someone to develop an anxiety disorder in the first place, but you can take steps to reduce the impact of symptoms if you're anxious:
Last Updated: 2011-08-23
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