Social Anxiety Disorder



Social Anxiety Disorder (social phobia) is the third largest mental health care problem in the world.

Latest government epidemiological data show social phobia affects over 7% of the population at any given time. The lifetime prevalence rate (i.e., the chances of developing social anxiety disorder at any time during the lifespan) stands at above 13%.

Definition: Social anxiety is the fear of social situations that involve interaction with other people. Put another way, social anxiety is the fear and anxiety of being judged and evaluated by other people. If a person usually becomes anxious in social situations, but seems fine when they are alone, then "social anxiety" may be the problem.

Perceptions: People with social anxiety are many times seen by others as being shy, quiet, backward, withdrawn, inhibited, unfriendly, nervous, aloof, and disinterested. People with social anxiety want to be "normal" socially, they want to make friends and they want to be involved and engaged in social interactions.

Having social anxiety prevents people from being able to do the things they want, however.

Triggering Symptoms: People with social anxiety usually experience significant distress in the following situations:

  • Being introduced to other people

  • Being teased or criticized

  • Being the center of attention

  • Social situations where the person exhibits excessive self-consciousness

  • Being watched or observed while doing something

  • Having to say something in a formal, public situation

  • Meeting people in authority ("important people/authority figures")

  • Feeling insecure and out of place in social situations ("I don't know what to say.")

  • Embarrassing easily (e.g., blushing)

  • Meeting other peoples' eyes

  • Swallowing, writing, talking, making phone calls if in public.

This list is not a complete list of symptoms -- other symptoms may be associated with social anxiety as well.

Emotional Symptoms: The feelings that accompany social anxiety include anxiety, intense fear, nervousness, automatic negative thinking cycles, racing heart, blushing, excessive sweating, dry throat and mouth, trembling, and muscle twitches.

Constant, intense anxiety is the most common feature.

Insight: People with social anxiety know that their anxiety is irrational and does not make logical sense. Nevertheless, thoughts and feelings of anxiety persist and show no signs of going away, without appropriate treatment.

Therapy: Cognitive-behavioral therapy for social anxiety has been markedly successful. Thousands of research studies now indicate that, after CBT, people with social anxiety disorder report a changed life -- one that is no longer controlled by fear and anxiety.

National Institutes of Mental Health-funded studies report a very high success rate using cognitive therapy and a behavioral therapy group. Both are essential to alleviating anxiety symptoms associated with social anxiety disorder.

Medication: Social anxiety medication is useful for many people, and psychologists and therapists should work with the persons medical doctor and/or psychiatrist if at all possible. For cases of generalized social anxiety, research indicates use of the anti-anxiety agents, and certain antidepressants in conjunction with CBT has proven most beneficial. As to antidepressants, the MAOIs have the highest success rate when combined with CBT. Medication without CBT has proven to be only temporarily helpful.

Prognosis: Markedly good. People completing CBT training report a high success ratio. In the NIMH longitudinal studies, people continued to report progress after the CBT behavioral group therapy was over.

Treatment Specialties: Social anxiety, as well as the other anxiety disorders, can be successfully treated today. In seeking help for this problem, we recommend searching for a specialist -- someone who understands this problem well and knows how to treat it. Social anxiety treatment must include an active behavioral therapy group, where members can work on their "fear" hierarchies in the group, and later, in real-life situations.