Social Anxiety Disorder

Social anxiety disorder (SAD), also known as social phobia, is a condition where individuals have extreme fear of being embarrassed, humiliated, or rejected in public performance or social situations. This fear comes from the dread of being negatively judged by others. The existence of social phobia as a separate condition was first recognized over fifty years ago, in 1966, distinguishing it from other fears like agoraphobia and specific phobias. Over the years, it has grown from being considered a rare disorder to being recognized as a common issue worldwide.

In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) included social phobia in its classifications, limiting the diagnosis based on certain criteria. However, those limitations were challenged, and by 1987, they were eventually removed in a revised edition. The manual went through further updates, mainly in 1994 when it added ‘SAD’ as an alternative name suggesting that it’s different from specific phobias due to certain unique clinical characteristics and how it develops.

With the release of the latest edition, DSM-5 in 2013, SAD turned into the primary term for this disorder, reflecting the evolving understanding of the condition. The newest edition expanded the diagnostic criteria for SAD, embracing not just fears of humiliation or embarrassment, but also fear of actions or anxiety symptoms that might insult others or lead to rejection. Additionally, it removed a classification subtype and introduced a new ‘performance only’ specifier.

Research involving families and twins indicates that genes could play a role in Social Anxiety Disorder (SAD), but they likely work in combination with environmental factors. However, finding specific genetic markers related to SAD has been challenging.

Parent-child relationships can contribute to SAD, too. For instance, children with parents who are overly controlling or invasive might develop a reserved or inhibited temperament, and this may heighten their risk of SAD.

Tough or stressful life experiences can also make a person more susceptible to SAD. The search for brain-based factors linked with SAD, although important, hasn’t exactly pinpointed any specific factors. That said, modern advances in brain imaging technology hold promise for better understanding of this condition in the future.

Recent findings suggest that a part of the brain known as the extended amygdala could be a critical area related to anxiety disorders, which includes SAD.

Research has found that Social Anxiety Disorder (SAD) affects about 5 to 10% of people worldwide in any given year, and between 8.4 to 15% of people may experience it at some point in their lives. These rates are similar in the United States, and there are the same proportions of children, adolescents, and adults affected. Women are more often affected by SAD than men. It comes third amongst mental health issues, with only substance use disorder and depression being more common. Amongst anxiety disorders, it is the most prevalent.

Social Anxiety Disorder (SAD) commonly begins with symptoms showing up in people below the age of 20, often starting as early as childhood. It’s a long-term condition that usually lasts for at least six months. Those with social anxiety are often less educated, single, and of a lower socioeconomic status. It’s also not unusual for people with SAD to avoid seeking help because they see their social anxiety as a personality trait rather than a condition that needs treatment. Furthermore, when they do see a doctor, it’s frequently due to other related conditions such as major depression or issues with using substances.

When examining Social Anxiety Disorder (SAD), it’s crucial to consult the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to check if the patient fits the criteria. An individual would classically experience high levels of fear or anxiety in at least one social setting where they could be scrutinized by others. They fear acting in a way that might receive negative judgement. Generally, these social situations induce anxiety or fear. It’s also a common trait to deal with such situations with discomfort or decide to avoid them altogether.

This fear or anxiety is often more intense than the actual danger that the social situation might present. Normally, this fear or anxiety lasts for 6 months or more and contributes to significant distress or dysfunction in the individual’s daily life. This fear should not be tied to the effects of a substance or another medical condition, nor should it be a symptom of another mental disorder. If a medical condition is present, the anxiety, avoidance, or fear should be excessive or unrelated to it. This disorder is typically identified when the fear is restricted strictly to performing or speaking in public.

A key characteristic of SAD is the fear of being negatively evaluated. Various tools can be utilized to identify SAD. Examples include the Social Phobia Inventory (SPIN), Mini-SPIN, Liebowitz Social Anxiety Scale (LSAS), Liebowitz Self-Rated Disability Scale, Disability Profile, Brief Social Phobia Scale (BSPS), and Social Phobia Safety Behaviors Scale and Self Statements During Public Speaking Scale.

Research suggests that the SPIN covers multiple symptoms of SAD, spanning from fear of negative evaluation, distress caused by anxiety’s physical symptoms, and the fear felt in uncertain social circumstances. In conversations, individuals with SAD might speak softly, provide brief answers, and maintain less eye contact than normal. Direct questioning often reveals these symptoms.

Research strongly shows that both medications and a therapy called Cognitive Behavioral Therapy (CBT) are effective in treating Social Anxiety Disorder (SAD). Data analysis indicates that individual CBT and certain depression medications, specifically selective serotonin reuptake inhibitors (SSRI), are effective treatments for SAD. Additionally, medications that affect serotonin and norepinephrine (SNRIs) have shown greater benefits than a placebo or “dummy” treatment. The SSRIs known as sertraline and paroxetine, as well as the SNRI venlafaxine, are FDA-approved treatments for SAD.

When comparing different types of therapy, CBT proved more effective for SAD than psychodynamic therapy and other psychological therapies. Other medications, including a beta-blocker called propranolol and a family of drugs known as benzodiazepines, are also used to treat SAD. Propranolol offers an advantage as it can be used on an “as-needed” basis and doesn’t have the risk of building tolerance or dependence like benzodiazepines do.

There is no evidence suggesting that using medication and psychological intervention together is more effective than using either treatment on its own. Though medication can have quicker effects, CBT generally has longer-lasting outcomes.

