Social Anxiety

Question 1

what is the epidemiology?

Answer 1

• Most common of anxiety disorders  12%
• Social phobias are more common in women
• More common in younger people

Question 2

Features of social anxiety?

Answer 2

• Fear of social situations e.g. being around people and having to interact with them
• Fear being watched and criticised/judged
• Persistent feelings of anxiety and self-consciousness with normal activities e.g. working, shopping, speaking on telephone
• Feeling of dread when situation is approaching and afterwards they analyse on ruminate on how they could have done better
• May experience chronic insecurity about relationships with others
• May have excessive sensitivity to criticism and profound fears of being judged negatively, mocked or rejected by others

Question 3

Physical symptoms of social anxiety?

Answer 3

• Trembling
• Blushing
• Sweating
• Palpitations
• Nausea
• Urge to go to the toilet frequently

Question 4

What are the two forms of social anxiety?

Answer 4

Generalised and performance social anxieties

Question 5

what is generalised social anxiety?

Answer 5

affects most, if not all areas of life, is more common type

Question 6

What is performance social anxiety?

Answer 6

the feelings only occur in a few specific situations e.g. public speaking, eating in public or dealing with authority figures

Question 7

What is the ICD-10 definition of social anxiety?

Answer 7

Fear of scrutiny by other people leading to avoidance of social situations. More pervasive social phobias are usually associated with low self-esteem and fear of criticism. They may present as a complaint of blushing, hand tremor, nausea, or urgency of micturition, the patient sometimes being convinced that one of these secondary manifestations of their anxiety is the primary problem. Symptoms may progress to panic attacks.

Question 8

What is the assessment of social anxiety?

Answer 8

• MINI SPIN - screening instrument for social anxiety disorder, has three questions which should be asked, and these questions are rated on a 5-point scale where 0 is not at all and 4 is extremely.

1. Fear of embarrassment causes me to avoid doing things or speaking to people
2. I avoid activities in which I am centre of attention
3. Being embarrassed or looking stupid are amongst my worst fears

• NICE recommends two questions as you have to be alert to possibility for depression also:
1. During the last month, have you been bothered by feeling down, depressed or hopeless?
2. During the last month, have you been bothered by having little interest or pleasure in doing things?
A yes to either of these questions is an indication for further assessment.

Question 9

Mx of social anxiety?

Answer 9

• CBT is FIRST LINE
• If declined - offer CBT-based support self help
• If WANT medication (and only if want and then still want when discussed with practitioner), may give SSRI e.g. citalopram or sertraline.