Social phobia

Social anxiety disorder (SAD), previously known as social phobia, is an anxiety disorder characterized by high levels of anxiety and self-consciousness in social situations, resulting in significant distress and an impaired ability to function in daily life. The defining feature of social anxiety disorder is a persistent fear of negative or positive evaluation by others. These fears can be triggered by perceived or actual scrutiny from others. Recent data suggest the prevalence of social anxiety disorder is rising, particularly among young people. Physical symptoms often include excessive blushing, excessive sweating, trembling, palpitations, muscle tension, shortness of breath, and nausea. Panic attacks can also occur under intense fear and discomfort. Some affected individuals may use alcohol or other drugs to reduce fears and inhibitions at social events. It is common for socially anxious individuals to self-medicate in this fashion, especially if they are undiagnosed, undertreated or untreated. This results in a heightened risk of alcohol use disorder, eating disorders, or other substance use disorders among sufferers. According to ICD-11 guidelines, an individual meets the criteria for social anxiety disorder if they experience persistent symptoms for at least several months, resulting in significant distress and impairment in personal, family, social, educational, occupational, or other important areas of functioning. The first line of treatment for social anxiety disorder is cognitive behavioral therapy (CBT) with or without medication. CBT is most effective when delivered individually, though it can be offered in a group format. The cognitive and behavioral components seek to change thought patterns and physical reactions to anxiety-inducing situations. Metacognitive therapy and acceptance and commitment therapy are alternative options with efficacy at least as high as CBT. The attention given to social anxiety disorder has significantly increased since 1999, with the approval and marketing of drugs for its treatment. Approved medications include the selective serotonin reuptake inhibitors (SSRIs) paroxetine, sertraline, and fluvoxamine, the serotonin–norepinephrine reuptake inhibitor (SNRI) venlafaxine, and the monoamine oxidase inhibitor (MAOI) phenelzine. Propranolol, a beta blocker, is sometimes used off-label for performance anxiety.