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Social Anxiety Disorder (Social Phobia)

Social Anxiety Disorder (SAD), or Social Phobia, is characterized by overwhelming anxiety and feelings of extreme self-consciousness in social situations. Some patients only suffer from this disorder in certain situations like speaking in public or making presentations in a class or office setting. Some are uncomfortable eating or drinking in front of others. In its most severe form, Social Anxiety Disorder causes symptoms whenever a person is around other people. People who suffer from this disorder know that their feelings are irrational. Even if they can work through those feelings and go out in public, they will still feel anxious before the event and have symptoms throughout the event.

Afterwards, they will often worry about how people saw them, or if they were judged or watched during the time they were in public. Not everyone who suffers from Social Phobia seems to be shy or withdrawn or nervous. Sometimes the patient will appear to be fine, and is not obviously anxious, but may still be experiencing fear and distress.

Many times, people with Social Anxiety Disorder are misperceived as shy, withdrawn or quiet individuals, who may be inhibited, unfriendly or aloof. In fact, people suffering from this social phobia want to have friends and to be involved in social situations, but their fear prevents this normal interaction. In general, Social Anxiety Disorder (social phobia) is undiagnosed and untreated in many people, though more doctors are becoming familiar with this disorder and are able to recognize it more readily.

What are the symptoms?

Because some people with Social Anxiety Disorder suffer symptoms only in certain situations, like speaking in public or making presentations or performing, some patients live a relatively symptom-free life, if they are not often placed in these difficult situations. For those with more encompassing symptoms that include any public situation – in other words, any time spent around other people where the patient is expected to socialize – symptoms may be more frequent and obvious. These symptoms include:

  • Excessive self-consciousness and anxiety in public and with other people
  • Fear of asking questions or being assertive, fear of being judged.
  • Easily embarrassed in public situations
  • Fear of interacting with people in public, talking, going to public restrooms, presenting or performing, taking tests
  • Trembling, nausea, sweating, feeling flushed, having a rapid heart beat, dry mouth or throat, while at social gatherings like parties or group events
  • Persistent fear of talking to authorities, meeting new people
  • Fear of being the center of attention, of being teased or evaluated
  • Feeling insecure, not knowing what to say
  • Feeling as if you are being watched while eating, writing, attending social gatherings, using the telephone, standing in an elevator
  • Unable to look others in the eye

Most of us have these fears on occasion, to some degree, in certain situations. However, those with social phobia experience symptoms often, and these symptoms create extreme distress and anxiety.

How is it diagnosed and treated?

Social Anxiety Disorder is not the same as Panic Disorder. People with social anxiety do not have panic attacks with resulting fear of a heart attack or other physical problems. Instead, people with social phobia know it is anxiety and they usually don’t go to an emergency room with their complaints, so this disorder often goes undetected. The biggest obstacle to diagnosing SAD is the fact that many doctors do not recognize the symptoms. People with social anxiety disorder are often misdiagnosed with schizophrenia, bipolar or manic-depressive disorder, clinical depression, or panic disorder. The other problem is that Social Phobia symptoms can vary widely from those that appear only when someone has to make a presentation at work, to those that appear every day of a person’s life, making socialization nearly impossible.

To diagnose this disorder, doctors will look for persistent fear of social or performance events where a person is meeting new people or feels exposed to scrutiny. The person will feel as if they may embarrass or humiliate themselves, or be the subject of teasing or staring. Children with SAD may cry or throw tantrums to get out of the situation if they are unable to express their discomfort with this type of socialization. The person suffering the symptoms always recognizes that their fear is unreasonable, but cannot shake the feeling.
Treatment(s) for Social Anxiety Disorder (SAD), or Social Phobia, can include one or more of the following modalities:

  • Behavioral Therapy Group
  • Social Skills Training
  • Cognitive behavioral therapy
  • Medications like SSRIs (Paxil, Zoloft), Paroxetine, Sertraline, Effexor, Cellexa, Luvox, Lexapro, Benzodiazepine

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SAD is the third largest mental health problem in the world. It is estimated that 7% of the American population suffer from this disorder, and the statistical chances of developing the disorder during your lifetime are 13%.

Slightly more females than males suffer from SAD.

The average age of onset of social phobia is 11-19, and onset after age 25 is less common, though existing phobias can remain dormant until a new situation brings them to the forefront (e.g. getting a new job that requires public speaking).

About 50% of the patients surveyed report that the symptoms first appeared in response to a specific situation. The remaining 50% report that this condition has persisted for as long as they can recall.

If you are in a crisis please call:
1-800-SUICIDE (784-2433) or
1-800-273-TALK (8255)

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