US Pharm. 2024;49(5):15-16.

Can Be a Crippling Condition

Social anxiety disorder, or social phobia, is a disabling mental health condition that is often characterized by an intense, persistent, excessive, overwhelming fear or self-consciousness in at least one social or performance situation. This anxiety is so great that it may interfere with daily living. People with social anxiety disorder often avoid social activities because they worry about being embarrassed, humiliated, or judged negatively in front of others or they fear that others will say bad things about them. They might avoid looking at or talking to people or may experience blushing, sweating, trembling, a very fast heartbeat, chest discomfort, shortness of breath, racing thoughts, dizziness, shy bladder, shaky voice, upset stomach, diarrhea, vomiting, or headaches before or during social situations. Individuals with social anxiety disorder are at increased risk for depression, substance abuse, and suicide. If left untreated, it can result in lower education, worse occupational performance, impaired social interactions, poorer-quality relationships, and lower quality of life.

Social Anxiety Disorder Is Common

Social anxiety affects about 5% to 10% of people across the world. It can develop at any time, but it usually emerges in early childhood or adolescence. The anxiety slowly becomes more serious over time, although it can fluctuate in severity. There is no identifiable cause for social anxiety disorder, but it appears to be influenced by biological, genetic, or environmental factors. Other risk factors for developing social anxiety disorder include those who have family members with anxiety disorders, female sex, those with a physical or behavioral condition that makes them feel self-conscious or nervous, and those who experienced overly controlling or intrusive parenting, bullying, ridicule, or abuse.

Symptoms Vary From Person to Person

Diagnosis is made based on medical history, symptoms, and behavior in social situations. Typically, the symptoms are present for at least 6 months and occur on more days than not. Someone with social anxiety disorder might feel fearful or anxious in different situations, such as public speaking, meeting new people, dating, being on a job interview, eating in front of other people, or using a public bathroom. The fear may vary in intensity. Some people may not be able to perform daily tasks or may avoid situations that cause anxiety or fear. Some may endure the social situation but experience intense anxiety and fear, and some may worry well in advance of a social situation. Some people may only experience this anxiety during specific social situations. For example, performance anxiety occurs when a person is severely anxious in situations such as delivering speeches.

A Treatable Disorder

Treatment options include psychotherapy, medications, or both. Cognitive behavioral therapy is used to help find different ways of thinking, behaving, and reacting to situations and to develop social skills, adjust negative thoughts, change the way people perceive situations and events, develop coping skills, manage the anxiety and triggers, and develop confidence and comfort in managing those situations. Exposure therapy is a kind of behavioral therapy in which the patient is progressively exposed to social situations that he or she fear and practices self-calming techniques. Mindfulness training, acceptance, and commitment training and other techniques that encourage relaxation, such as deep breathing, positive self-talk, meditation, visual imagery, muscle relaxation, listening to music, and yoga, can also help manage anxiety. Joining support groups can help as well.

Medications such as paroxetine or sertraline are another way to help manage social anxiety disorder. They are started at low dosages and are gradually increased to an optimal dosage. They can take several weeks to months to have an effect. Benzodiazepines are antianxiety medications that work quickly and are for short-term use only since they can be sedating or habit-forming and require increasingly larger dosages to achieve the same effect. The beta-blocker propranolol is used to relieve sweating, trembling, shaky voice, and fast heartbeat in those with performance anxiety, but it is not helpful for other forms of social anxiety disorder. Other steps that might help include limiting alcohol intake, caffeine, other stimulants, and certain OTC cold medications.

A pharmacist can help identify which medications to avoid. It is recommended to get regular exercise, sleep, and meals. Remember that it is always crucial to talk to your doctor before starting or stopping any medications. Treatment can take some time to work, so it is important to remain patient and consistent. Be sure to keep going to appointments and taking medications as they are prescribed. If you have any questions about or changes to your conditions, make sure to talk to your healthcare provider.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

To comment on this article, contact