Social Anxiety Disorder

Social Anxiety Disorder (SAD), also known as social phobia, is an anxiety disorder characterised by significant fear and anxiety in social situations. It leads to considerable distress and impairs daily functioning. Individuals with SAD fear negative evaluations from others, which can trigger both physical and psychological symptoms.

Signs and Symptoms

Cognitive Aspects

Individuals with SAD experience intense fear of how they will be perceived by others. They may feel overly self-conscious and review their social performance excessively. Cognitive distortions, where neutral conversations are interpreted negatively, are common.

Behavioural Aspects

SAD leads to persistent fear of social situations where scrutiny is possible. This results in avoidance of social interactions like small groups, dating, and public speaking. Affected individuals may isolate themselves to avoid perceived humiliation.

Physiological Aspects

Physical symptoms of SAD include excessive sweating, trembling, rapid heartbeat, nausea, and shortness of breath. Blushing and a 'walk disturbance' can also occur, especially in social situations.

Social Aspects

People with SAD avoid normal social interactions, affecting their personal relationships and leading to social isolation. They may become addicted to social media, suffer from sleep deprivation, and experience low self-esteem and depression.

Problematic Digital Media Use

Numerous studies have found associations between problematic social media use and increased anxiety, including social anxiety. Screen time and behaviours like cybervictimisation contribute significantly to anxiety symptoms.

Diagnosis

DSM-5 Criteria

The DSM-5 outlines the following criteria for diagnosing SAD:

• Marked fear or anxiety about social situations where scrutiny is possible.
• Fear of acting in a way that will be negatively evaluated.
• Social situations almost always provoke fear or anxiety.
• Situations are avoided or endured with intense fear.
• Fear or anxiety is out of proportion to the actual threat.
• Symptoms persist for six months or more.
• Significant distress or impairment in social, occupational, or other important areas of functioning.
• Symptoms are not attributable to substances or another medical condition.
• Fear is not better explained by another mental disorder.

Differential Diagnosis

SAD must be distinguished from other conditions like autism spectrum disorders, bipolar disorder, and ADHD. Co-occurrence with these conditions is common.

Treatment

Psychotherapies

Cognitive Behavioural Therapy (CBT) is the first-line treatment for SAD. It aims to change thought patterns and physical reactions to anxiety-inducing situations. Acceptance and Commitment Therapy (ACT) and social skills training (SST) are also useful. Expressive therapies like art therapy can improve emotional regulation and quality of life.

Medications

Selective Serotonin Reuptake Inhibitors (SSRIs) are the first choice for medication, effective in reducing social anxiety symptoms. Other medications include:

• Monoamine oxidase inhibitors (MAOIs) for treatment-resistant cases.
• Benzodiazepines for short-term relief.
• Anticonvulsants like gabapentin and pregabalin.
• Beta-blockers for performance anxiety.
• Novel treatments like D-cycloserine combined with exposure therapy.

Epidemiology

SAD is prevalent globally, with varying rates. For instance, it affects 2-7% of the population in the United States and 1-2.7% in Australia. Onset typically occurs during adolescence, making individuals susceptible to depression and substance use disorders.

History

Descriptions of shyness date back to Hippocrates around 400 B.C. The term "social phobia" was first used in the early 1900s and was officially included in the DSM-III in 1980. Increased research and attention to SAD began in the 1990s with the approval of drugs like paroxetine.

Conclusion

Social Anxiety Disorder is a complex condition with significant impacts on individuals' lives. Effective treatments include cognitive-behavioural therapies and various medications. Early diagnosis and intervention are very important for managing the disorder and improving quality of life.

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Self-assessment MCQs (single best answer)

What is another name for Social Anxiety Disorder?

Which therapy is considered the first-line treatment for Social Anxiety Disorder?

What is a common physical symptom of Social Anxiety Disorder?

How long must symptoms persist for a diagnosis of Social Anxiety Disorder according to the DSM-5?

Which of the following is NOT a cognitive aspect of Social Anxiety Disorder?

Which medication is considered the first choice for treating Social Anxiety Disorder?

What is a behavioural aspect of Social Anxiety Disorder?

What is the prevalence of Social Anxiety Disorder in the United States?

Which of the following is NOT used as a treatment for Social Anxiety Disorder?

When was the term "social phobia" first officially included in the DSM?