B. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack.
C. The person recognizes that the fear is excessive or unreasonable.
D. The feared social or preformance situations are avoided or else are endured with intense anxiety or distress.
E. The avoidance, anxious anticipation, or distress in the feared social or preformance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
G. The fear or avoidance is not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder.
Social Anxiety Fact Sheet
Social Anxiety Disorder (social phobia) is the third largest mental health care problem in the world.
Latest government epidemiological data show social anxiety affects over 7% of the population at any given time. The lifetime prevalence rate (i.e., the chances of developing social anxiety disorder at any time during the lifespan) stands at above 13%.
Definition: Social anxiety is the fear of social situations that involve interaction with other people. Put another way, social anxiety is the fear and anxiety of being judged and evaluated by other people. If a person usually becomes anxious in social situations, but seems fine when they are alone, then "social anxiety" may be the problem.
Perceptions: People with social anxiety are many times seen by others as being shy, quiet, backward, withdrawn, inhibited, unfriendly, nervous, aloof, and disinterested. People with social anxiety want to be "normal" socially, they want to make friends and they want to be involved and engaged in social interactions.
Having social anxiety prevents people from being able to do the things they want to do. People with social anxiety want to be friendly, open, and sociable. It is fear (anxiety) that holds them back from participating.
Social anxiety is a fully treatable condition and can be overcome.
Triggering Symptoms: People with social anxiety usually experience significant distress in the following situations:
Being introduced to other people
Being teased or criticized
Being the center of attention
Being watched or observed while doing something
Having to say something in a formal, public situation
Meeting people in authority ("important people/authority figures")
Feeling insecure and out of place in social situations ("I don’t know what to say.")
Embarrassing easily (e.g., blushing, shaking)
Meeting other peoples’ eyes
Swallowing, writing, talking, making phone calls if in public
This list is not a complete list of symptoms -- other symptoms may be associated with social anxiety as well.
Emotional Symptoms: The feelings that accompany social anxiety include anxiety, intense fear, nervousness, automatic negative thinking cycles, racing heart, blushing, excessive sweating, dry throat and mouth, trembling, and muscle twitches.
Constant, intense anxiety (fear) is the most common feature.
Insight: People with social anxiety know that their anxiety is irrational and does not make logical sense. Nevertheless, thoughts and feelings of anxiety persist and show no signs of going away, without appropriate treatment.
Therapy: Cognitive-behavioral therapy for social anxiety has been markedly successful. Thousands of research studies now indicate that, after CBT, people with social anxiety disorder report a changed life -- one that is no longer controlled by fear and anxiety. Appropriate therapy is markedly successful in changing people's thoughts, beliefs, feelings, and behavior.
National Institutes of Mental Health-funded studies report a very high success rate using cognitive therapy with a behavioral therapy group. Both are essential to alleviating anxiety symptoms associated with social anxiety disorder.
Medication: Social anxiety medication is useful for many, but not all, people with social anxiety disorder. Psychologists and therapists should work with the persons’ medical doctor and/or psychiatrist if at all possible. For cases of generalized social anxiety, research indicates use of the anti-anxiety agents, and certain antidepressants in conjunction with CBT has proven most beneficial. As to antidepressants, the MAOIs have the highest success rate when combined with CBT. Medication without the use of cognitive-behavioral therapy has proven to be only temporarily helpful.
In particular, antidepressant treatment using SSRIs has been shown to be useless.
Prognosis: Markedly good. People completing CBT training report a high success ratio. In the NIMH longitudinal studies, people continued to report progress after the CBT behavioral group therapy was over. We have found that repetition is the key to overcoming social anxiety disorder. Therapy is not difficult. What matters is a person's continuing commitment to getting better.
Treatment Specialties: Social anxiety, as well as the other anxiety disorders, can be successfully treated today. In seeking help for this problem, we recommend searching for a specialist -- someone who understands this problem well and knows how to treat it.
Social anxiety treatment must include an active behavioral therapy group, where members can work on their "fear" hierarchies in the group, and later, in real-life situations.
Differential Diagnosis and Comorbidity: Social anxiety disorder is one of the five major anxiety disorders as listed in the DSM-IV.
Social anxiety is many times mixed up with panic disorder. People with social anxiety do not experience panic attacks, in which the principal fear is of having a medical problem (e.g., heart attack). People with social anxiety realize that it is anxiety and fear that they are experiencing. They may say things like "It was awful and I panicked!", but, when questioned, they are talking about feeling highly anxious. They are not talking about the fear of having a medical problem. People with social anxiety tend not to go to hospital emergency rooms after an anxiety problem. People with panic disorder many times go to hospital emergency rooms, because they feel there is something medically and physically wrong with them.
High rates of alcoholism and other substance abuse, family difficulties and problems, lack of personal relationships, and difficulty in obtaining and continuing with employment are among the everyday problems experienced by many people with social anxiety disorder.
Lack of professional and knowledgeable therapists is the biggest and most relevant problem to overcoming social anxiety. While we know it can be done, and a vast amount of clinical and research evidence supports this, overcoming social anxiety is difficult because of the scarcity of treatment options for people with this persistent anxiety disorder.
Copyright © 1997, 2000, 2009, The Social Phobia/Social Anxiety Association.