Social Anxiety Disorder and Generalized Anxiety Disorder

Social Anxiety Disorder (SAD)

• Definition: Social Anxiety Disorder (SAD) is an intense, chronic fear of being judged by others in social situations.
• Distinction from Specific Phobia:
• SAD usually involves anxiety in multiple social situations (e.g., meeting people, speaking in public), whereas specific phobias are often limited to certain triggers.
• SAD disrupts daily life significantly more than specific phobias, making it difficult to avoid social encounters.
• Often comorbid with other mental health disorders, such as substance use disorders and depression.

Social Anxiety Disorder vs. Shyness

• Prevalence of Shyness:
• About 48% of college students identify as "shy."
• Only 18% of these students meet the diagnostic criteria for SAD.
• Key Differences:
• SAD: Persistent fear, greater impairment in functioning.
• Shyness: Often less debilitating, manageable without treatment.

SAD Diagnostic Criteria

1. Marked Fear: Fear about one or more social situations where the individual may be scrutinized by others.
2. Fear of Negative Evaluation: Concern that actions or symptoms will lead to negative judgments from others.
3. Provocation of Anxiety: Social situations almost always trigger significant fear or anxiety.
4. Avoidance or Endurance: Avoidance of social interactions or enduring them with intense anxiety.
5. Disproportionate Fear: Fear that is excessively related to the actual threat posed and to sociocultural context.
6. Persistence: Fear and anxiety lasting 6 months or longer.
7. Significant Distress/Impairment: Results in clinically significant distress or impairs social, occupational, or important areas of functioning.

Types of SAD

• Generalized SAD: Involves fears about a broad range of social situations.
• Public Speaking SAD: Specific fear of public speaking beyond what is typically experienced, categorized under DSM.

Prevalence and Course

• Lifetime Prevalence: About 10% for generalized SAD and 20% for public speaking type.
• Onset: Typically begins in adolescence or young adulthood.
• Chronic Nature: Average duration of 16 years; 80% do not seek treatment, leading to negative impact on education and employment.
• Comorbidities: High rates of comorbidity with other issues like substance use and depression.

Demographics

• Gender: More common in women (1.5 to 2 times), though men may be more likely to seek treatment.
• Ethnicity: More prevalent among white Americans. Mixed evidence on prevalence in sexual minorities.

Biological Theories

• Genetics: SAD often runs in families, linked to temperamental factors like behavioral inhibition.
• Neurotransmitters: Dysregulation of serotonin, dopamine, and GABA in the limbic system affects mood regulation.

Treatments

Biological Treatments

• Medications:
• SSRIs and SNRIs show efficacy (40-70% response rate), but symptoms often recur after discontinuation.

Psychological (Cognitive) Treatments

• Cognitive Behavioral Therapy (CBT):
• Focuses on cognitive restructuring and behavioral exposure to feared situations.
• Questions automatic negative thoughts related to social abilities.
• Counteracting Safety Behaviors:
• Patients learn the ineffectiveness of avoidance strategies (e.g., over-preparing, using substances).
• Social Skills Training:
• Many individuals with SAD possess adequate social skills but require practice in real contexts.

Examples of Common Exposures

• Initial conversations, job interviews, asking for dates, interactions with authority figures, and public speaking are common practice areas.

Comparative Treatment Analysis

• Effectiveness: SSRIs and CBT have comparable effects, but CBT provides lasting benefits once treatment is completed while medication effects diminish after stopping.

Conclusion

• SAD can severely impair functioning but treatments are available that are effective; understanding the disorder in depth aids in identifying symptoms and seeking help effectively.