Social Anxiety Disorder

Diagnosis

To diagnose social anxiety disorder, your health care provider evaluates whether your symptoms may be caused by another medical condition or whether social anxiety exists alongside another physical or mental health issue. Diagnosis is based on a combination of a physical exam, a discussion of your symptoms and how often they occur, and a review of situations that trigger anxiety. You may also complete self-report questionnaires that help identify patterns of social fears or avoidance.

Your provider may use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to confirm the diagnosis. These criteria include persistent and intense fear or anxiety about social situations due to fear of being judged or embarrassed, avoidance of these situations or enduring them with significant fear, anxiety that is out of proportion to the situation, symptoms that interfere with daily life, and symptoms that cannot be explained by another medical condition, medication or substance use.

Treatment

Treatment for social anxiety disorder depends on how much the condition affects daily functioning. The most common and effective approaches include psychotherapy, medications or a combination of both.

Psychotherapy is often the first-line treatment and helps most people manage symptoms. Cognitive behavioral therapy is especially effective, whether done individually or in a group setting. In exposure-based CBT, you gradually face feared situations to build coping skills and confidence. Skills training and role-playing may be used to practice social interactions and challenge negative thoughts. Repeated exposure to social situations is particularly helpful in reducing worry over time.

Medications may also be used to manage symptoms. Selective serotonin reuptake inhibitors are often the first choice, such as paroxetine or sertraline. Another option is the serotonin and norepinephrine reuptake inhibitor venlafaxine. These medicines are typically started at low doses and gradually increased to reduce side effects. It may take weeks or months for improvement to become noticeable.

Other medications may be recommended when needed, including:

• Other antidepressants that may offer benefit if first-line options are not effective

• Anti-anxiety medications such as benzodiazepines, used short term because they can be sedating or habit-forming

• Beta blockers, which may be helpful in reducing physical symptoms like rapid heartbeat or shaking during specific anxiety-provoking situations

Staying committed to treatment is important. Progress in therapy can continue steadily, and medication adjustments may be needed to find the best fit. Some people may eventually stop medication if symptoms improve, while others may need long-term treatment to prevent relapse.

Alternative therapies such as herbal remedies have shown mixed results. It is important to discuss any supplements with your health care provider to ensure they are safe and do not interact with current medications.