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Social Anxiety Disorder (Social Phobia)


Disease: Social Anxiety Disorder (Social Phobia) Social Anxiety Disorder (Social Phobia)
Category: Psychiatric diseases
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Disease Definition:

Feeling nervous in certain social situations is quite normal. For example, someone may have butterflies in their stomach while giving a presentation. This isn't considered social anxiety disorder.
When someone has social anxiety disorder, they will feel extreme fear and self-consciousness during everyday interactions, such as eating with acquaintances, writing a check in public or going to a party with lots of strangers. Having social anxiety disorder will disrupt a person’s life by fear.
This disorder is treatable. The symptoms of social anxiety disorder could be treated with medication, positive coping skills and cognitive behavioral therapy.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


Social anxiety disorder is a chronic mental health condition in which people fear that they will embarrass or humiliate themselves. One who has this disorder thinks that everyone is watching or judging him/her.

Some of the behavioral and emotional signs and symptoms of this disorder are:

  • Fear of situations in which they may be judged
  • Avoiding situations where they might be the center of attention
  • Anxiety that disrupts their daily routine, school, work or other activities
  • Intense fear of being in situations in which they don't know people
  • Avoiding doing things or speaking to people out of embarrassment or fear
  • Fear that others will notice that they look anxious
  • Worrying about embarrassing or humiliating themselves

Some of the physical signs and symptoms of social anxiety disorder are:

  • Muscle tension
  • Palpitations
  • Blushing
  • Nausea
  • Shaky voice
  • Shaking or trembling
  • Cold, clammy hands
  • Diarrhea
  • Difficulty making eye contact
  • Stomach upset
  • Confusion
  • Profuse sweating
  • Difficulty talking

A person who has this disorder may also be affected by hypersensitivity to criticism, low self-esteem, poor social skills, negative self-talk and have trouble being assertive.
Worrying about having any symptoms of social anxiety disorder can actually cause them, or make them worse. If someone has social anxiety disorder, they will worry about developing symptoms, which will make them avoid the situations that may trigger those symptoms, because they will realize that the anxiety or fear is much greater than the situation.
Someone who doesn’t like making speeches may still be able to do so without being overly anxious. People may not need treatment if their fears or anxieties don't really bother them.
The symptoms of social anxiety disorder are much more severe and last longer. This is what makes this disorder different from everyday nervousness.
Someone should call a doctor in case social anxiety disorder disrupts his/her life, causes distress and affects daily activities.

A person with social anxiety disorder may find it difficult to endure some of these common, everyday experiences:

  • Making eye contact
  • Returning items to a store
  • Writing in front of others
  • Initiating conversations
  • Using a public telephone or restroom
  • Interacting with strangers
  • Ordering food in a restaurant
  • Being introduced to strangers
  • Going into a room in which people are already seated.

If someone is facing a lot of stress and demand, signs and symptoms may flare up, but if they completely avoid situations that usually make them anxious, signs and symptoms may disappear.
If someone doesn’t get treatment, their anxiety will persist over the long term, despite the fact that avoidance may make them feel better in the short term.


Environmental factors and genes play a role in the development of this disorder, just like many other mental health conditions. Some of the possible causes of social anxiety disorder that are currently under study are:

This disorder seems to run in families. Specific genes that play a role in anxiety and fear are still being researched. However, there has been evidence that this condition's hereditary component is at least partly due to anxious behavior learned from other members of the family.

Natural chemicals in the body may play a role in social anxiety disorder. Researchers are studying this idea. For instance, serotonin is a neurotransmitter that helps regulate mood and emotions, as well as other things. An imbalance of serotonin may be a contributing factor. Serotonin may be extra effective in people with social anxiety disorder.

Fear responses:
It has been suggested that amygdala, which is a structure in the brain, may play a role in controlling fear response. Increased anxiety in social situations may be caused in people who have an overactive amygdala, because they may have a heightened fear response.
Between 3 and 13% of people in Western countries experience social anxiety disorder at some point in their lives. This disorder is one of the most common mental disorders. Although social anxiety disorder can sometimes begin in childhood or adulthood, but in most cases, it begins in the early to mid-teens.

Some of the factors that can increase the risk of developing this disorder may be:

Women are more likely to have social anxiety disorder than men.

