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Social anxiety disorder is characterised by an intense fear of embarrassment in social or performance situations that is out of proportion to any actual threat posed, and resultant avoidance of social situations. Much more than just “shyness”, social anxiety disorder can cause overwhelming fear regarding everyday activities, typically involving other people.
Symptoms of social anxiety disorder include fear and avoidance of situations like meeting strangers, starting conversations, talking in groups, talking to authority figures, and public displays from eating to performing. People with social anxiety disorder tend to worry before or after social situations, imagining how their fears could be played out or how they appeared to other people. The condition often occurs alongside other mental health problems, most notably other anxiety disorders and depression and alcohol abuse. Intense feelings of anxiety can lead to physical symptoms of panic include shaking, sweating and heart palpitations.
Healthcare professionals use a questionnaire and score system to diagnose social anxiety disorder, though only half of sufferers seek treatment and even then usually after 15-20 years. Recognition by GPs in primary care is often poor.
There are no recent prevalence estimates for the UK, though US studies have shown it to be the third most common psychiatric condition after major depression and alcohol dependence. It is more prevalent in women though men are more likely to seek treatment. Environmental factors are important; children who are bullied, abused or whose parents display anxious behaviour are at a higher risk of developing the condition. Social anxiety disorder has an early age of onset (13 years) and significant numbers of people who develop the condition in adolescence recover before reaching adulthood.
Cognitive Behavioural Therapy (CBT) is the most effective psychological treatment. Antidepressant medication may be recommended alone or in conjunction with CBT for people who are also depressed. For those for whom the condition lasts into adulthood the chance of recovery without treatment is very low compared to other mental health conditions, though excellent with treatment.
NICE clinical guidelines on social anxiety disorder
National Collaborating Centre for Mental Health guidelines on social anxiety disorder
NHS Choices information page
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