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Social Phobia: Diagnosis and Treatment of Social Anxiety Disorder

Comprehensive evaluation and evidence-based management of social anxiety disorder including cognitive behavioral therapy, exposure therapy and pharmacotherapy

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Psikiyatri department. Book Appointment →

What is Social Phobia: Diagnosis and Treatment of Social Anxiety Disorder?

Social anxiety disorder is persistent intense fear of social situations where person may be evaluated, judged or scrutinized by others.

DSM-5 criteria include marked fear or anxiety about social situations, fear of negative evaluation, avoidance or endurance with intense distress.

Generalized subtype involves fear across most social situations while performance-only subtype is restricted to specific public performance situations.

Lifetime prevalence approximates 12% with female predominance and typical onset in adolescence affecting academic and social development.

Significant comorbidity with major depression, other anxiety disorders, and substance use disorders is common requiring comprehensive evaluation.

Symptoms

Intense fear and physiological anxiety symptoms including palpitations, sweating, trembling, blushing in social situations.
Anticipatory anxiety beginning days or weeks before anticipated social events significantly impairs preparation and performance.
Avoidance behaviors lead to occupational underachievement, social isolation and limited romantic relationships.
Safety behaviors including alcohol use, scripted speech, avoiding eye contact, sitting in inconspicuous locations maintain symptoms.
Negative self-evaluation, fear of negative evaluation by others, post-event rumination and processing maintain anxiety.

Risk Factors

Behavioral inhibition temperament in childhood with shyness and slow-to-warm-up behavior predicts later social anxiety.
Family history of anxiety disorders particularly social phobia suggests genetic and environmental contribution.
Adverse childhood experiences including bullying, social rejection, parental criticism or overprotection contribute to development.
Female sex with hormonal influences during adolescence increases vulnerability.
Cultural factors influencing presentation including Taijin Kyofusho in Japanese culture and varying expression across cultures.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent significant distress or impairment in social, occupational or academic functioning warrants psychiatric evaluation.
  • Anticipatory anxiety, panic attacks in social situations, or avoidance limiting daily functioning indicates treatment need.
  • Comorbid depression, substance use disorder, or suicidal ideation requires urgent comprehensive evaluation.
  • Chronic untreated symptoms with progression to severe avoidance and social isolation warrant intensive intervention.
  • Multidisciplinary care including psychiatrist, psychotherapist, primary care physician and family support optimizes outcomes.

Treatment Methods

01
Cognitive behavioral therapy with exposure components including in-vivo and imaginal exposure represents first-line psychotherapy.
02
Selective serotonin reuptake inhibitors including paroxetine, sertraline, escitalopram and SNRI venlafaxine are first-line pharmacotherapy.
03
Beta-blockers including propranolol provide on-demand performance anxiety relief for specific situations.
04
Group cognitive behavioral therapy provides structured exposure and peer support reducing isolation.
05
Comprehensive treatment plan including psychoeducation, mindfulness-based interventions, social skills training, gradual exposure hierarchy implementation, attention to comorbidities, and long-term maintenance therapy with relapse prevention strategies optimizes recovery from this commonly chronic but highly treatable anxiety disorder.

Which Department to Visit?

You can visit our Psikiyatri department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.