Specific (simple) phobia; social phobia

Specific (simple) phobia; social phobia 

Social anxiety disorder sometimes known as social phobia is a type of anxiety disorder that causes anxiety or fear in social settings.

Someone with this disorder has trouble talking with people, meeting new people, and attending social gatherings. They may feel anxious about others judging or scrutinizing them. They may understand their fears are irrational but feel powerless to overcome them.

Social anxiety is different from shyness. Shyness can make socializing, school, and work difficult, but it doesn’t disrupt life to the same extent as social anxiety. Social anxiety is persistent and overwhelming and may affect everyday activities, such as shopping for groceries.

According to the Anxiety and Depression Association of America (ADAA), around 15 million American adults have social anxiety disorder. It often starts during the teenage years.

Causes 

There’s no one thing that causes social anxiety disorder. Genetics likely has something to do with it: If you have a family member with social phobia, you’re more at risk of having it, too. It could also be linked to having an overactive amygdala; the part of the brain that controls your fear response.

Social anxiety disorder usually comes on around 13 years of age. It can be linked to a history of abuse, bullying, or teasing. Shy kids are also more likely to become socially anxious adults, as are children with overbearing or controlling parents. If you develop a health condition that draws attention to your appearance or voice, that could trigger social anxiety, too.

Symptoms

Feelings of shyness or discomfort in certain situations aren't necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on personality traits and life experiences. Some people are naturally reserved and others are more outgoing.

In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interfere with relationships, daily routines, work, school or other activities. Social anxiety disorder typically begins in the early to mid-teens, though it can sometimes start in younger children or in adults.

Emotional and behavioral symptoms

Signs and symptoms of social anxiety disorder can include constant:

• Fear of situations in which you may be judged negatively
• Worry about embarrassing or humiliating yourself
• Intense fear of interacting or talking with strangers
• Fear that others will notice that you look anxious
• Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice
• Avoidance of doing things or speaking to people out of fear of embarrassment
• Avoidance of situations where you might be the center of attention
• Anxiety in anticipation of a feared activity or event
• Intense fear or anxiety during social situations
• Analysis of your performance and identification of flaws in your interactions after a social situation
• Expectation of the worst possible consequences from a negative experience during a social situation

For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.

Performance type of social anxiety disorder is when you experience intense fear and anxiety during speaking or performing in public but not in other types of more general social situations.

Physical symptoms

Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:

• Blushing
• Fast heartbeat
• Trembling
• Sweating
• Upset stomach or nausea
• Trouble catching your breath
• Dizziness or lightheadedness
• Feeling that your mind has gone blank
• Muscle tension
• Avoiding common social situations

Common, everyday experiences may be hard to endure when you have social anxiety disorder, including:

• Interacting with unfamiliar people or strangers
• Attending parties or social gatherings
• Going to work or school
• Starting conversations
• Making eye contact
• Dating
• Entering a room in which people are already seated
• Returning items to a store
• Eating in front of others
• Using a public restroom

Social anxiety disorder symptoms can change over time. They may flare up if you're facing a lot of changes, stress or demands in your life. Although avoiding situations that produce anxiety may make you feel better in the short term, your anxiety is likely to continue over the long term if you don't get treatment.

Diagnosis

A doctor may ask questions about the person’s medical history and carry out a physical exam to rule out any physical causes of their symptoms. They may then refer the person to a mental health professional. A mental health professional will ask the person about their symptoms, including when they occur, how often they occur, and when they started. Clinicians use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to diagnose mental health conditions, including social anxiety disorder.

The diagnostic criteria for this condition include:

• having a persistent fear about one or more social situations that might involve scrutiny from others (such as conversations, social interactions, being observed, or performing in front of others)
• having a fear of acting in a way that others will judge negatively or that might lead to rejection or offense (such as a fear of seeming anxious or of doing something embarrassing)
• avoiding situations that might cause feelings of anxiety
• experiencing symptoms that persist for 6 months or longer, cause significant distress, or impair the person’s work, social life, or other key areas