Social anxiety disorder

• Overview:

  • fear of social situations is overwhelming and disproportionate
  • Fearful of being negatively judged by others
  • Every day social interactions, being observed by others, and performing in front of others
  • Strive to avoid these situations or endure them with intense feelings of anxiety or fear
• Epidemiology:

  •  up to 15% of adults may have social anxiety disorder during their lifetime.
  • Median age of onset is 13 years
  • One of the most persistent anxiety disorders
  • More commonly affects women
  • Significant comorbidity between social anxiety disorder and other mental health problems including depression
• Risk factors:

  • Female sex
  • Family history of anxiety disorder
  • Adverse childhood experiences
  • Overprotection as a child
  • Shy and/or timid temperament
  • Embarrassing situations
  • Noticeable condition
  • Other mental health disorders
• The DSM-V refers to a clinical diagnosis of social anxiety disorder, whereas the ICD-11 refers to social phobia.
• Identification:

  • Use the 3-item mini-social phobia inventory (Mini-SPIN)
  • Or consider asking the following 2 questions:
  • Do you find yourself avoiding social situations or activities?
  • Are you fearful or embarrassed in social situations?
• The main differentials for social anxiety disorder are another anxiety disorder, OCD, or autism spectrum disorder.
• Management:

  • Psychological therapies - CBT (first line) or psychodynamic therapy
  • Medication - first line SSRIs