SAD - Social Anxiety Disorder

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Social anxiety disorder, also known as social phobia, involves intense fear of certain social situations — especially situations that are unfamiliar or in which you’ll be watched or evaluated by others. These social situations may be so frightening that you get anxious just thinking about them or go to great lengths to avoid them.

Underlying social anxiety disorder is the fear of being scrutinized, judged, or embarrassed in public. You may be afraid that people will think badly of you or that you won’t measure up in comparison to others. And even though you probably realize that your fears of being judged are at least somewhat irrational and overblown, you still can’t help feeling anxious.

Although it may feel like you’re the only one with this problem, social anxiety disorder is actually quite common. Many people struggle with these fears. But the situations that trigger the symptoms of social phobia can be different.

Some people experience anxiety in most social and performance situations, a condition known as generalized social anxiety disorder. For other people with social phobia, anxiety is connected with specific social situations, such as speaking to strangers, eating at restaurants, or going to parties. The most common specific social phobia is fear of public speaking or performing in front of an audience.


The following situations are often stressful for people with social anxiety disorder:

Meeting new people

Being the center of attention

Being watched while doing something

Making small talk

Public speaking

Performing on stage

Being teased or criticized

Talking with “important” people or authority figures

Being called on in class

Going on a date

Making phone calls

Using public bathrooms

Taking exams.

Eating or drinking in public

Speaking up in a meeting

Attending parties or other social gathering

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Signs and symptoms of social anxiety disorder (social phobia)

Just because you occasionally get nervous in social situations doesn’t mean you have social anxiety disorder, or social phobia. Many people are shy or self-conscious — at least from time to time — yet it doesn’t get in the way of their everyday functioning. Social anxiety disorder, on the other hand, does interfere with your normal routine and causes tremendous distress.

For example, it’s perfectly normal to get the jitters before giving a speech. But if you have social anxiety disorder, you might worry for weeks ahead of time, call in sick to get out of it, or start shaking so bad during the speech that you can hardly speak.


Psychological symptoms of social anxiety disorder (social phobia)

Intense worry for days, weeks, or even months before an upcoming social situation.

Extreme fear of being watched or judged by others, especially people you don’t know.

Excessive self-consciousness and anxiety in everyday social situations.

Fear that you’ll act in ways that that will embarrass or humiliate yourself.

Fear that others will notice that you’re nervous.

Avoidance of social situations to a degree that limits your activities or disrupts your life.

Physical symptoms of social anxiety disorder (social phobia)

Pounding heart or tight chest

Shaky voice

Rapid breathing

Sweating or hot flashes

Upset stomach, nausea

Dry mouth

Trembling or shaking

Muscle tension

Blushing

Dizziness, feeling faint

Clammy hands

Twitching

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Getting help for social anxiety disorder (social phobia)

While it may seem like there’s nothing you can do about the symptoms of social anxiety disorder (social phobia), in reality, there are many things that can help. The best treatment approach for social anxiety disorder varies from person to person. You may find that self-help strategies are enough to ease your anxiety symptoms, or you may need professional help as well, such as therapy or medication. But whatever your approach, you can overcome your social anxiety if seek the help you need and make a commitment to treatment.


Medication for social anxiety disorder (social phobia)

Medication is sometimes used to relieve the symptoms of social anxiety, but it’s not a cure for social anxiety disorder or social phobia. If you stop taking medication, your symptoms will probably return full force. Medication is considered most helpful when used in addition to therapy and other self-help techniques that address the root cause of social anxiety disorder.

Three types of medication are used in the treatment of social anxiety disorder (social phobia):

Beta blockers – Beta blockers are used for relieving performance anxiety. They work by blocking the flow of adrenaline that occurs when you’re anxious. While beta blockers don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat.

Antidepressants – Antidepressants can be helpful when social anxiety disorder is severe and debilitating. Three specific antidepressants—Paxil, Effexor, and Zoloft—have been approved by the U.S. Food and Drug Administration for the treatment of social phobia.

Benzodiazepines – Benzodiazepines are fast-acting anti-anxiety medications. However, they are sedating and addictive, so they are typically prescribed only when other medications for social phobia have not worked.


Therapy for social anxiety disorder (social phobia)

Of all the treatments available, cognitive-behavioral therapy (CBT) has been shown to work the best for treating social anxiety disorder, or social phobia. Cognitive-behavioral therapy is based on the premise that what you think affects how you feel, and your feelings affect your behavior. So if you change the way you think about social situations that give you anxiety, you’ll feel and function better.

Cognitive-behavioral therapy for social phobia typically involves:

Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises.

Challenging negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views.

Facing the social situations you fear in a gradual, systematic way, rather than avoiding them.

Other cognitive-behavioral techniques for social anxiety disorder include role-playing and social skills training, often as part of a therapy group.

Group therapy for social anxiety disorder uses acting, videotaping and observing, mock interviews, and other exercises to work on situations that make you anxious in the real world. As you practice and prepare for situations you’re afraid of, you will become more and more comfortable and confident in your social abilities, and your anxiety will lessen.