Social Anxiety Disorder: Symptoms, diagnosis, treatment

The symptoms of social anxiety disorder include:

• A feeling of being watched and judged by people all the time.
• Inability to concentrate or remember things.
• Avoiding social occasions or situations like group discussions, eating with friends or attending parties.
• Trying to avoid eye contact while speaking.
• Slurred speech, speaking quietly, mumbling, mixing up words.
• Sudden events of anxiety attacks which include blushing, sweating or trembling, pounding heart, palpitations, dizziness or nausea, shortness of breath.
• Inability to relax, feeling strange aches and pain in the body.
• Having low self-esteem.

There is no certain cause of social anxiety disorder in a person but some scientists believe that it can be due to underdeveloped social skills, while others think that it could be inherited from the family.

Some scientists also believe that social anxiety disorder could be the result of overactivity of the amygdala, the mid part of the brain responsible for controlling emotions and memories.

A doctor diagnoses the disorder by asking questions about the frequency and intensity of the anxiety attacks. The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV, 1994) set four major criteria for diagnosing society anxiety disorder in a person:

• Whenever a person meets unfamiliar people or is exposed to a crowd full of unknown people, he/she starts showing signs of anxiety. They get conscious of their personality and behaviour. They fear that their behaviour may be embarrassing or humiliating.
• Even the thought of getting exposed to social situations provokes anxiety. 
• The person recognises that their fear is extreme but unreasonable.
• The person tries to avoid social or performance situations. If they are exposed to one such situation, they deal with intense anxiety.

Social anxiety disorder can be treated with the help of psychotherapy and drug therapy.

Well-trained therapists help a person deal with their anxiety issues effectively. Psychotherapy involves:

• Exposure therapy: The person is exposed to some fearful situations continuously, as this would make them used to dealing with such situations without anxiety.
• Social skills training: The person is taught how to make good conversations which helps them get comfortable with new people.
• Cognitive therapy: Cognitive therapy focuses on diminishing irrational thoughts or beliefs that give rise to social anxiety in a person.
• Cognitive behaviour therapy: Cognitive behaviour therapy is a blend of cognitive therapy and exposure therapy. The therapist would give assignments to the person which would include activities like conversing with people around them or preparing a speech. This helps in building their confidence.

For the extensive treatment of the disease, drug therapy is given along with psychotherapy. Drug therapy is continued for at least a year, after which the doses are tapered and eventually discontinued. These are the three types of drugs that can be given to the affected person:

• Antidepressants: Selective serotonin reuptake inhibitors like citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline, are the drugs of choice for treating social anxiety disorders.
• Anxiolytics: These include benzodiazepines like clonazepam which have been effective in treating social anxiety disorder.
• Anticonvulsants: Gabapentin and pregabalin have been reported to help in cases involving social anxiety disorder.

Social anxiety disorder can be extremely debilitating for the person suffering, and can cause extreme reactions that can be difficult to deal with either personally, or by the people surrounding the person.

A large section of people in India have been known to suffer from different problems relating to mental health, and social anxiety disorder is one of the primary causes.

With the right and timely diagnosis and rehabilitative methods along with the right medication, social anxiety disorder can be effectively managed in individuals.