Overview, complications, and treatment of social anxiety disorder (SAD)

Definition

The anxiety disorder known as social anxiety disorder, formerly known as social phobia, is characterized by overwhelming worry and extreme self-consciousness in routine social situations.

People who suffer from social anxiety disorder constantly, intensely, and chronically worry about what other people will think of them, how they will perceive them, and how their own behavior will make them look.

Their anxiety could be so intense that it prevents them from participating in other things like work or school.

Despite the fact that many sufferers of this illness are aware that their dread of people may be excessive or illogical, they are unable to get over it.

They frequently fret for days or weeks before a feared catastrophe occurs.

Additionally, they frequently struggle with depression and low self-esteem.

 

The symptoms of social anxiety disorder may only manifest in a certain scenario, such as a fear of public speaking, or they may appear whenever a person is with other people.

Social anxiety disorder can have negative effects if left untreated.

People might be prevented from attending job or school or from making acquaintances, for instance. 

Physical signs of social anxiety disorder include blushing, sweating, shaking, nausea, and difficulty speaking. These signs frequently go hand in hand with the disorder's extreme stress.

These outward signs, which increase the fear of rejection, can feed on themselves and produce new sources of anxiety, perpetuating the vicious cycle:

The more people with social anxiety disorder worry about displaying these symptoms, the higher the likelihood that they will do so. 

Depression or other anxiety disorders, such as panic disorder or obsessive-compulsive disorder, may also coexist with it. It frequently runs in families.

Self-medication with alcohol or other substances is practiced by some people with social anxiety disorder, which can result in addiction. 

Epidemiology

Depending on a person's gender and ethnicity, social anxiety disorder has a different lifetime prevalence.

According to research, 12% of Americans satisfy the criteria for social anxiety disorder, with numbers varied greatly in other nations.

Compared to men, women are more likely to develop the condition.

Although the disorder is common in other populations, anxiety can manifest itself in various ways.

Taijin Kyofusho, one variation of the illness, has a major cultural component.

Many of the characteristics of Taijin Kyofusho, which is largely found in Japan and Korea, reflect the cultural distinctions between American and Japanese cultures.

Individuals with Taijin Kyofusho, in contrast to the more westernized variety of social anxiety disorder, do not worry about embarrassing themselves; instead, they experience an illogical fear that others will find their smell, motions, or facial expressions (such as blushing) embarrassing.

They always worry that being with them will be unpleasant or disrespectful.

 

Social anxiety disorder risk factors

Your risk of getting social anxiety disorder may be impacted by a number of factors, including: 

Negative life events: Social anxiety disorder may be more prone to develop in kids who are taunted, bullied, rejected, ridiculed, or humiliated.

The illness may also be correlated with family conflict, trauma, abuse, or other unfortunate life occurrences.

New social or professional demands: Making a speech, meeting new people, or having to give a crucial presentation at work can all bring on symptoms of social anxiety disorder.

Having an attention-grabbing appearance or condition:

People may experience social anxiety disorder as a result of facial disfigurement, stuttering, Parkinson's disease-related tremors, and other disorders that make them feel self-conscious.

Temperament: Children that exhibit shyness, trepidation, withdrawal, or restraint while interacting with unfamiliar circumstances or people may be more likely to develop the disorder.

People with social anxiety disorder frequently admit to being very shy as kids.

(However, shyness and social anxiety disorder are not the same.) 

Causes of social anxiety disorder

Even though it might seem like you're the only one, social anxiety is actually fairly widespread.

A lot of people battle these worries.

However, the circumstances under which social anxiety disorder symptoms are triggered can vary. 

Many social settings cause anxiety for some people.

Others associate their anxiety with particular social events, such as interacting with strangers, mingling at gatherings, or giving a performance in front of an audience.

Triggers of social anxiety include: 

Meeting new people

Making small talk

Speaking in public

Speaking with or meeting "important" persons or authorities Being the center of attention

Doing something while being observed

Having a date

Receiving teasing or criticism

Getting involved in a meeting

Being called on in class

Using public restrooms

Taking exams

Having food or beverages in public

Making phone calls

participating in social events such as parties 

Social anxiety disorder symptoms

Social anxiety is more than shyness. It’s an intense fear that doesn’t go away.

It could impact:

Daily activities

Self-confidence

Relationships

life at work or school

Many people occasionally worry about social situations.

An individual with social anxiety feels extremely anxious before, during, and after an event. 

 

You may have social anxiety if you:

Dread going out with others, striking up a conversation, answering the phone, working, or shopping

Avoid social activities like group chats, dining with company, and parties, or worry excessively about them.

Always worry about doing something you think is embarrassing – blushing, sweating or appearing incompetent

Have trouble acting in public due to social anxiety, aversion to eye contact, or low self-esteem

Frequently experience symptoms including nausea, sweating, shaking, or heart palpitations.

Social anxiety disorder complications 

Many persons who have social anxiety also struggle with other mental health conditions, such as:

Depression

Disordered generalized anxiety

Disorder of body dysmorphia

Symptoms of social anxiety disorder

It can take control of your life if untreated.

