Social anxiety disorder (also known as social phobia) is a diagnosis referring to excessive long-lasting social anxiety causing relatively extreme distress and impaired ability to function in at least some areas of daily life. The diagnosis can be of a 'specific' disorder (when only some particular situations are feared) or a generalized disorder. Generalized social anxiety disorder typically involves a persistent, intense, and chronic fear of being judged by others and of potentially being embarrassed or humiliated by their own actions. These fears can be triggered by perceived or actual scrutiny by others. An early diagnosis may help in minimizing the symptoms and the development of additional problems such as depression. Some sufferers may use alcohol or drugs to reduce fears and inhibitions at social events.

Diagnostic criteria for 300.23 Social Phobia.

a) A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.

b) Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack. In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.

c) The person recognizes that the fear is excessive or unreasonable.

d) The feared social or performance situations are avoided or else are endured with intense anxiety or distress.

e) The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

f) In individuals under age 18 years, the duration is at least 6 months.

g) The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., Panic Disorder With or Without Agoraphobia, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).

h) If a general medical condition or another mental disorder is present, the fear in Criterion (a) is unrelated to it. (e.g., the fear is not of stuttering or trembling in Parkinson's disease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa).

Social phobics experience dread over how they will be presented to others. They may be overly self-conscious, pay high self-attention after the activity, or have high performance standards for themselves. A sufferer attempts to create a well-mannered impression on others but believes he or she is unable to do so.

Prior to a potentially anxiety-provoking social situation, sufferers may deliberate many times over what could go wrong and how to deal with each unexpected case. After the event, they may have the perception they performed unsatisfactorily. Consequently, they will review anything that may have possibly been abnormal or embarrassing for up to weeks after the event.

Feared activities may include almost any type of social interaction, especially in small groups, such as dating, parties, talking to strangers or restaurants. Physical symptoms often accompanying social anxiety disorder include excessive blushing, sweating (hyperhidrosis), trembling, nausea, and stammering. Panic attacks may also occur under intense fear and discomfort.

Phobias are usually controlled by escape and avoidance behaviors. For instance, a student may leave the room when talking in front of the class (escape) and refrain from doing verbal presentations because of the previously encountered anxiety attack (avoid). Minor avoidance behaviors are exposed when a person avoids eye contact and crosses arms to avoid recognizable shaking. A fight-or-flight response is then triggered in such events.

Social anxiety disorder is common but many are afraid to seek psychiatric help, leading to an understatement of the problem. Prevalence rates can also vary widely because of its vague diagnostic criteria and its overlapping symptoms with other disorders.

The National Comorbidity Survey of over 8,000 American correspondents in 1994 revealed a 12-month prevalence rates of 7.9% and lifetime prevalence rates of 13.3% making it the third most prevalent psychiatric disorder after depression and alcohol dependence and the most apparent of the anxiety disorders. According to U.S. epidemiological data from the National Institute of Mental Health, social phobia affects 5.3 million adult Americans in any given year.

Onset of social phobia typically occurs between 11 and 19 years of age. Onset after age 25 is rare. Social anxiety disorder occurs in females nearly twice as often as males, although men are more likely to seek help. The prevalence of social phobia appears to be increasing among white, married, and well-educated individuals. Although as a group, those with generalized social phobia are less likely to graduate from high school and are more likely to rely on government financial assistance or have low level salaries.

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