When diagnosing Social Anxiety Disorder (SAD), it’s crucial to differentiate it from several other conditions. These may include autism spectrum disorder, panic disorder, agoraphobia, depression, addictions, body dysmorphic disorder, and certain personality disorders like avoidant and schizoid personality disorders. According to the DSM-5, a widely recognized manual for diagnosing mental disorders, the symptoms of SAD should not be better accounted for by another mental disorder. A few other potential diagnoses to eliminate are “Hikikomori,” a severe form of social withdrawal observed in about 1.2% of adults in Japan and last for over 6 months, and schizophrenia. Proper distinguishing between these illnesses is crucial to make an accurate diagnosis of SAD.

If Social Anxiety Disorder (SAD) is not addressed, it can have serious consequences. It’s prevalent and can significantly disrupt a person’s life. Common side effects include struggling with education and work, difficulty interacting socially, having poor-quality relationships, and experiencing a decrease in overall life quality. Notably, it can also lead to thoughts of suicide, low self-esteem, and issues with personal finances and employment. It’s often associated with lower socioeconomic status and being single.

One key issue is that many people with SAD might not realize they have a mental health problem, so they do not seek the help they need.

Almost 90% of people with Social Anxiety Disorder (SAD) also have other mental health issues. SAD can also predict the onset of major depression and problems with alcohol use. People who have multiple mental health conditions often experience more severe symptoms, may have difficulty responding to treatment, may struggle more with daily activities, and have higher rates of thoughts of suicide.

Many people with Seasonal Affective Disorder (SAD) may not be aware that they are suffering from a condition that can be treated. As a result, they often don’t look for treatment. It’s crucial to spread awareness about SAD to the public. By educating patients and the general public, we can both treat current cases and help prevent new ones from developing.

Frequently asked questions

Social Anxiety Disorder (SAD), also known as social phobia, is a condition where individuals have extreme fear of being embarrassed, humiliated, or rejected in public performance or social situations.

Social Anxiety Disorder affects about 5 to 10% of people worldwide in any given year, and between 8.4 to 15% of people may experience it at some point in their lives.

Signs and symptoms of Social Anxiety Disorder (SAD) can vary from person to person, but commonly include: 1. Excessive fear or anxiety in social situations: Individuals with SAD often experience intense fear or anxiety when faced with social situations, such as speaking in public, meeting new people, or participating in group activities. 2. Avoidance of social situations: People with SAD may go to great lengths to avoid social situations that trigger their anxiety. This can include avoiding parties, gatherings, or even everyday activities like going to school or work. 3. Physical symptoms: SAD can also manifest in physical symptoms such as rapid heartbeat, sweating, trembling, blushing, or feeling nauseous. These symptoms can be distressing and may further contribute to the individual's anxiety. 4. Negative self-image: Individuals with SAD often have a negative perception of themselves and worry excessively about being judged or humiliated by others. They may constantly fear that others are scrutinizing their every move or appearance. 5. Difficulty in making and maintaining relationships: Social anxiety can make it challenging for individuals to form and maintain relationships. They may struggle with initiating conversations, making eye contact, or participating in social activities, leading to feelings of isolation and loneliness. 6. Impact on daily life: SAD can significantly impact various aspects of a person's life, including their academic or professional performance, personal relationships, and overall quality of life. It's important to note that these symptoms can vary in severity and may be influenced by individual differences. If you or someone you know is experiencing these symptoms, it is advisable to seek professional help for an accurate diagnosis and appropriate treatment.

Genes, environmental factors, parent-child relationships, and tough or stressful life experiences can contribute to Social Anxiety Disorder (SAD).

The doctor needs to rule out the following conditions when diagnosing Social Anxiety Disorder: - Autism spectrum disorder - Panic disorder - Agoraphobia - Depression - Addictions - Body dysmorphic disorder - Avoidant personality disorder - Schizoid personality disorder - Hikikomori (a severe form of social withdrawal observed in about 1.2% of adults in Japan) - Schizophrenia

There are no specific tests for diagnosing Social Anxiety Disorder (SAD). Instead, the diagnosis is made based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, various tools can be utilized to identify SAD, such as the Social Phobia Inventory (SPIN), Mini-SPIN, Liebowitz Social Anxiety Scale (LSAS), Liebowitz Self-Rated Disability Scale, Disability Profile, Brief Social Phobia Scale (BSPS), and Social Phobia Safety Behaviors Scale and Self Statements During Public Speaking Scale. These tools help assess the severity and impact of social anxiety symptoms.

Social Anxiety Disorder (SAD) can be treated through a combination of medications and therapy, specifically Cognitive Behavioral Therapy (CBT). Certain depression medications, such as selective serotonin reuptake inhibitors (SSRIs) and medications that affect serotonin and norepinephrine (SNRIs), have been found to be effective in treating SAD. FDA-approved medications for SAD include sertraline, paroxetine, and venlafaxine. In terms of therapy, CBT has been shown to be more effective for SAD compared to psychodynamic therapy and other psychological therapies. Other medications like propranolol and benzodiazepines are also used to treat SAD, with propranolol offering advantages such as being used on an "as-needed" basis and not having the risk of tolerance or dependence. It is important to note that there is no evidence suggesting that combining medication and psychological intervention is more effective than using either treatment alone, although medication may have quicker effects while CBT generally has longer-lasting outcomes.

The text does not provide information about the side effects when treating Social Anxiety Disorder.

If Social Anxiety Disorder (SAD) is not addressed, it can have serious consequences. Common side effects include struggling with education and work, difficulty interacting socially, having poor-quality relationships, and experiencing a decrease in overall life quality. It can also lead to thoughts of suicide, low self-esteem, and issues with personal finances and employment. It's often associated with lower socioeconomic status and being single.

A psychiatrist or a psychologist.

Anxiety & Panic Disorders Mental Health