Description

It is normal to feel nervous in some social situations. For example, going on a date or giving a presentation may cause that feeling of butterflies in the stomach. But in social anxiety disorder, also called social phobia, everyday interactions cause significant anxiety, self-consciousness and embarrassment because you fear scrutiny or judged negatively by others.

In the disorder, social anxiety disorder, fear and anxiety lead to avoidance that can disrupt your life. Severe stress can affect your relationships, daily routines, work, school or other activities.

Social anxiety disorder can be a chronic mental health condition, but the learning of coping skills in psychotherapy and taking medications that can help you to gain confidence and improve their ability to interact with others.

Social anxiety disorder care at Mayo Clinic

Symptoms

Feelings of shyness or discomfort in certain situations are not necessarily signs of social anxiety disorder, especially in children. Comfort levels in social situations vary, depending on the personality traits and life experiences. Some people are naturally reserved and others are more outgoing.

In contrast to journal, nervousness, social anxiety disorder, including fear, anxiety and avoidance that interfere with relationships, daily routines, work, school or other activities. Social anxiety disorder typically begins in the first half of the adolescents, although it may begin in young children or in adults.

Emotional and behavioral symptoms

The signs and symptoms of social anxiety disorder may include constant:

  • The fear of situations in which you may be judged negatively
  • Worrying about embarrassing or humiliating yourself
  • Intense fear of interacting or talking with strangers
  • Fear that others will notice that you look anxious
  • The fear of the physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a trembling voice
  • Avoiding doing things or speaking to people out of fear, of shame
  • The avoidance of situations in which you might be the center of attention
  • The anxiety in the anticipation of a feared activity or event
  • Intense fear or anxiety in social situations
  • The analysis of your performance and identifying flaws in your interactions after a social situation
  • The expectation of the worst possible consequences from a negative experience during a social situation

For children, the anxiety about interacting with adults or peers can be demonstrated by crying, tantrums, clinging to parents or refusal to speak in social situations.

Performance type of social anxiety disorder is when the experience of intense fear and anxiety during speaking or performing in public, but not in other types of more general social situations.

Physical symptoms

Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:

  • Blushing
  • Fast heartbeat
  • Trembling
  • Sweating
  • Upset stomach or nausea
  • Difficulty breathing
  • Dizziness or lightheadedness
  • Feeling that your mind has gone blank
  • Muscle tension

Avoid social situations common

Common, everyday experiences can be difficult to withstand when you have social anxiety disorder, including:

  • The interaction with unknown people or strangers
  • Attend parties or social gatherings
  • To go to work or school
  • Starting conversations
  • Make eye contact
  • Dating
  • Enter a room in which people are already seated
  • Returning items to a store
  • Eating in front of others
  • The use of a public bathroom

Social anxiety disorder symptoms can change over time. They may explode if they are facing a lot of change, stress or demands in your life. Despite avoiding situations that produce anxiety can make you feel better in the short term, your anxiety is likely to continue in the long term if you do not receive treatment.

When to see a doctor

Consult your doctor or a mental health professional if you fear and avoid normal social situations, because they cause shame, worry or panic.

Causes

Like many other mental health conditions, social anxiety disorder likely arises from a complex interplay of biological and environmental factors. Possible causes include:

  • Inherited traits. Anxiety disorders tend to run in families. However, it is not entirely clear how much of this can be due to genetics and how much is due to learned behavior.
  • The structure of the brain. A brain structure called the amygdala (uh-MIG-duh-luh) may play a role in the control of the fear response. People who have an overactive amygdala may be an increase in the fear response, causing increased anxiety in social situations.
  • Environment. Social anxiety disorder may be a learned behavior — some people may develop significant anxiety after an awkward or embarrassing social situation. Also, there may be an association between social anxiety disorder and parents that the model anxious behavior in social situations or are more controlling or overprotective of their children.

Risk factors

There are several factors that can increase the risk of developing social anxiety disorder, including:

  • The history of the family. You're more likely to develop social anxiety disorder if their biological parents or siblings have the condition.
  • Negative experiences. Children who experience teasing, bullying, rejection, ridicule, or humiliation can be more prone to social anxiety disorder. In addition, other negative events of life, such as family conflicts, trauma or abuse, may be associated with this disorder.
  • Temperament. Children who are shy, timid, withdrawn or subject when you face new situations or people who may be at increased risk.
  • Social or work demands. Social anxiety disorder symptoms usually begin in adolescence, but meeting new people, giving a speech in public or make an important presentation work can trigger symptoms for the first time.
  • To have an appearance or condition that draws attention. For example, the facial disfigurement, stuttering or shaking due to Parkinson's disease may increase feelings of self-consciousness, and they can trigger the disorder, social anxiety disorder in some people.