Children at greatest risk of developing social anxiety disorder are those who are shy, withdrawn, restrained when facing new situations or people.

Family history:
It has been indicated that if someone’s biological parents or siblings have social anxiety disorder, that person will be more likely to develop it too.

Social anxiety disorder may be associated with parents who are more controlling or protective of their children. Some experts consider this disorder as a learned behavior. It means that after witnessing the anxious behavior of others, a person may develop social anxiety disorder.

New social or work demands:
In some cases, the initial signs and symptoms of social anxiety disorder may occur while giving an important work presentation, meeting new people or giving a speech in public. However, these symptoms usually have their roots in adolescence.

Negative experiences:
People who are more susceptible to developing social anxiety disorder are those who have experienced rejection, teasing, humiliation, ridicule or bullying as children. This disorder can also be associated with other negative experiences, such as sexual abuse or family conflict.



Social anxiety disorder can be impairing if it's left untreated. The patient’s life may be run by his/her anxieties. Despite the fact that fears are holding a person with this disorder back from excelling, but he/she will be considered an "underachiever". This disorder and the anxieties that are caused by it may interfere with school, work, relationships or enjoyment of life. In some severe cases, a person may quit work, drop out of school or lose friends.
Depression, substance abuse, suicide and excessive drinking are some of the other health problems that social anxiety disorder may end up causing.


Often persisting for life, the severity of social anxiety disorder increases sometimes, and decreases at other times. By controlling symptoms, treatment may help a person become more confident in social situations, and maybe even relaxed.
Usually used in combination, medications and cognitive behavioral therapy, which is a type of psychotherapy, are the most effective treatments for social anxiety disorder.

The symptoms of about 75% of people who have social anxiety disorder are improved by cognitive behavioral therapy. Cognitive behavioral therapy focuses on the point that the way someone behaves or reacts is determined by that person’s own thoughts, and not by other people or situations. This therapy can help a patient to change the way he/she thinks and behaves in a positive way, even if an unwanted situation won't change, for example, a person still has to give a presentation to management. Cognitive behavioral therapy teaches how to recognize and change negative thoughts that a person has about him/herself.
Exposure therapy is included in cognitive behavioral therapy, in which the patient will work up gradually, in order to face the situations that he/she fears most. This type of therapy will help the patient be more skilled at coping with these anxiety-inducing situations, and to develop the confidence that they need in order to face them. To gain comfort and confidence relating to others and practice social skills, the patient could participate in skills training or role-playing. The treatment plan may also include relaxation or stress management techniques.

This disorder could be treated with several types of medications. However, for the persistent symptoms of social anxiety disorder, the safest and most effective medications are selective serotonin reuptake inhibitors (SSRIs). The patient may be prescribed:

  • Fluvoxamine
  • Paroxetine
  • Fluoxetine
  • Sertraline


Another first-line therapy for social anxiety disorder is the drug venlafaxine, which is a serotonin and norepinephrine reuptake inhibitor.
The patient will initially start with a low dose of medications, which will gradually be increased to a full dose in order to reduce the risk of side effects. Improvement of symptoms will be noticed after about three months of treatment.

To reduce symptoms of social anxiety disorder, the doctor or mental health provider may also prescribe some other medications, such as:

Other antidepressants:
In order to find the most effective antidepressant which also has the fewest unpleasant side effects, several different ones may have to be tried.

Anti-anxiety medications:
The levels of anxiety may be reduced by benzodiazepines, a type of anti-anxiety medication that could be sedating. Additionally, they are usually prescribed for only short-term use because they can be addictive.

Beta blockers:
The stimulating effect of epinephrine (adrenaline) is blocked by these medications. These medications work best when they are used infrequently to control symptoms for a particular situation such as giving a speech, because they reduce heart rate, pounding of the heart, blood pressure and shaking limbs and voice. However, they aren't recommended for general treatment of social anxiety disorder.
People should keep in mind that finding the right medication for their situation will take some trial and error, so they shouldn't give up treatment if it doesn't work quickly. Over several weeks or months, they can continue to make strides in therapy.
In order to prevent a relapse, people may sometimes need to take medication for social anxiety disorder for years. However, in other cases, people may discontinue their medication in case their symptoms of social anxiety disorder fade over time.


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