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Approaching Social Phobia: How to Treat Social Anxiety Disorder

June 20, 2016

Anxiety disorders are the most common mental illness in the US. Learn more about diagnostic criteria, symptoms and how to treat social anxiety disorder.

Social anxiety disorder is one of 10 anxiety disorders identified by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Also known as social phobia, it is important not to confuse social anxiety disorder with other anxiety disorders containing the word “phobia.”

  • In social anxiety disorder (social phobia), the individual is fearful or anxious about or avoidant of social interactions and situations that involve the possibility of being scrutinized.
  • Individuals with specific phobia are fearful or anxious about or avoidant of specific objects or situations.
  • Individuals with agoraphobia are fearful and anxious about two or more of the following: using public transportation; being in open spaces; being in enclosed places; standing in line or being in a crowd; or being outside of the home alone in other situations.

All of these anxiety disorders demonstrate the difference between fear and phobia, which can be summarized by the level and length of the fear. For phobias and any other anxiety disorders, fear or anxiety is excessive and persists beyond normally appropriate periods.

Overview of Social Anxiety Disorder

Diagnostic Criteria and Symptoms of Anxiety

  • Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions, being observed and performing in front of others.
  • The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated.
  • The social situations almost always provoke fear or anxiety.
  • The social situations are avoided or endured with intense fear or anxiety.
  • The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
  • The fear, anxiety or avoidance is persistent, typically lasting for six months or more.
  • The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
  • The fear, anxiety or avoidance is not attributable to the physiological effects of a substance or another medical condition.
  • The fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder or autism spectrum disorder.
  • If another medical condition is present, the fear, anxiety or avoidance is clearly unrelated or is excessive.

Other Features of Social Anxiety Disorder

  • Prevalence: Social anxiety disorder affects 7 percent of adults in the United States. In much of the world, prevalence rates are lower and cluster around 0.5 to 2 percent; median prevalence in Europe is 2.3 percent. Prevalence rates decrease with age, and females are somewhat more likely than men to have social anxiety disorder.
  • Onset: Median age of onset for social anxiety disorder in the United States is 13 years, with 75 percent of individuals having an age of onset between 8 and 15 years. Onset can occur from a childhood history of social inhibition or shyness, from early childhood or following a humiliating experience (such as being bullied). However, it may develop slowly. First onset in adulthood is relatively rare.
  • Differential Diagnosis: Normative shyness is a personality trait and is not pathological. A small portion (12 percent) of self-identified shy individuals in the United States have symptoms meeting diagnostic criteria for social anxiety disorder. Compared to agoraphobia, individuals with social anxiety disorder are likely to be calm when left entirely alone, and they are most fearful of scrutiny from others. The DSM-5 includes differential diagnosis guidance for several other disorders.
  • Comorbidity: Social anxiety disorder is often present with other anxiety disorders, major depressive disorder and substance abuse disorders. Chronic social isolation in the course of social anxiety may result in major depressive disorder.

How to Treat Social Anxiety Disorder

In some cases, medications may be used to treat social anxiety disorder. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs) and monoamine oxidase inhibitors (MAOIs) can help reduce anxiety. Other medications for anxiety include tranquilizers (benzodiazepines) or beta-blockers.

First-line treatment for social anxiety disorder is cognitive-behavior therapy (CBT). Interventions in CBT such as cognitive restructuring, which involves reappraisal in the context of exposure to feared social situations and negative self-beliefs, contribute to the effectiveness of CBT for social anxiety disorder, according to JAMA Psychiatry. Other interventions include exposure and response prevention technique, relaxation techniques and systematic desensitization.

Helping Individuals With Social Anxiety Disorder

Anxiety disorders are the most common mental illness in the United States, according to the Anxiety and Depression Association of America. However, only one-third of those who have anxiety disorders receive treatment.

Grace College’s online M.A. in Clinical Mental Health Counseling prepares graduates for work in counseling environments. This faith-based program allows students to complete the majority of their coursework in a fully online format, while attending an annual seven- to 10-day residency on campus in scenic Winona Lake, Indiana. The program is accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).