Psychologists and psychiatrists at Shier Private Practice in Scottsdale, AZ specialize in the treatment of social anxiety disorder. Our private outpatient clinic offers a comprehensive psychiatric/medical assessment and treatment plan. Treatment may include medications, behavioral therapies or a combination of treatments.

Social anxiety disorder is a type of anxiety disorder that is marked by significant fear and anxiety surrounding social situations. Individuals with social anxiety disorder fear being scrutinized by their peers and worry about public humiliation. Social anxiety may significantly interfere with daily routines and functioning in social and occupational settings. Individuals with social anxiety disorder may experience increased heart rate, trouble breathing, upset stomach, dizziness and/or muscle tension when confronting social situations. Anticipatory anxiety may occur far in advance of upcoming social situations.

Social anxiety disorder has a 12 month prevalence of 7% in the United States. The median age of onset is 13 years of age, with 75% of individuals having an age of onset between the ages of 8 and 15 years.

The DSM-5 Criteria for social anxiety disorder are as follows:

1. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
2. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated.
3. The social situations almost always provoke fear or anxiety.
4. The social situations are avoided or endured with intense fear or anxiety.
5. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
6. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
7. The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
8. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance or another medical condition.
9. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder.
10. If another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

Social anxiety disorder likely develops as a result of a complex interaction between environment, genetics and brain structure. It is not uncommon for anxiety disorders to run in families. It is difficult to know whether this relationship is due to genetics or learned behaviors i.e. witnessing anxious behaviors of others. Brain research has shown that the amygdala of the brain may play a role in fear response to anxiety. Those with overactive amygdalas may experienced heightened fear responses and thus a higher level of anxiety in social situations.

Other research has shown that there may also be an association between social anxiety disorder and over-protective/over-controlling parents. Individuals who experience negative social experiences such as bullying, who are shy in childhood when facing social situations, and who have health conditions that draw attention may be at higher risk for developing social anxiety disorder.

The diagnosis of social anxiety disorder requires a thorough biopsychosocial and medical assessment to confirm the diagnosis and rule out other psychological or medical conditions.

While symptoms of social anxiety may change over time, they are likely to return with increases in stress or demands. Over time, the symptoms may lessen or anxiety may persist without treatment. According to the DSM-5, in 60% of individuals that did not seek treatment, their social anxiety took several years or longer to resolve on its own. Social anxiety disorder can affect several aspects of daily functioning and may lead to low self-esteem, hypersensitivity to criticism, isolation, low academic and occupational achievement, substance abuse, and depressive symptoms if left untreated.

Psychotherapy and medications have both shown to be effective in the treatment of social anxiety disorder. To improve outcomes, it is common that these two forms of treatment are used together.

There are three Selective Serotonin Reuptake Inhibitors (SSRIs) that are currently approved by the FDA for the treatment of social anxiety disorder. These medications include Paroxetine/Paxil, Sertraline/Zoloft, and Venlafaxine/Effexor.

Cognitive behavioral therapy (CBT) is the most common type of psychotherapy in the treatment of social anxiety disorder. During CBT, exposure therapy may be used to gradually increase an individual’s ability to cope with anxiety-inducing situations.

1. Self care – Maintain a healthy physical status. Good diet and exercise provides significant psychological benefits and can help reduce stress and anxiety. Make sure you are taking care of yourself and getting plenty of rest.
2. Stress reduction – Setting limits on requests that may increase your stress levels.
3. Relaxation and meditation – Learn how to control your breathing and ease your muscle tension when you are feeling stressed or anxious in social situations.
4. Avoid drugs and alcohol – Avoid self-medicating as this may worsen anxiety symptoms and increase your risk for physical health issues.
5. Seek support from friends and family- Avoid long periods of social isolation as this may worsen symptoms of depression and anxiety.
6. Join a support group – Support groups will help you meet others with similar experiences, share coping strategies, and gain a sense empowerment and connection.

Last update: February 25, 2019

The content on this website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.