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Social Anxiety Disorder (SAD)

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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:

  • Being excessively self-conscious and anxious in daily social activities
  • Worrying about a feared social event or situation for weeks or months in advance before the event
  • Worrying about other people’s opinions and judgments about himself
  • Being scared that one’s actions will cause severe embarrassment or humiliation
  • Being anxious that other people would notice the anxiety and fear
  • Blushing or face turning red in social situations
  • Trembling or shaking in voice or body when in feared situations
  • Breathing problems, , shortness of breath, chest tightness, or racing heart beat
  • Upset stomach or feeling ‘butterflies’ in your stomach
  • Nausea, dizziness, feeling of passing out/fainting


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:

  • Constant fear of being embarrassed or humiliated in social situations especially when feeling that other people are scrutinizing you
  • Social situations causing a high level of fear and anxiety
  • Recognition of the fact that the anxiety is rather unreasonable and irrational
  • Avoidance of social situations which trigger anxiety or fear
  • The level of fear or anxiety is interfering with normal daily functions and activities
  • For individuals under 18 years of age, symptoms lasting for at least six months
  • The fear or anxiety is not caused by other health problems or medical or mental conditions or disorders


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.

  • Medications

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:

    • Sertraline or Zoloft
    • Fluoxetine or Prozac, Sarafem or others
    • Citalopram, Escitalopram or Celexa, Lexapro
    • Paroxetine or Paxil
    • Fluvoxamine or Luvox

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:

    • Other antidepressants (such as mirtazapine, bupropion, etc.)
    • Anti-anxiety medications or benzodiazepines
    • Beta blockers, etc.

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.

  • Psychotherapy

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.

2 Responses to “Social Anxiety Disorder (SAD)”

  1. Ann Taylor says:

    I always had social anxiety when I was in elementary school. Thanks to my middle school teacher. Doing many presentations helped a lot.

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