Complications

Left untreated, the disorder of social anxiety can control your life. Anxiety can interfere with work, school, relationships, or the enjoyment of life. This disorder can cause:

  • Low self-esteem
  • Problems to be assertive
  • Negative self-talk
  • Hypersensitivity to criticism
  • Poor social skills
  • Isolation and difficult social relationships
  • Low academic and employment achievement
  • Substance abuse, such as excessive consumption of alcohol
  • Suicide or suicide attempts

Other anxiety disorders and certain other mental health disorders, particularly major depressive disorder, and substance abuse problems often occur with social anxiety disorder.

Prevention

There is No way to predict what is going to cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of the symptoms if you're anxious:

  • Get help in time. Anxiety, like many other mental health conditions, it can be difficult to treat if you wait.
  • Keep a journal. Keep track of your personal life can help you and your mental health professional to identify what's causing you stress and what seems to help you feel better.
  • Set priorities in your life. You can reduce anxiety by carefully managing your time and energy. Make sure that you spend your time doing the things you enjoy.
  • Avoid unhealthy use of substances. Use of drugs and Alcohol, and even caffeine or nicotine use can cause or worsen anxiety. If you're addicted to any of these substances, quitting smoking can make you anxious. If you are unable to quit smoking on your own, consult your health care provider or find a treatment program or a support group to help you.

Diagnosis

Your healthcare provider will want to determine whether other conditions may be the cause of your anxiety or if you have social anxiety disorder, along with another physical or mental health disorder.

Your health care provider can determine a diagnosis based on:

  • Physical exam to help assess whether any medical conditions or medications may trigger symptoms of anxiety
  • Discussion of the symptoms, the frequency with which they occur and in what situations
  • Review of a list of situations to see if they make you anxious
  • Self-report questionnaires about symptoms of social anxiety
  • Criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American psychiatric Association

DSM-5 criteria for social anxiety disorder are:

  • Persistent, intense fear or anxiety about specific social situations, because he believes that it may be negatively judged, embarrassed or humiliated
  • The avoidance of the anxiety-producing social situations or long-lasting with intense fear or anxiety
  • Excessive anxiety that is out of proportion with the situation
  • The anxiety or distress that interferes with your daily life
  • The fear or anxiety that is not better explained by a medical condition, medication or substance abuse

Treatment

The treatment depends on the amount of social anxiety disorder affects your ability to function in daily life. The most common treatment for social anxiety disorder includes psychotherapy (also called psychological counseling or psychotherapy or medications or both.

Psychotherapy

Psychotherapy improves symptoms in most people with social anxiety disorder. In therapy, you learn to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations.

The cognitive-behavioral therapy (CBT) is the most effective type of psychotherapy for anxiety, and can be equally effective when carried out individually or in groups.

In the exposure-based CBT, gradually work up to facing the situations you fear most. This can improve their coping skills and help to develop the confidence to cope with anxiety-inducing situations. You can also participate in skills training or role-play to practice their social skills and increase the comfort and trust of the relationship with others. The practice of exposure to social situations is particularly useful to challenge your concerns.

First elections in drugs

Although several types of drugs are available, selective serotonin reuptake inhibitors (Ssris) are often the first type of medicine that it was the persistence of the symptoms of social anxiety. Your doctor may prescribe paroxetine (Paxil), or sertraline (Zoloft).

The serotonin and noradrenaline reuptake inhibitors (SSRIS), venlafaxine (Effexor XR) may also be an option for social anxiety disorder.

To reduce the risk of side effects, your doctor may start you on a low dose of medication and gradually increase your prescription to a full dose. It can take several weeks to several months of treatment for your symptoms to improve markedly.

Other medications

Your doctor may also prescribe other medications for symptoms of social anxiety, such as:

  • Other antidepressants. You may need to try different types of antidepressants to find the one that's most effective for you with the least amount of side effects.
  • Anti-anxiety medications. Benzodiazepines (ben-zoe-die-AZ-uh-peens) can reduce your level of anxiety. Despite the fact that often the work quickly, they can be habit-forming and sedatives, so that is typically prescribed only for short-term use.
  • Beta-blockers. These medications act by blocking the stimulating effect of epinephrine (adrenaline). You can reduce the heart rate, blood pressure, pounding heart, and the trembling of the voice, and the extremities. Because of that, they can work better when used infrequently for the control of symptoms for a particular situation, such as giving a speech. Are not recommended for the general treatment of social anxiety disorder.

Stick with it

Don't give up if the treatment does not work quickly. You can continue to make progress in psychotherapy for several weeks or months. The learning of new skills to help you control anxiety takes time. And to find the right medication for your situation can take a little trial and error.

For some people, the symptoms of social anxiety disorder may disappear with time, and the medication can be discontinued. Others may need to take medications for years to prevent a relapse.

To make the most of treatment, keep your doctor or therapy appointments, challenge yourself by setting goals for the approach of social situations that cause you anxiety, take medications as directed, and talk to your health care provider about any change in your condition.

