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Social Anxiety Disorder

Social anxiety disorder is intense anxiety or fear of being judged, negatively evaluated, or rejected in a social or performance situation. It took a series of events over time to lead its diagnosis. In the early years of its discovery, it was referred to as social phobia and social neurosis. Later in the 1960s, Isaac Marks proposed that they could be considered something as other than phobias. Decades after in 1980, social phobia became an official psychiatric diagnosis and was described as a fear of performance situations; however, it did not include fears of less formal situations. Finally in 1994, the term social anxiety disorder replaced social phobia in DSM-IV. It now referred to how broad and generalized fears can for a patient with the disorder. 

Cause

Social anxiety disorder does not have any one specific factor that causes it but rather a combination of biological and environmental factors. One component that may contribute is genetics since anxiety disorders usually run in the family. Another factor is the structure of a person’s brain. A person who has an overactive amygdala (a structure in the brain that helps control a person’s fear response) may have higher anxiety in social situations because of an increased fear response. A third factor may be a person’s environment. While it is not totally clear, social anxiety could possibly be a behavior that is learned over time.

Symptoms

Although some people experience discomfort in social situations, it isn’t always social anxiety disorder. Social anxiety disorder is when a person’s fear and anxiety are intense enough that it interferes with their daily life. It usually appears during early to middle teenage years. Some emotional or behavioral symptoms may include:

- Fear of acting or appearing anxious
- Worry about being seen as dumb, awkward, or uninteresting
- Avoiding social or performance situations
- Experiencing significant anxiety and distress while in a social situation
- Fear of interacting with strangers
- Fear of physical symptoms that may be embarrassing
- Analysis of a social interaction and their performance and criticizing themselves

Physical symptoms that may also appear alongside behavioral symptoms are:

- Rapid heart rate
- Nausea
- Sweating
- Full-blown anxiety attacks
- Stomachaches
- Shortness of breath
- Dizziness
- Dry mouth
- Blushing
- Headaches

Those with social anxiety disorder do recognize that their fear is excessive and unreasonable, but feel powerless about their anxiety 

Treatments

Usually, the treatment for social anxiety disorder is a combination of psychotherapy and medications. For psychotherapy, the treatment involves psychological counseling or talk therapy. It has been very effective for most patients and improves symptoms. Psychotherapy helps people recognize and change their negative thoughts about their anxiety. It also helps them develop skills to deal with social situations. One form of psychotherapy, cognitive behavioral therapy, is the most effective type for anxiety. It is exposure-based and improves coping skills and develops people’s confidence in situations that may cause anxiety through skills training and roleplay. 

 Another aspect of treatment is medication. There are a variety of medications out there that are used to treat social anxiety. The most common ones are:

- SSRIs
- Paxil (paroxetine)
- Zoloft (sertraline)
- SNRI
- Effexor XR (venlafaxine)
- Antidepressants
- Anti-anxiety Medications
- Beta Blockers  

Anti-anxiety medications are very helpful in lowering the level of anxiety, but are only required for short-term use. Beta blockers are useful when dealing with extreme physical symptoms and can block the stimulating effect of epinephrine, reduce heart rate and blood pressure, and stop shaking voice/limbs. They work best when controlling symptoms for a specific situation.