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CHAPTER 10 Mental Disorders
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Social anxiety disorder

Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterised by an intense fear in one or more social situations causing considerable distress and impaired ability to function in at least some parts of daily life. These fears can be triggered by perceived or actual scrutiny from others. It is the most common anxiety disorder and one of the most common psychiatric disorders, with 12% of American adults having experienced it.Physical symptoms often accompanying social anxiety disorder include excessive blushing, excess sweating, trembling, palpitations and nausea. Stammering may be present, along with rapid speech. Panic attacks can also occur under intense fear and discomfort. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. It is common for sufferers of social phobia to self-medicate in this fashion, especially if they are undiagnosed, untreated, or both; this can lead to alcoholism, eating disorders or other kinds of substance abuse. SAD is sometimes referred to as an 'illness of lost opportunities' where 'individuals make major life choices to accommodate their illness.' Standardized rating scales such as the Social Phobia Inventory, the SPAI-B and Liebowitz Social Anxiety Scale can be used to screen for social anxiety disorder and measure the severity of anxiety.The first line treatment for social anxiety disorder is cognitive behavioral therapy with medications recommended only in those who are not interested in therapy. Cognitive behavioral therapy is effective in treating social phobia, whether delivered individually or in a group setting. The cognitive and behavioral components seek to change thought patterns and physical reactions to anxiety-inducing situations. The attention given to social anxiety disorder has significantly increased since 1999 with the approval and marketing of drugs for its treatment. Prescribed medications include several classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). Other commonly used medications include beta blockers and benzodiazepines.
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