Social Phobia (Social Anxiety Disorder, SAD)
Full description of Social Phobia (Social Anxiety Disorder, SAD). Definition, signs, symptoms, and causes of Social Anxiety Disorder, Social Phobia.
Description of Social Phobia (Social Anxiety Disorder, SAD)
Social Anxiety Disorder is the third most common psychiatric disorder in America behind depression and alcohol abuse. At some point in their life, 7-13% of American adults suffer from social anxiety disorder. It affects men and women equally and children and teens who are very "social status" conscious are especially susceptible to SAD. Some people are shy by nature and, early in life, show timidness that later develops into social phobia. Others first experience anxiety in social situations around the time of puberty.
Social Anxiety Disorder (social phobia) is not the same as shyness; it's really extreme shyness, where someone is actually afraid of being in a social or performance situation to the point where it impacts or disrupts their lives. People with social phobia are concerned that their performance or actions will seem inappropriate. Often they worry that their anxiety will be obvious - that they will sweat, blush, vomit, or tremble or that their voice will quaver. They also worry that they will lose their train of thought or that they will not be able to find the words to express themselves. So many times, people with social anxiety disorder don't even show up at any event or social situation where they could be even the slightest focus of attention.
Social Anxiety Triggers
Some social phobias are tied to specific performance situations, producing anxiety only when the people must perform a particular activity in public. The same activity performed alone produces no anxiety. Situations that commonly trigger anxiety among people with social phobia include the following:
- Public speaking
- Performing publicly, such as reading in church or playing a musical instrument
- Eating with others
- Signing a document before witnesses
- Using a public bathroom
A more general type of social phobia is characterized by anxiety in many social situations.
In both types of social phobia, people's anxiety comes from the belief that if their performance falls short of expectations, they will feel embarrassed and humiliated.
Diagnostic Criteria for Social Phobia (Social Anxiety Disorder)
A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.
Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.
The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.
The feared social or performance situations are avoided or else are endured with intense anxiety or distress.
The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
In individuals under age 18 years, the duration is at least 6 months.
The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., Panic Disorder With or Without Agoraphobia, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).
If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e.g., the fear is not of Stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa.
If the fears include most social situations (also consider the additional diagnosis of Avoidant Personality Disorder)
Causes of Social Phobia (Social Anxiety Disorder, SAD)
Like most mental illnesses, scientists aren't sure what causes Social Anxiety Disorder. At this point, there are two primary theories:
- Environmental Exposure: People with social phobia may acquire their fear from observing the behavior and consequences of others, a process called observational learning or social modeling.
- Earlier Negative Social Consequences: Being the victim of bullying, facing a particularly embarrassing situation in public, having a disability or being disfigured and being teased or extremely self-conscious about it.
Other possible causes of social phobia include:
- an overactive amygdala, the part of the brain that controls fear responses
- a brain chemical imbalance
- genetics may play a relatively minor role
For comprehensive information on social phobia and other forms of anxiety, visit the HealhtyPlace.com Anxiety-Panic Community.
Sources: 1. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association. 2. Merck Manual, Home Edition for Patients and Caregivers, last revised 2006.
Last Updated: 18 November 2017
Reviewed by Harry Croft, MD