Social Anxiety Disorder

Question 1

Social anxiety disorder domains

Answer 1

• Fear of being embarrassed in public
• Fear of speaking in public
• Fear of eating in public

Question 2

Diagnostic criteria for social anxiety disorder

Answer 2

• A marked, persistent fear of at least one social or performance situation in which exposure to unfamiiar people or possible scrutiny of others occurs. The person fears that he or she will act in a way or show anxiety symptoms that will be humiliating or embarassing
• Symptoms must be at least 6 months in duration
• Exposure to the situation invariably provokes anxiety that may be in the form of a panic attack
• The person recognizes that the fear is unreasonable
• Avoidance, anxious anticipation, or distress associated with the feared situation(s) interferes with the person’s function or normal routine

Question 3

Treatment of social anxiety disorder

Answer 3

Psychotherapy (in the form of CBT with desensitization, rehearsal, and exposure) is first line

In some cases, psychopharmcotherapy for severe social phobia is successful utilizing SSRIs, SNRIs (especially venlafaxine), benzodiazepines, and buspirone. Buspirone can also augment an SSRI in treatment.

Propranolol or atenolol used just prior to the feared situation can also reduce anxiety symptoms.

There is no conclusive evidence for rTMS at this time.