Social

Anxiety
Disorder
 Table of Contents
Social anxiety
Clinical Features
1
disorder
Introduction 4 Here you could
describe the topic of
the section
Course and
Cause
2 Neuro chemical
Genetic
5 Prognosis

Psychological
Environmental
Treatment
3 Criteria
DSM-5 Diagnostic 6 Pharmacotherapy
Psychotherapy
 Social Anxiety
disorder
● Social anxiety disorder (also
referred to as social phobia)
involves the fear of social
situations, including situations
that involve scrutiny or
contact with strangers.
● The fear is of potential
embarrassment or negative
evaluation, not the situation
itself
● https://youtu.be/QLjPrNe63kk
?si=ezEos-oZ_CVXEmbz
 Causes

Neurochemical Factors
• Efficacy of beta-blockers for performance anxiety
suggests adrenergic system involvement
• Possibly due to excessive norepinephrine/epinephrine
release or sensitivity
• Better response to MAOIs than tricyclics for
generalized social anxiety points to potential
dopaminergic dysfunction
 Causes

Genetic Factors
• First-degree relatives of those with social anxiety are 3
times more likely to also have the disorder
• Studies of twins indicate higher concordance rates in
identical (monozygotic) twins compared to fraternal
(dizygotic) twins
• This suggests a genetic vulnerability component to
developing social anxiety disorder
 Causes
Psychological factors:
● Negative thought patterns, low self-esteem, and
cognitive biases (e.g., overestimating the likelihood of negative
social events) can play a role in the development and
maintenance of Social Phobia.
Environmental factors
● Traumatic social experiences, such as bullying or humiliation,
during childhood or adolescence, and parenting styles that
promote insecurity or social withdrawal, may increase the risk of
developing Social Phobia.
Some infants exhibit an innate "behaviorally inhibited"
temperament - shyness/withdrawal. This increases risk for later
 DSM-5 Diagnostic Criteria

A. Marked fear or anxiety about one or more social situations

in which the individual is exposed to possible scrutiny by
others. Examples include social interactions (e.g., having a
conversation, meeting unfamiliar people), being observed
(e.g., eating or drinking), and performing in front of others
(e.g., giving a speech).
Note: In children, the anxiety must occur in peer settings and
just during interactions with adults.
B. The individual fears that he or she will act in a way or
show anxiety symptoms that will be negatively evaluated
(i.e., will be humiliating or embarrassing; will lead to
 DSM-5 Diagnostic Criteria

C. The social situations almost always provoke fear or

anxiety.
Note: In children, the fear of anxiety may be expressed by
crying, tantrums, freezing, clinging, shrinking, or failing
to speak in social situations.
D. The social situations are avoided or endured with
intense fear or anxiety.
E. The fear of anxiety is out of proportion to the actual
threat posed by the social situations and to the
sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typical ly
 DSM-5 Diagnostic Criteria

G. The fear, anxiety, or avoidance causes clinically

significant distress or impairment in social,
occupational, or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to
the physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition.
 DSM-5 Diagnostic Criteria

I. The fear, anxiety, or avoidance is not better explained

by the symptoms of another mental disorder, such as
panic disorder, body dysmorphic disorder, or autism
spectrum disorder.
J. If another medical condition (e.g., Parkinson's
disease, obesity, disfigurement from burns or injury)
is present, the fear, anxiety, or avoidance is clearly
unrelated or is excessive.
Specify if: Performance only: If the fear is restricted to
speaking or performing in public.
 Clinical Features

1. The core clinical features of Social Phobia include:

2. Intense fear or anxiety in social situations where the individual
may be scrutinized or evaluated by others.
3. Physical symptoms, such as trembling, blushing, sweating,
palpitations, and muscle tension, when faced with social
situations.
4. Avoidance of social situations or enduring them with intense
anxiety.
5. Anticipatory anxiety before social situations.
6. Negative self-perception and self-consciousness about one's
appearance or behavior in social situations.
 Course and Prognosis
• Social anxiety disorder tends to first emerge in late
childhood or adolescence
• Without treatment, it often runs a chronic and
unremitting course over many years
• It can significantly disrupt major life activities and
milestones like education, career, and relationships
• However, those who do respond to treatment tend to
have a better long-term prognosis
 Treatment - Pharmacotherapy
Effective medications include:
● SSRIs (considered first-line for generalized social anxiety)
● Benzodiazepines (alprazolam, clonazepam)
● Venlafaxine (Effexor)
● Buspirone (BuSpar) - can augment SSRIs
Severe cases may require MAOIs like phenelzine (Nardil) - 45-
90mg/day, 50-70% response rate
For performance anxiety:
Beta-blockers (atenolol 50-100mg or propranolol 20-40mg) taken
before exposure
Short/intermediate-acting benzodiazepines (lorazepam, alprazolam)
 Treatment - Psychotherapy
 Cognitive and behavioural techniques
● Cognitive retraining
● Desensitization
● Exposure/rehearsal in sessions
● Homework assignments
 Usually involves combination of behavioural and cognitive
methods
Key Points:
 Medications and psychotherapy both effective
 SSRIs considered first-line for generalized type
 Adjuncts like benzodiazepines, beta-blockers for performance
situations
 Combination of cognitive and behavioural psychotherapy
techniques
 Thanks!
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