Alternative medicine

Several herbal remedies have been studied as treatments for anxiety, but the results are mixed. Before taking any herbal remedies or supplements, discuss it with your health care team to make sure that it is safe and does not interact with the medicines you take.

Lifestyle and home remedies

Although social anxiety disorder generally requires help from a medical expert or psychotherapist qualified, you can try some of these techniques to handle situations that may trigger the symptoms:

  • Learn stress-reduction skills.
  • Physical exercise or be physically active on a regular basis.
  • Get enough sleep.
  • Maintaining a healthy diet and well-balanced.
  • Avoid the consumption of alcohol.
  • Limit or avoid the consumption of caffeine.
  • Participate in social situations by reaching out to people with whom you are comfortable.

Practice in small steps

In the first place, consider your fears to identify what situations cause the most anxiety. Then, gradually, the practice of these activities until they cause less anxiety. Start with small steps of setting daily or weekly goals in situations that are not overwhelming. The more you practice, the less anxious you'll feel.

Consider the practice of these situations:

  • Eat with a close relative, friend or acquaintance in a public place.
  • To purpose of making contact with eyes and return the greetings of the others, or be the first to say hello.
  • Give someone a compliment.
  • Ask a retail employee to help you find an item.
  • Get directions from a stranger.
  • Show interest in others — to ask about their homes, children, grandchildren, hobbies or travel, for example.
  • Call a friend to make plans.

Prepare for social situations

First, be social when you are feeling anxious is a challenge. As painful or difficult as it may initially seem, don't avoid the situations that trigger your symptoms. By regularly facing this kind of situations, so that will continue to build and strengthen their coping skills.

These strategies can help you begin to cope with situations that make you nervous:

  • Prepare for the conversation, for example, by reading about the current events in order to identify the interesting stories that can speak.
  • Focus on the personal qualities you like about yourself.
  • The practice of relaxation exercises.
  • Learn stress management techniques.
  • Set realistic social goals.
  • Pay attention to how often the embarrassing situations you're afraid of actually take place. You may notice that the scenarios that fear usually does not come to pass.
  • When embarrassing situations does not happen, remember that your feelings will pass and you can handle until you do. Most of the people around you don't notice it or it does not matter as much as you think, or is it more merciful than you assume.

Avoid the use of alcohol to calm your nerves. May seem to help temporarily, but in the long term can make you feel even more anxious.

Coping and support

These coping methods can help to ease your anxiety:

  • Routinely reach out to friends and family members.
  • Join a local or to the reputation of an internet-based support group.
  • Join a group that offers opportunities to improve communication and public speaking skills, such as Toastmasters International.
  • Make pleasant or relaxing activities, such as hobbies, when you feel anxious.

Over time, these coping methods can help control the symptoms and prevent relapse. Remember that you can get through moments of anxiety, your anxiety is short-lived and that the negative consequences of so much worry rarely come to pass.

Preparing for your appointment

You can see your primary care provider or your doctor may refer you to a mental health professional. Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

  • Situations you've been avoiding, especially those that are important to your operation
  • The symptoms I have been experiencing, and for how long, including any of the symptoms that may seem unrelated to the reason for your appointment
  • Key of the personal information that is especially significant events or changes in his life shortly before your symptoms
  • Medical information, including other physical or mental health conditions with which you have been diagnosed
  • All the drugs, vitamins, herbs, or other supplements you are taking, including the dosage
  • Questions to ask your health care provider or a mental health professional

You can ask a trusted family member or friend to go with you to your appointment, if possible, to help you remember important information.

Some questions to ask your health care provider may include:

  • What do you think is the cause of my symptoms?
  • There are other possible causes?
  • How are you going to determine my diagnosis?
  • I need to see a mental health specialist?
  • Is my condition likely temporary or chronic?
  • They are effective treatments available for this disease?
  • With the treatment, could possibly be comfortable in situations that make me so anxious now?
  • I'm in a higher risk of other mental health problems?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask questions during your appointment.

What to expect from your health care provider

Your health care provider or a mental health professional will likely ask you a series of questions. Be prepared to answer to reserve a time to go over any points you want to focus on. Your health care provider may ask:

  • Does the fear of the shame of the case to avoid certain activities or to talk to people?
  • Avoid activities in which you are the center of attention?
  • Would you say that to be embarrassed or appear stupid is one of your worst fears?
  • When did you first notice these symptoms?
  • When symptoms are more likely to occur?
  • Nothing seems to make your symptoms better or worse?
  • How are the symptoms that affect their lives, including work and personal relationships?
  • Have you ever had any symptoms when you're not being observed by others?
  • Any of your close relatives of the similar symptoms?
  • Have you been diagnosed with any medical condition?
  • Has received treatment for the symptoms of mental health or mental illness in the past? If yes, what type of therapy was more beneficial?
  • Have you ever thought of harming yourself or others?
  • Do you drink alcohol or use recreational drugs? If so, how often?
Symptoms and treatment of Social anxiety disorder (social phobia)