Social anxiety disorder, also known as social phobia is a type of anxiety disorder which leads to extreme fear in social settings. People who have this disorder have trouble meeting new people, talking to people and even attending social gathering as they fear being judged by others. However, they may realize that their fears are unreasonable or irrational but feel powerless to overcome them. It is completely normally to feel anxious at times. However, when you have social anxiety disorder you have a constant fear of being judged by others or humiliated in front of others. Such individuals may avoid all kinds of social situations like shopping, job interviews, eating in public, talking on the phone, going to the doctor, speaking in public etc.

Common Triggers

• Public speaking
• Eating in public
• Being the center of attention
• Meeting new people
• Talking to strangers
• Job interviews
• Going to school or work
• Making eye contact with people
• Using public restrooms

Causes

• Inherited traits:Anxiety disorders tend to run in families. However, it isn’t entirely clear how much of this may be due to genetics and how much is due to learned behavior.
• Brain structure: A structure in the brain called the amygdala may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.
• Environment: Social anxiety disorder may be a learned behavior — some people may develop the condition after an unpleasant or embarrassing social situation. Also, there may be an association between social anxiety disorder and parents who either model anxious behavior in social situations or are more controlling or overprotective of their children.

Risk factors

• Family history: You’re more likely to develop social anxiety disorder if your biological parents or siblings have the condition.
• Negative experiences: Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder. In addition, other negative events in life, such as family conflict, trauma or abuse, may be associated with social anxiety disorder.
• Temperament: Children who are shy, timid, withdrawn or restrained when facing new situations or people may be at greater risk.
• New social or work demands: Social anxiety disorder symptoms typically start in the teenage years, but meeting new people, giving a speech in public or making an important work presentation may trigger symptoms for the first time.
• Having an appearance or condition that draws attention: For example, facial disfigurement, stuttering or tremors due to Parkinson’s disease can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.

Symptoms

Physical symptoms

• Excessive sweating
• Nausea
• Blushing
• Trembling or shaking
• Difficulty speaking
• Dizziness or lightheadedness
• Rapid heart rate

Psychological symptoms

• Missing school or work due to anxiety
• Worrying that other people will notice you are nervous or stressed
• Worrying about embarrassing yourself in a social situation
• Worrying for days or weeks before an event
• Avoiding social situations or trying to blend into the background if you decide to attend

Behavioral symptoms

• Need to always bring someone along wherever you go
• Drinking before social situations in order to soothe the nerves
• Staying quiet or hiding in the background in order to escape embarrassment
• Avoiding social situations to a degree that limits your activities or disrupts your life

Treatment

• Psychotherapy: Psychotherapy improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations. Cognitive behavioural therapy is the most effective type of psychotherapy for anxiety, and it can be equally effective when conducted individually or in groups.In exposure-based cognitive behavioral therapy, you gradually work up to facing the situations you fear most. This can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others. Practicing exposures to social situations is particularly helpful to challenge your worries.
• Medication:  Though several types of medications are available, selective serotonin reuptake inhibitors (SSRIs) are often the first type of drug tried for persistent symptoms of social anxiety. Your doctor may prescribe paroxetine (Paxil) or sertraline (Zoloft).The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety disorder.

• Other antidepressants: You may have to try several different antidepressants to find one that’s the most effective for you with the fewest side effects.
• Anti-anxiety medications: Benzodiazepines (ben-zoe-die-AZ-uh-peens) may reduce your level of anxiety. Although they often work quickly, they can be habit-forming and sedating, so they’re typically prescribed for only short-term use.
• Beta blockers: These medications work by blocking the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart and shaking voice and limbs. Because of that, they may work best when used infrequently to control symptoms for a particular situation, such as giving a speech. They’re not recommended for general treatment of social anxiety disorder.
• Alternative medicines: Several herbal remedies have been studied as treatments for anxiety. Results tend to be mixed, and in several studies, people report no benefits from their use. More research is needed to fully understand the risks and benefits. Some herbal supplements, such as kava and valerian, increase the risk of serious liver damage. Other supplements, such as passionflower or theanine, may have a calming effect, but they’re often combined with other products so it’s hard to tell whether they help with symptoms of anxiety.