Social Anxiety Disorder (SAD), sometimes known by the older name of social phobia, is a condition beyond normal shyness. This disorder is characterized by severe, persistent, and disproportionate fear or anxiety about one or more social situations; Situations where one feels may be scrutinized, scrutinized or negatively judged by others. The prevalence of this disorder is significant and can have profound negative effects on interpersonal relationships, academic performance, career advancement, and the overall quality of a person's life. Correctly understanding the nature of social phobia and distinguishing it from normal anxieties is the first step for effective diagnosis and intervention. Diagnostic criteria for social phobia based on DSM-5 Accurate diagnosis of social anxiety disorder is made by mental health professionals based on the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The person must experience phobias about social situations where there is a possibility of being scrutinized by others (such as talking, meeting strangers, being observed eating or drinking, or performing in front of others). The person is worried that doing something or that his anxiety symptoms (flushing, shaking, sweating) will be revealed and this will lead to humiliation or rejection. These situations almost always cause fear or anxiety, and the person either actively avoids them or tolerates them with great distress. In fact, the social phobia must be disproportionate to the actual threat of the situation, persist for at least six months, and cause significant distress or impairment in functioning. Other mental disorders, drug effects, or medical conditions should also be ruled out. DSM-5 also includes a Performance Only Specifier for cases where the fear is limited to performing or speaking in public. Distinguishing social anxiety from natural shyness and specific fears It is important not to confuse social anxiety disorder (SAD) with normal shyness. Shyness is a personality trait that may cause mild discomfort in social situations, but usually does not lead to severe dysfunction or widespread avoidance. In contrast, SAD is associated with much more intense, pervasive, and debilitating fear and anxiety. SAD should be distinguished from specific phobias. While the focus of fear in social phobia is the fear of negative evaluation by others in the context of social interactions or functions, in specific phobias the fear is highly focused on a very specific object or situation (such as fear of animals, heights, flying, or injections). Accurate differential diagnosis by a specialist is essential for treatment planning. Common panic situations and clinical manifestations People with social phobia may fear and avoid a wide range of situations. Situations that may seem ordinary in the eyes of many people. Knowing these situations helps to better understand this disorder: - Social interactions: such as starting or continuing conversations with others (especially strangers), participating in parties. - Being observed: such as eating, drinking or writing in the presence of others. - Performance in the presence of others: such as public speaking, conference presentations, sports or musical performances. The clinical manifestations of this disorder are multifaceted. Cognitively, the person is preoccupied with self-inflicted negative thoughts about themselves and the judgment of others (they must think I'm stupid, my voice shakes, and everyone knows). Behaviorally, avoiding fearful situations is the most common strategy, but using safety behaviors such as avoiding eye contact, practicing too much talking, or drinking alcohol before social situations is also seen. Physiological symptoms are also very annoying and include blushing, heavy sweating, trembling hands or voice, palpitations, digestive problems (such as heartburn) and shortness of breath. The range of these symptoms can indicate the severity of social phobia. Evidence-based treatment approaches for social phobia Fortunately, social anxiety disorder responds well to the treatment of social phobia. The main evidence-based treatments include psychotherapy and pharmacotherapy. Of course, each of these treatments has its own conditions, and therefore you should consult a specialist doctor to choose them. Some treatment methods for social phobia: - Psychotherapy: Cognitive Behavioral Therapy (CBT) is known as the most effective approach. - Psychological education about the nature of social anxiety. - Cognitive restructuring to identify and challenge spontaneous negative thoughts and dysfunctional beliefs. - Exposure therapy, which includes gradual and planned exposure to fearful social situations to reduce anxiety. - Sometimes social skills training (Social Skills Training) if needed. CBT can be done individually or in groups. - Drug therapy: antidepressants from the categories of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are usually considered as the first line of drug treatment for social phobia. On the other hand, other drugs such as benzodiazepines or beta-blockers may sometimes be prescribed to control situational anxiety (e.g. before a speech), but due to the risk of dependence or side effects, they are not considered the main treatment. Specialized management and treatment of social phobia at Noorali Specialized Center Social anxiety disorder or social phobia is a real challenge for many people that can prevent them from reaching their full potential in life. However, this disorder is not a dead end. With correct and timely diagnosis and using effective and evidence-based treatments such as cognitive-behavioral therapy and, if needed, drug therapy, people can learn how to manage their anxiety. Nurali Counseling and Psychological Services Center, with a team of experienced specialists in the field of diagnosis and treatment of anxiety disorders, is ready to provide services based on current knowledge to our dear clients. If you are struggling with symptoms of social anxiety, contact us for a thorough evaluation and to begin an effective treatment plan.