Health Zone

Social Anxiety Disorder

Feeling anxious in situations where we can be the focus of attention is understandable and normal. This might be giving a talk or a speech, or a presentation to work colleagues. For those with social anxiety however, being in situations where they feel they are under the scrutiny of others causes extreme anxiety. This fear of social situations can also include eating in front of others or making conversation at a party. Underpinning this fear is a fear that others are thinking negatively of them, and/or fear possible criticism or being humiliated. The intensity of this fear results in the person avoiding situations where they will feel socially anxious.

Signs & symptoms

The major signs and symptoms of social anxiety disorder, according to the DSM-5 (2013) include:

Intense fear or anxiety about one or more social situations where a person feels they may be under scrutiny by others. For example, meeting new people, eating or drinking socially, having a conversation, giving a speech.
The person fears that others will notice their anxiety symptoms and/or that others will think of them negatively.
That they will feel humiliated, embarrassed and rejected by others.
The social situation is avoided or experienced with significant anxiety.

Some of the anxious symptoms a person might experience include:

Blushing
Finding it difficult to speak (e.g., stammering)
Sweating
Trembling and shaking
Gastrointestinal symptoms such as nausea, and diarrhoea

Prevalence

Some 10% of Australians will experience social anxiety in their lifetime. In any 12 months 4.7% of Australians will be diagnosed. Social anxiety is more common in women than men. It tends to develop in later childhood with the average age of onset around 13 years of age.

Main treatments

Psychological treatment, most frequently Cognitive Behavioural Therapy (CBT) has been found to be effective in the treatment of social anxiety. This approach looks at how a person thinks (their cognitions), what they do (their behaviour) and how this affects how they feel. This approach also includes education about the anxiety so a person has some understanding of what they are feeling and why. The cognitive (thinking) aspect of CBT will look at fear generating thoughts and challenging these and developing more helpful, encouraging thoughts. Behaviour aspects of this approach include relaxation strategies to reduce anxiety and graduated exposure, a gradual introduction to those feared situations. In severe anxiety medication may be used.
Some antidepressants are also useful in treating anxiety. This type of medication is preferred over the short acting and addictive drugs such as benzodiazepines. These types of medications are only used for brief periods of time.