What is Social Anxiety Disorder (SAD)?
At some point, we all experience feelings of anxiety as a normal reaction to the stresses of everyday life or to major life events. However, some individuals have exaggerated symptoms of anxiety when observed by others in particular social situations, which severely hampers their daily life. These patients actually suffer from a recognised psychiatric illness: Social anxiety disorder.
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What is Social Anxiety Disorder?
How Common is Social Anxiety Disorder?
How Serious is the Condition?
How Can Social Anxiety Disorder be Treated?
What is Social Anxiety Disorder?
Social anxiety disorder is not just extreme shyness, but is a recognised psychiatric disorder (with specific diagnostic criteria), (ref.1 ) where patients experience intense fear of being scrutinized in social situations. The situations that trigger the anxiety symptoms vary between patients, but meeting new people or something as simple as eating in public, or using the telephone, can provoke crippling anxiety levels with physical symptoms, such as trembling and extreme sweating. The anxiety patients' feeling is persistent and is so intense, that they develop specific avoidance behaviour in order not to expose themselves to the feared situations. Their avoidance behaviour can severely interfere with their social and working life. Social anxiety disorder can be divided into a less and a more generalised form; about 50% of those suffering from social anxiety disorder have the generalised form, where many social situations are affected. Anxiety and social dysfunction are, naturally, more severe in those with the more pervasive generalised disorder. The biochemistry behind social anxiety disorder is complex and still not fully understood, but various neurotransmitter systems in the brain (“chemical communicators”) appear to function incorrectly.
How Common is Social Anxiety Disorder?
Approximately 7% of the population will suffer from the disorder during their lifetime (ref.2). The condition is equally common in men and women. Social anxiety disorder is a chronic illness, that usually starts early in life, generally between 15 and 16 years of age, an age where the development of social skills is particularly important.
How Serious is the Condition?
As social anxiety disorder starts early on in life, and as it seriously hampers participation in everyday life (even to the point of isolation from society), people suffering from the condition often do not reach their full educational or working potential. In addition, levels of unemployment and the degree of financial dependence on others are frequently higher for patients with this illness. The individual patient's situation is often worsened by the fact that he or she has a higher risk of suffering from other psychiatric disorders, including other anxiety disorders, or other conditions such as major depression, and alcohol and/or drug dependence. The risk of suicide is increased in patients with social anxiety disorder compared to the general public, and increases further if they suffer from another psychiatric illness at the same time.
How can Social Anxiety Disorder be Treated?
While behavioural therapy does have some effect in treating social anxiety, the mainstay of treatment is now the newer antidepressants (ref.3 ), the selective serotonin reuptake inhibitors (SSRIs) and the serotonin-noradrenalin reuptake inhibitors (SNRIs), which modify brain dysfunction in specific neurotransmitter systems. These drugs are effective without having the dependence problems seen after treatment with the medication previously used for this condition, the benzodiazepines. For those patients who are depressed, as well as suffering from social anxiety disorder, SSRIs have the added bonus, compared to benzodiazepines, of documented effect in depression. Social anxiety disorder requires early recognition and effective long-term management in order to provide sustained recovery for the patient. The goal of treatment is to allow the patient to function normally in daily relationships as well retaining productivity in the work place.
References:
1. Diagnostic and Statistical Manual of Mental Disorders. Fourth Ed. (DSM-IV). Washington DC: American Psychiatric Association; 1994.
2. Montgomery SA. How common is social anxiety. In: SSRIs and Social Anxiety. London UK: Science Press Ltd; 1999. p. 10-16.
3. Uhlenhuth EH, Balter MB, Ban TA, Yang K. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997. Depress Anxiety 1999; 9: 107-116.