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Social anxiety disorder (social phobia)
Diagnosis
Your doctor will want to determine whether other conditions may be causing your anxiety or if you have social anxiety disorder along with another physical or mental health disorder.
Your doctor may determine a diagnosis based on:
Physical exam to help assess whether any medical condition or medication may trigger symptoms of anxiety
Discussion of your symptoms, how often they occur and in what situations
Review of a list of situations to see if they make you anxious
Self-report questionnaires about symptoms of social anxiety
Criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
DSM-5 criteria for social anxiety disorder include:
Persistent, intense fear or anxiety about specific social situations because you believe you may be judged, embarrassed or humiliated
Avoidance of anxiety-producing social situations or enduring them with intense fear or anxiety
Excessive anxiety that's out of proportion to the situation
Anxiety or distress that interferes with your daily living
Fear or anxiety that is not better explained by a medical condition, medication or substance abuse
Treatment
Treatment depends on how much social anxiety disorder affects your ability to function in daily life. The two most common types of treatment for social anxiety disorder are psychotherapy (also called psychological counseling or talk therapy) or medications or both.
Psychotherapy
Psychotherapy improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations.
Cognitive behavioral therapy is the most effective type of psychotherapy for anxiety, and it can be equally effective when conducted individually or in groups.
In exposure-based cognitive behavioral therapy, you gradually work up to facing the situations you fear most. This can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others. Practicing exposures to social situations is particularly helpful to challenge your worries.
First choices in medications
Though several types of medications are available, selective serotonin reuptake inhibitors (SSRIs) are often the first type of drug tried for persistent symptoms of social anxiety. Your doctor may prescribe paroxetine (Paxil) or sertraline (Zoloft).
The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety disorder.
To reduce the risk of side effects, your doctor may start you at a low dose of medication and gradually increase your prescription to a full dose. It may take several weeks to several months of treatment for your symptoms to noticeably improve.
Other medications
Your doctor may also prescribe other medications for symptoms of social anxiety, such as:
Other antidepressants. You may have to try several different antidepressants to find one that's the most effective for you with the fewest side effects.
Anti-anxiety medications. Benzodiazepines (ben-zoe-die-AZ-uh-peens) may reduce your level of anxiety. Although they often work quickly, they can be habit-forming and sedating, so they're typically prescribed for only short-term user...
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