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One of the most common anxiety disorders - Social anxiety disorder is much more than "shyness". It can be intense fear and anxiety over simple everyday activities, such as shopping or speaking on the phone.

Many people sometimes worry about certain social situations, but someone with social anxiety disorder will worry excessively about them before, during and afterwards. They fear doing or saying something they think will be embarrassing or humiliating, such as blushing, sweating or appearing incompetent.

Social anxiety disorder is a type of complex phobia. This type of phobia has a disruptive or disabling impact on a person's life. It can severely affect a person's confidence and self-esteem, interfere with relationships and impair performance at work or school.

Social anxiety disorder often starts during childhood or adolescence and tends to be more common in women. It's a recognised disorder that can be effectively treated, so you should look for help if you think you have it.

Signs of social anxiety disorder

A child with social anxiety disorder may cry more than usual, freeze, or have tantrums. They may fear going to school and taking part in classroom activities and school performances.

Teens and adults with social anxiety disorder may dread everyday activities, such as:

Panic attacks

The fear of a social situation can sometimes build up to a panic attack, where you feel an overwhelming sense of fear, apprehension and anxiety. This usually only lasts a few minutes.

You may also experience physical symptoms, such as feeling sick, sweating, trembling and heart palpitations. These symptoms often reach a peak before quickly passing. Although these type of symptoms can be alarming, they don't cause any physical harm.

Other mental health problems

Many people with social anxiety disorder will also have another mental health problem, such as:

Some people may also have a substance or alcohol misuse problem, because they use drugs or alcohol as a way of coping with their anxiety.

What causes social anxiety disorder?


As with many mental health conditions, social anxiety disorder is most probably the result of a combination of genetic and environmental factors.

Anxiety disorders often run in families, so you're more likely to have social anxiety disorder if a close family member is affected. However, the exact nature of the relationship between genetics and learned behaviour is uncertain.

The behaviour of parents may also have an influence on whether their child will develop social anxiety disorder. If you have worried or anxious parents, it can often affect your ability to cope with anxiety during childhood, adolescence and adulthood.

People with social anxiety disorder often describe their parents as:

Getting help

If you think you may have social anxiety disorder, you should try to see a therapist for help.

Your therapist should make it as easy as possible for you to have a consultation with them. For example, they may offer you an assessment over the phone if it's easier, or they may give you an appointment when their practice is less busy – for example, before or after normal hours.

If your anxiety is severe, or you'd like your child to be assessed, your chosen therapist may be able to make a home visit.

Diagnosing social anxiety disorder

Your therapist may ask you some questions from a diagnostic questionnaire, such as the Social Phobia Inventory, Social Phobia Scale or Social Interaction Anxiety Scale. These give a score that indicates your level of anxiety in social situations (there are similar scales designed for use on children).

The type of questions asked include:

Your therapist will want to rule out other possible causes of your fear, such as generalised anxiety disorder or agoraphobia (a fear of being in situations where escape might be difficult, or where help wouldn't be available if things go wrong).

They'll also want to explore whether you have any other problems that would need to be treated separately, such as depression or an alcohol or drug problem.

Treating social anxiety disorder in adults

If you've been diagnosed with social anxiety disorder, there are a number of different treatment options available.

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural therapy (C.B.T.) is one of the most effective treatments for social anxiety disorder.

Generally, C.B.T. works by helping you identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to change your behaviour and replace unhelpful beliefs with more realistic and balanced ones.

C.B.T. teaches new skills and helps you understand how to react more positively to situations that would usually cause you anxiety.

Your therapy sessions may include learning about social anxiety, graduated exposure to feared social situations (which may include some homework), examining and modifying your core beliefs and helping to prevent relapse.

C.B.T. involves a considerable time commitment. The exact amount of time required can vary, depending on your specific condition and response to therapy. One example is 15 hourly sessions, plus one of 90 minutes. However, you may require fewer or more sessions, or you may need fewer sessions that last longer.

Antidepressants

Some people may benefit from trying a type of antidepressant medication, usually a selective serotonin re uptake inhibitor (SSRI), either instead of or in combination with individual C.B.T..

SSRIs increase the level of serotonin in your brain. They can be taken on a long-term basis.

Escitalopram or sertraline are the two SSRIs often prescribed to treat social anxiety disorder.

Psychotherapy

If all of the above interventions aren't right for you, for whatever reason, you may be offered interpersonal psychotherapy or short-term psychotherapy specifically designed for social anxiety disorder.

Psychotherapy generally involves talking to a trained therapist either one-to-one, or with your wife, husband or partner. It allows you to look deeper into your problems and worries, and deal with troublesome habits and a wide range of mental disorders.

Interpersonal psychotherapy aims to link social anxiety to relationship problem areas and address these.

Short-term psychotherapy for social anxiety disorder aims to improve your social skills, and encourage you to face feared social situations outside therapy sessions.

Treating social anxiety disorder in children

The psychological therapies offered to adults outlined above should also be considered for children.

individual CBT should take into account how well the child or young person can process thoughts and emotions.

For individual CBT, the recommended number of sessions is eight to 12, each one lasting 45 minutes. Sessions will include gradually exposing the child to feared or avoided social situations and training them in social skills, rehearsing their use in social situations. There will also be training for parents.

Parent-driven CBT is more appropriate for younger children. Parents are trained to use CBT-based materials with their children, such as books designed to treat their child's anxiety problem.

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Social anxiety disorder (social phobia) is a persistent and overwhelming fear of social situations.

Social Anxiety Disorder (Social Phobia)