Social anxiety disorder (SAD), also known as social phobia, is the most common anxiety disorder. It is one of the most common psychiatric disorders: 12% of American adults have experienced it. It is characterized by intense fear in one or more social situations, causing considerable distress and impaired ability to function in at least some parts of daily life. These fears can be triggered by perceived or actual scrutiny from others. While the fear of social interaction may be recognized by the person as excessive or unreasonable, overcoming it can be quite difficult. Some people suffering from social anxiety disorder fear a wide range of social situations while others may only show anxiety in performance situations. In the latter case, the specifier “performance only” is added to the diagnosis. Social anxiety disorder is known to appear at an early age in most cases. Fifty percent of those who develop this disorder have developed it by the age of 11, and 80% have developed it by age 20. This early age of onset may lead to people with social anxiety disorder being particularly vulnerable to depressive illnesses, drug abuse and other psychological conflicts. Physical symptoms often accompanying social anxiety disorder include excessive blushing, excess sweating, trembling, palpitations and nausea. Stammering may be present, along with rapid speech. Panic attacks can also occur under intense fear and discomfort. An early diagnosis may help minimize the symptoms and the development of additional problems, such as depression. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. It is common for sufferers of social phobia to self-medicate in this fashion, especially if they are undiagnosed, untreated, or both; this can lead to alcoholism, eating disorders or other kinds of substance abuse. SAD is sometimes referred to as an ‘illness of lost opportunities’ where ‘individuals make major life choices to accommodate their illness.’ Standardized rating scales such as the Social Phobia Inventory, the SPAI-B and Liebowitz Social Anxiety Scale can be used to screen for social anxiety disorder and measure the severity of anxiety. The first line treatment for social anxiety disorder is cognitive behavioral therapy with medications recommended only in those who are not interested in therapy. Cognitive behavioral therapy is effective in treating social phobia, whether delivered individually or in a group setting. The cognitive and behavioral components seek to change thought patterns and physical reactions to anxiety-inducing situations. The attention given to social anxiety disorder has significantly increased since 1999 with the approval and marketing of drugs for its treatment. Prescribed medications include several classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). Other commonly used medications include beta blockers and benzodiazepines. Kava-kava has also attracted attention as a possible treatment, although safety concerns exist.
