Social Anxiety Disorder

Social anxiety (ang-ZY-e-tee) disorder is an intense, long-lasting fear of social situations in which embarrassment might occur.

Kim was shy. She did not like to raise her hand in class, but when the English teacher asked her a question, she answered in a soft voice. Angie, on the other hand, was so afraid of being called on that she began skipping English class. Her problem went beyond ordinary shyness. She was suffering from social anxiety disorder.

What Is Social Anxiety Disorder?

Social anxiety disorder, also known as social phobia (FO-bee-a), is an intense, long-lasting fear of embarrassment in social situations. It is different from shyness or stage fright, however. Social anxiety disorder involves extreme anxiety, an unpleasant feeling of fear, worry, or nervousness. It may cause people to avoid social situations, or to feel intensely self-conscious or uncomfortable and may lead to problems at home, work, or school.

Some people with social anxiety disorder are afraid of one particular type of situation, such as giving a speech, talking in class, eating in a restaurant, or going to a party. Others, however, have a broad form of the disorder, in which they fear and avoid almost any interaction with other people. In its most extreme form, the disorder can greatly limit people's lives. It makes it hard for them to go to school or work. It also makes it almost impossible for them to have any friends at all. Some children who have a particular and intense form of social phobia that causes them to be too anxious to speak in certain situations may have another type of disorder, known as selective mutism.

What Causes Social Anxiety Disorder?

There are probably several causes for social anxiety disorder. People may learn their fear in part from watching how other people behave and what results from their behavior. Research also suggests that some people may inherit a tendency for anxiety. Research points to the possible role of the amygdala (a-MIG-da-la), a small structure inside the brain that is believed to be the seat of fear responses, whether learned or inherited. In addition, some studies have looked at the role of various hormones ^* , which have an effect on how the body responds to stress. Scientists are exploring the idea that certain hormones may influence some people to overreact to criticism shown by others.

What Are the Symptoms of Social Anxiety Disorder?

Children with social anxiety disorder may cry, throw tantrums, freeze, shy away from others, or avoid or refuse to participate or perform in certain situations without really understanding what the problem is. Teenagers and adults, on the other hand, realize the source of their fears. While they know their fears can be extreme, unreasonable, or out of proportion they feel they cannot control them. Instead, they avoid the feared situation, or they face it with great distress. People with social anxiety disorder commonly fear situations including:

• giving a speech
• performing on stage
• eating in a restaurant
• using a public restroom
• talking in class
• talking to a teacher
• going on dates
• going to parties
• meeting someone new
• talking on the phone

About 4 percent of adults in the United States show symptoms of social anxiety disorder in any given year. The problem typically starts in childhood or the early teen years. It occurs twice as often in women as men, but a higher percentage of men who have social anxiety disorder seek treatment for it.

How Are Teenagers Affected?

Most teenagers feel self-conscious at times, but those who are gripped by social anxiety disorder may be so overcome by self-doubt and worry that they find it hard to join in social activities. Instead, they may withdraw to the point where they have trouble making and keeping friends or participating in class. Their constant fear of being judged harshly or criticized may lead them to fret too much about their health and appearance. Some teenagers may try to escape the anxiety by drinking alcohol or using drugs. Others may try to mask fear by acting like class clowns. Still others may stop going to school or taking part in after-school activities and may avoid opportunities to socialize with friends. As a result, their grades may fall, and their self-esteem may decline.

How Is Social Anxiety Disorder Treated?

Medications

Four out of five people with social anxiety disorder feel better when treated with medications, psychotherapy, or both. Several kinds of medications have been shown to help people with the disorder. Though they cannot cure social anxiety, certain medications, called selective serotonin ^* reuptake inhibitors, can decrease the intensity of anxiety, allowing people to learn and practice new ways to feel comfortable in social situations. These medications work to correct imbalances in neurotransmitters ^* (like serotonin), which play a part in mood conditions such as anxiety and depression. Other medications that are sometimes used include benzodiazepines (BEN-zo-dy-AZ-a-peenz), fast-acting agents that help people relax and decrease physical symptoms of anxiety like sweating, trembling, and a pounding heart.

Psychotherapy

In psychotherapy (sy-ko-THER-a-pee), people talk about their feelings with a mental health professional, who can help them change the thoughts, behaviors, or relationships that play a part in their problems. With social anxiety, certain approaches to therapy can be especially helpful. Exposure (ex-PO-zhur) therapy is the name of a technique in which people are gradually introduced, in a relaxed and supportive environment, to situations that frighten them, until they begin to feel more and more comfortable. Anxiety management training refers to various techniques, such as deep breathing, that people can be taught to use to help control their distress. Cognitive techniques help people learn to identify their beliefs that might not be reasonable (for example, "I will die if I have to give this talk") and replace them with more realistic ideas about the likelihood of danger in social situations (for example, "It might be uncomfortable, but I know the material, and I will be okay.").