Definition and Diagnosis
Social Anxiety Disorder is marked by intense fear or anxiety about social situations in which the person may be scrutinized, such as conversations, meeting new people, or performing in front of others, driven by a fear of embarrassment or negative evaluation.
Epidemiology
It is among the most prevalent anxiety disorders, with lifetime prevalence estimates around 12% in the general population. Onset is typically in early-to-mid adolescence.
Risk Factors
Behavioral inhibition in childhood, overprotective or critical parenting styles, a history of bullying or social rejection, and family history of social anxiety all raise risk. The condition is also more likely in individuals with other anxiety disorders.
Symptoms and Subtypes
Symptoms include blushing, sweating, trembling, a rapid heartbeat, and avoidance of or intense distress during social interactions or performance situations. Many individuals also experience significant anticipatory anxiety in the days leading up to a feared event.
Diagnosis
Clinicians assess the persistence (typically six months or more), consistency across social situations, and degree of functional impairment, in line with DSM-5-TR criteria. A specifier for performance-only social anxiety is used when fear is limited to public speaking or performing.
Treatment
CBT, particularly exposure-based approaches and social skills training, is a well-supported first-line treatment. SSRIs and SNRIs are effective pharmacological options, and group therapy formats can provide valuable in-vivo practice.
Prognosis
Without treatment, Social Anxiety Disorder tends to be persistent and can limit educational, occupational, and relational opportunities. Treatment response is generally good, though improvement is often gradual and benefits from sustained practice.
Reference
Kaplan, H. I., & Sadock, B. J. (2022). Kaplan & Sadock's Synopsis of Psychiatry (12th ed.). Wolters Kluwer.