Social Phobia Social Anxiety Disorder - Types Of Anxiety Disorders: Anxiety Disorder

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Social phobia (social anxiety disorder)

The experience: A girl, age 17, is invited to a dinner party at the home of her brother's future in-laws, but the prospect fills her with such intense dread that she doesn't think she can bear it. Although she knows it's irrational, she can't stand socializing with people she doesn't know. She's afraid they'll think she's stupid or incompetent. She tells her parents and brother that she can't attend the party, but they become angry with her. They want to know why she often tries to wriggle out of attending social gatherings. Her parents insist that she have a consultation with a psychologist, and the therapist diagnoses social phobia.

Symptoms: People with social phobia feel a persistent and powerful uneasiness, self-consciousness, and fear of humiliation in ordinary social situations with unfamiliar people or where scrutiny by others is possible. These situations usually cause anxiety and sometimes a panic attack. Social phobia often leads people to avoid parties and other gatherings. Adults with social phobia realize that their fear is excessive or unreasonable, but most children do not.

The symptoms and diagnostic criteria differ somewhat for children and adults. In children, common symptoms are crying, throwing tantrums, and withdrawing when in the company of unfamiliar peers or adults. But children with social phobia are capable of appropriate social relationships with familiar people. Their symptoms must last at least six months, whereas in adults the symptoms can come and go with the waxing and waning of stress. For example, a person who has social phobia when single may find that it nearly disappears after marriage, but it flares up again after divorce or the spouse's death. In both children and adults, the symptoms tend to be ongoing and severe. More than half of those with social phobia also have specific phobia.

Because social phobia shares some of its symptoms with panic disorder and generalized anxiety disorder, it can be difficult to distinguish them. But there are important differences. Although social avoidance is sometimes a symptom of panic disorder, it's not the main symptom. People with panic disorder may withdraw from social situations, but they also avoid other situations, such as driving through tunnels. And although fear of embarrassment or humiliation can be a symptom of generalized anxiety disorder, it's not the main source of anxiety (see "Do you have social phobia?" below).

Cause: Preliminary animal research suggests that reduced brain levels of serotonin and dopamine, two neurotransmitters that affect mood and anxiety, may be involved. Researchers are also studying the amygdala.

Prevalence: About 7% of Americans have social phobia, and 12% will experience it at some point in their lives.

Who's at risk: Social phobia is twice as common among women as it is among men. It rarely starts after age 25, and children, adolescents, and young adults are at the highest risk.

Effective treatments: SSRIs are usually used first, often with benzodiazepines. Some newer antidepressants — including venlafaxine (Effexor) — are also effective. MAO inhibitors are sometimes prescribed for people who don't respond to SSRIs (see "Medications for anxiety disorders").

Cognitive behavioral therapy is usually combined with medication in treating social phobia. Two forms of cognitive behavioral therapy are especially beneficial: anxiety management training and cognitive restructuring. Anxiety management focuses on teaching relaxation techniques such as deep breathing to help control anxiety. Cognitive restructuring teaches people how to recognize the thought processes that lead to the phobia and replace them with new assessments and expectations. Group cognitive behavioral therapy and advice on improving social skills can also help build confidence in social situations.

Last updated:	September 05, 2008