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Social Anxiety Disorder
Social anxiety disorder (SAD) is the extreme fearfulness of specific social events or situations. The person feels being judged by other people. Dropping something accidentally in a public place can cause a person to be extremely anxious, fearful, and overwhelmed. Attending to a party can be very distressing for some people and many would decline invitations to social activities.
The fear of such social situations is clearly exaggerated and unreasonable but the person cannot help himself or herself to manage the fear and associated anxiety. The level of fear can be so intense that it could result in the person’s total avoidance of the social events and social isolation. A student may be so anxious that he or she would totally avoid going to school for fear of being called on in class. The fear of embarrassment could impact on the person’s daily functioning. Fear of public speaking is the most common symptom of social anxiety disorder.
Different situations can make different persons anxious, fearful, stressed out and overwhelmed. To name a few, these situations may include being asked to perform on stage, talk to people of authority, eating in public or in restaurants, using public bathrooms, etc. Other situations that make a person think they will cause themselves shame and humiliation will most likely trigger anxiety.
Symptoms of Social Anxiety Disorder
Social anxiety disorder affects the person’s daily routine significantly. For example an office secretary suffering from SAD may not be able to function well as her work will require her to meet and greet strangers visiting the office. Her fear of meeting new people may lead to calling in sick when there would be guests coming to office or to meet with her boss. This disorder has debilitating effects on the person’s social and performance responsibilities.
Social anxiety disorder causes both emotional and physical symptoms including:
Diagnosis
Like most psychiatric conditions, there are no specific tests to diagnose social anxiety disorder. A comprehensive psychiatric evaluation should be conducted by a psychiatrist or licensed mental health provider to establish a formal diagnosis. Information booklets, websites, clinical guidelines, and self assessment tests can help to learn about one’s emotional and psychological state.
To be diagnosed with social anxiety disorder (SAD), one must meet the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). DSM 5 will be published by the American Psychiatric Association in 2013 and will make some changes to criteria listed in DSM-IV.
People exhibiting any of the following may meet criteria for SAD:
Treatment
Like many other mental health conditions, treatment options include various medications and psychotherapy. Any of the two used individually or in combination may prove to be beneficial and effective.
There are several types of medications that are proven to be effective in treatment for social anxiety disorder. Selective serotonin reuptake inhibitors (SSRI) are usually the first line of treatment prescribed to persons suffering from symptoms of social anxiety disorder. Some of the commonly prescribed SSRIs are:
Another medication group is serotonin and norepinephrine reuptake inhibitors (SNRI), which may be prescribed by doctors to persons suffering from SAD. Venlafaxine (Effexor), Desvenlafaxine (Pristiq), and Duloxetine (Cymbalta) are among the SNRIs.
If any of the medications from the mentioned groups do not help in reducing the symptoms or improving quality of life, clinicians may recommend medications from other groups such as:
The prescribing doctor monitors the response and adverse or side effects of medications to determine if the medication is suitable, the dose is adequate or adjustments should be made. The patient and doctor should work closely to achieve good response to treatment, relief, and ideally full recovery from symptoms.
Also known as psychological counselling or talk therapy, this treatment modality also helps to improve the symptoms of social anxiety disorder. Therapy will allow the person to learn, recognize and alter or manage negative thoughts, feelings and behavioural patterns.
There are different types of psychotherapy used by clinicians and mental health providers to treat SAD. Cognitive behavioural therapy (CBT) is probably the most commonly used method. This therapy dwells on the idea that a person’s own thoughts determine his/her feelings, behaviours and reactions in certain situations. It is not the other people or situation dictating how a person will behave or react. In that sense, a person can choose, control, and change the way he/she feels and acts.
Cognitive behavioral therapy may also include exposure therapy or gradual exposure desensitization therapy, where the person is gradually prepared to face or confront the causes of fear in a controlled environment. This type of therapy allows a person to learn various coping mechanisms and techniques which will help in reducing the degree of fear and anxiety felt in certain situations.
Interpersonal, supportive, psychodynamic, dialectical, behavioral, mindfulness, and relaxation-based therapies are some other therapy types that can be used in the treatment of SAD.
Dr. Dalkilic (Dr. Dal) has been a Diplomat of the American Board of Psychiatry and Neurology since 2000 and has been practicing psychiatry in New Jersey and the Greater Philadelphia area. He specializes in the treatment of eating, anxiety, bipolar and depressive disorders, as well as psychopharmacology. He has been a Clinical Professor of Psychiatry at Cooper Medical School of Rowan University and an Associate Professor of Clinical Psychiatry at Temple University School of Medicine, Department of Psychiatry. Dr. Dal graduated from Psychiatry Residency Training Program of Yale University in 1999 and is a graduate of Marmara University School of Medicine, Istanbul. He began his MPH training at Yale University School of Public Health and obtained his MPH degree from George Washington University, School of Public Health and Health Services, in 2002. He was selected and participated in the 2008 Future Leaders in Psychiatry Program organized by Emory University, while practicing psychiatry at Virginia Commonwealth University, School of Medicine, as an Assistant Professor of Psychiatry (2005-2009).
I always had social anxiety when I was in elementary school. Thanks to my middle school teacher. Doing many presentations helped a lot.
I had a similar experience. I think ADHD is really easy to treat if you find the right physician.