Anxiety can prevent one from enjoying life, relationships, job, or school.

 

This condition may result in:

A low sense of self

Lack of assertiveness

Self-critical thoughts

Being overly sensitive to criticism

Inadequate social skills

Isolation and challenging social interactions

low success in school and at work

Drug abuse, such as abusing alcohol by consuming too much of it

Suicide or attempted suicide

Social anxiety disorder frequently co-occurs with other anxiety disorders and specific other mental health conditions, including major depressive disorder and substance abuse issues. 

Diagnostic procedures

Based on a description of your symptoms and behavioral patterns, your healthcare professional will make the diagnosis of social anxiety disorder.

You will be asked to describe the symptoms you are experiencing and the circumstances in which they appear during your consultation.

 

The DSM-5's diagnostic standards for social anxiety disorder include the following: 

A marked worry or anxiety that lasts for at least six months regarding one or more social occasions when the person may be subject to observation from others. 

Fear of displaying anxiety symptoms in a way that would be perceived adversely by others.

Children must experience anxiety among peers and not simply adults for it to be considered childhood anxiety.

Fear and anxiety are nearly always brought on by social settings.

The social circumstances are either avoided or bravely endured.

The level of fear or anxiety is excessive compared to the actual threat the circumstance poses.

Differential Diagnosis

Many illnesses have characteristics in common with social anxiety disorder.

These are frequently identified in conjunction with SAD.

 

The following conditions may be included in the differential diagnosis: 

Selective mutism: Selective mutism, which is typically diagnosed in childhood, is characterized by an inability to communicate in particular social contexts (such as at school).

The disease prevents affected children from speaking in class, yet they may converse with their family at home. 

Childhood-onset fluency disorder (stuttering): Classified as a neurodevelopmental disorder, childhood-onset fluency disorder can also make people self-conscious when speaking in front of others. 

The symptoms of avoidant personality disorder are similar to those of social anxiety disorder, but they are more severe and show a wider pattern of avoidance.

Panic disorder: People who suffer from panic disorder frequently experience sudden, unforeseen panic attacks.

People with panic disorder, as opposed to those with SAD, could think their anxiety has a medical origin.

Agoraphobia: Also known as panic disorder, agoraphobia is the dread of experiencing a panic attack in a situation from which it would be challenging to flee.

Although panic disorder and agoraphobia are different disorders, people with social anxiety disorder may also be diagnosed with them.

Autism spectrum disorder (ASD): Social communication impairment occurs in a variety of circumstances in autism spectrum disorder.

Social anxiety can coexist with high-functioning autism in children (Level 1).

 

Differential Diagnosis

You could also want professional assistance if you've tried the self-help methods mentioned above and are still having trouble controlling your crippling social anxiety.

Therapy

The most effective professional treatment for social anxiety disorder has been demonstrated to be cognitive-behavioral therapy (CBT).

The foundation of cognitive behavioral therapy (CBT) is the idea that thoughts influence feelings, and feelings influence behavior.

You will thus feel and perform better if you alter the way you think about social circumstances that cause you worry. 

CBT for social anxiety may entail: 

Acquiring the skills necessary to manage the physical signs and symptoms of anxiety through breathing exercises and relaxation methods. 

Challenging and replacing negative, harmful attitudes that cause and feed social anxiety with more rational viewpoints. 

Rather than avoiding social settings, face your fears gradually and methodically. 

Although you can study and practice these techniques on your own, if self-help has proven difficult for you, a therapist's additional support and direction may be helpful.

Practicing social skills and other CBT approaches, frequently in a therapy group.

Acting, videotaping and watching, fake interviews, and other exercises are used in group therapy to address real-world anxiety-provoking circumstances.

You will grow more at ease and experience less anxiety as you practice and get ready for the situations you're frightened of. 

Medication

Although it is not a cure, medication is occasionally used to treat the symptoms of social anxiety.

It is thought to be most beneficial when taken in conjunction with self-help methods and treatment to address the underlying causes of your social anxiety condition.

In order to treat social anxiety, three different forms of medicine are used:

Beta blockers are used for relieving performance anxiety. While they don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat.

In cases of severe and incapacitating social anxiety disorder, antidepressants may be beneficial.

Fast-acting anti-anxiety drugs include benzodiazepines.

They are, however, sedating and addicting, so doctors normally only recommend them when other drugs have failed.

 

Social anxiety disorder prevention

By lowering anxiety levels and developing coping mechanisms for anxious circumstances, anxiety attacks can be avoided.

Adapt your way of life to lessen anxiety

Learn and put into practice methods for lowering stress, like deep breathing and meditation.

Be physically active and exercise on a regular basis

Obtain enough rest.

Consume a nutritious, balanced diet.

Avoid drinking and smoking.

Limit or stay away from caffeinated beverages like coffee and tea.

Sedative plants like chamomile, valerian, kava root, and passion flower are known to provide relaxing effects.

Participate in social gatherings and spend time with a companion you find comforting.