ICD-10 code: F40.10
Social anxiety disorder (SAD, also called social phobia) is part of a cluster of diagnoses called the anxiety disorders. Anxiety disorders are a group of psychiatric conditions that include:
These disorders are characterized primarily by the experience of excessive fear and anxiety. People with generalized anxiety disorder spend a lot of time worrying about a lot of different things. People with social anxiety disorder feel very anxious around other people because they are afraid of embarrassing themselves or being disliked. People with panic disorder have sudden rushes of intense fear or discomfort called panic attacks. They often worry about having another panic attack and might avoid certain situations that might trigger a panic attack. People with agoraphobia are afraid of going into certain situations because they are afraid it might be difficult to escape or because they might experience panic-like or other embarrassing symptoms. Commonly avoided situations are using public transportation, being in open spaces like parking lots, being in enclosed places like movie theaters, or being in a crowd. People with a specific phobia are afraid of a certain object or situation, such as flying, heights, animals, or seeing blood. People with separation anxiety disorder are afraid of being away from a certain person, usually because they are afraid that something bad might happen to them or the other person if they are separated.
The anxiety disorders are characterized by excessive fear and anxiety, along with behavioral disturbances, like avoiding certain places, people, or situations. The anxiety disorders differ from each other in the target or focus of the fear. In some anxiety disorders, like specific phobia, the person is only excessively fearful of a very specific object or situation. In other anxiety disorders, like GAD, the person may feel anxious a great deal of the time or about a lot of different things.
SAD is a psychiatric disorder that affects approximately 3-7% of adults. SADis characterized by the following symptoms:
Sometimes social anxiety symptoms occur only in performance situations (like public speaking). In other cases, the person may feel extremely fearful or anxious in many different social situations. Some of the most common situations that socially anxious individuals fear and avoid include:
SAD severity can range from mild to debilitating. In severe cases, SAD can lead to inability to work, go to school, or have enjoyable relationships. Many people with SAD also have other psychiatric conditions, most commonly other anxiety disorders, major depressive disorder, and alcohol or other substance use disorders.
SAD is characterized by abnormalities of brain function , including hyperactivation of the amygdala (involved in emotion generation) and abnormal connectivity between the amygdala and the ventral prefrontal cortex (involved in emotion regulation), which are thought to contribute to symptoms. In addition, certain beliefs ("no one likes me," "I will embarrass myself") and avoidance of feared situations is thought to contribute to the persistence of anxiety.
SAD is treatable. Published treatment guidelines for SAD include those from the Society of Clinical Psychology, the Anxiety and Depression Association of America, and the National Institute for Clinical Excellence.
First Line Treatments
For more information about drug prescribing in social anxiety disorder, click here.
Second Line Treatments
In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might be considered.