Social anxiety disorder (neurotic / phobias)

Question 1

Who does social anxiety disorder affect?

Answer 1

-One of the most common anxiety disorders
-More common in women and young people
-Only 5% seek help, commonly only after 15-20 years

Question 2

What causes social anxiety disorder?

Answer 2

-Persistent fear and anxiety about one or more social / performance situations
-A fairly normal trait but may become a disease when severity interferes with daily life
2 forms:
-Generalised social anxiety = affects most / all of life, affects 70% of those with the disorder
-Performance social anxiety = feelings occur in specific situations eg eating in public

Question 3

How does social anxiety disorder present?

Answer 3

-A fear of being around people and having to interact with them
-Fear of being watched and criticised
-Normal activities eg work, shopping, speaking on the phone, are marked by persistent anxiety
-Dread a situation and analyse their performance afterwards
-Physical symptoms:
–Trembling
–Blushing
–Sweating
–Palpitations
-Often are insecure in relationships, excessively sensitive to criticism and fears of being judged, mocked or rejected
-Often starts in adolescence

Question 4

How would you identify social anxiety?

Answer 4

-Use the 3-item Mini-Social Phobia Inventory (self-rating scale)
-Asking questions such as
–Do you find yourself avoiding social situations?
–Are you fearful or embarrassed in social situations?

Question 5

What are the differential diagnoses for social anxiety disorder?

Answer 5

-Panic disorder
-Agoraphobia
-Separation anxiety disorder
-GAD
-Specific phobias

Question 6

What treatment would you consider in someone with social anxiety?

Answer 6

1st line:
-CBT / CBT-based self-help
-SSRI if above is rejected
2nd line:
-Combine CBT with medication if only partial responses seen
-SNRI / MAOIs if no improvement with SSRIs
NB Must assess for suicide risk and refer if required