Social Anxiety Disorder
What is "social anxiety disorder"?
Social anxiety disorder is social phobia marked by the persistent fear of embarrassment in certain situations. This is accompanied by a lot of worry and anxiety, and avoidance of these situations. A person with social anxiety disorder would be looked at as being extremely shy and very sensitive to criticism. The disorder really goes beyond the personality trait of shyness to a point of interfering with normal interpersonal relations.
What are the signs that someone has a social anxiety disorder?
A person with social anxiety disorder may appear tremulous in a social situation. They may have poor eye contact. If you were to shake their hand, it may appear cold and clammy. In general, these individuals will avoid situations where they have to meet people, where they may have to speak, and in some cases where they even have to eat in the presence of others. Additionally, after this pattern of behaviour, these individuals often develop very low self esteem because they're aware that they have this disability. They're also aware that their fear and worries are unreasonable but yet they feel helpless to do anything about it.
What are the most common causes of social anxiety disorder?
We don't really know what causes social anxiety disorder; however, there is some research that points to some genetic predispositions. This work implicates some of the serotonin neurotransmitter pathways as being involved in the development of this disorder as well as other anxiety disorders. This would fit with the fact that serotonin reuptake inhibitors such as fluoxetine are helpful to people with social anxiety disorder.
What are the most common dangers associated with social anxiety disorder?
As with all anxiety disorders, the main danger with social anxiety disorder is the impact that the disease has on social or occupational functioning. Since social anxiety disorder really can affect performance, any kind of situation where performance, especially in front of other people, is required is going to be impaired. So if you're a student and you have to participate in class, that's going to really cause some problems. If in your job you have to interact or make presentations, social anxiety disorder is going to make it difficult for you to do your job well in advance.
How will a psychiatrist determine whether I suffer from social anxiety disorder?
As with other mental illnesses, the first job of a psychiatrist when diagnosing social anxiety disorder is to collect information about the present illness, as well as important details about your past and your family psychiatric history. Once that's completed, the psychiatrist will develop in his mind a list of the possible disorders that might explain your symptoms, including social anxiety disorder. Then, through a process of elimination, which may require medical tests or medical examinations to rule out medical causes of anxiety, he or she will arrive at the correct diagnosis.
What are the common treatments for social anxiety disorder?
The common treatments for social anxiety disorder include pharmacotherapy, typically with antidepressants and psychotherapy. Antidepressants that can be used to treat social anxiety disorder are the SSRIs, or the serotonin reuptake inhibitors, such as fluoxetine or citalopram. Sometimes, we also use a beta blocker called propranolol which can block some of those performance anxiety symptoms. In fact, sometimes performers - musicians or public speakers - will use a little bit of propranolol to dampen some anxiety symptoms such as increased heart rate and general edginess. Cognitive behavioral therapy is a focus on relaxation and is useful for treating social anxiety disorder. It's important to remember that if you've had social anxiety disorder for a while, you've really had a pattern of social dysfunction. Low self-esteem and depression can accompany social phobia; this needs to be dealt with as a separate issue and often psychotherapy can be very helpful. It's important to get treatment for social anxiety disorder because these symptoms can be effectively treated.
Who is most at risk for developing social anxiety disorder?
As with other anxiety disorders, social phobia (or social anxiety disorder) occurs somewhat more in women compared to men. Typically people with this disorder were shy as children, but that's in no way predictive of developing a disorder. Other than that, we really don't have good ideas of who is going to develop the illness.
Is there anything I can do to avoid developing social anxiety disorder?
There's very little that can be done to prevent the development of social anxiety disorder. However, what can be done is prevention of the sequela of having the disorder for a long period of time. If you get treatment early, through early recognition, you can prevent the impairment in social, school, or occupational function and really get back on track.
What are "specific phobias"?
There's another category of phobias that we call "specific phobias," and these relate to situational or natural kinds of circumstances in which a person develops profound worry or fear. This would include the fear of heights, enclosed spaces like elevators, or may include a natural situation such as water, thunderstorms, or even various kinds of animals. Now, it's important to differentiate the specific phobia from the natural, more ordinary fear of, say spiders or a dog. In most cases, that fear is not disabling and doesn't entail rearrangement of your entire schedule to avoid an encounter with such things.