Anxiety & Panic Disorders Health Center

Social Anxiety Disorder

What Causes Social Anxiety Disorder?

There is no single known cause of social anxiety disorder, but research suggests that biological, psychological, and environmental factors may play a role in its development.

• Biological: Social anxiety disorder may be related to an imbalance of the neurotransmitter serotonin. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell in the brain. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts to stressful situations, leading to anxiety. In addition, social anxiety disorder appears to run in families. This means that the disorder may be passed on in families through genes, the material that contains instructions for the function of each cell in the body.
• Psychological: The development of social anxiety disorder may stem from an embarrassing or humiliating experience at a social event in the past.
• Environmental: People with social anxiety disorder may develop their fear from observing the behavior of others or seeing what happened to someone else as the result of their behavior (such as being laughed at or made fun of). Further, children who are sheltered or overprotected by their parents may not learn good social skills as part of their normal development.

How Is Social Anxiety Disorder Diagnosed?

If symptoms of social anxiety disorder are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical exam. Although there are no lab tests to specifically diagnose social anxiety disorder, the doctor may use various tests to make sure that a physical illness isn't the cause of the symptoms.

If no physical illness is found, you may be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for an anxiety disorder. The doctor bases his or her diagnosis of social anxiety disorder on reports of the intensity and duration of symptoms, including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate social anxiety disorder.

How Is Social Anxiety Disorder Treated?

For social anxiety disorder, the most effective treatment currently available is cognitive behavioral therapy (CBT). Medication may also be used to help ease the symptoms of social anxiety disorder so that CBT is more effective. Drugs may also be used alone.

• Cognitive-behavior therapy: The goal of CBT is to guide the person's thoughts in a more rational direction and help the person stop avoiding situations that once caused anxiety. It teaches people to react differently to the situations that trigger their anxiety symptoms. Therapy may include systematic desensitization or real life exposure to the feared situation. With systematic desensitization, the person imagines the frightening situation and works through his or her fears in a safe and relaxed environment, such as the therapist's office. Real life exposure gradually exposes the person to the situation but with the support of the therapist.
• Medication: There are several different types of drugs used to treat social anxiety disorder, including: antidepressants, like Paxil; tranquilizers (benzodiazepines), such as Klonopin and Ativan; beta-blockers, often used to treat heart conditions, may also be used to minimize certain physical symptoms of anxiety, such as shaking and rapid heartbeat.

Counseling to improve self-esteem and social skills, as well as relaxation techniques, such as deep breathing, may also help a person deal with social anxiety disorder.