SOCIAL ANXIETY DISORDERBYEMMANUEL,GODWIN5th Year Medical StudentCollege of MedicineUniversity of Nigeria , Enugu Campus

OUTLINE

•Introduction•Epidemiology•Clinical Features•Diagnostic Criteria•Treatment•Course and Prognosis

Introduction

Social anxiety disorder is also known as social phobia.

The term phobia refers to an excessive fear of a specific object, circumstance, or situation

A social phobia is a strong, persisting fear of situations in which embarrassment can occur.

Introduction cont’d

Marked and persistent fear of one or more social or performance situations in which the person is concerned about negative evaluation or scrutiny by others, for example:Public speaking, writing, eating, or drinking in public, initiating or maintaining conversations.  Fears humiliation or embarrassment, perhaps by manifesting anxiety symptoms (e.g., blushing or sweating)  Feared social or performance situations are avoided or endured with intense anxiety or distress

Introduction cont’d

•They may be particularly bordered and unable to urinate in public lavatory or have frequent urge to micturate, with fear of incontinence. Some may fear they may vomit in public places.

•Alcohol misuse and depression are common co morbidities.

Epidemiology

•Occurs more in late childhood and early adolescent and affects females more than males

•It can be generalized or specific.

Clinical features

Psychological arousal•Fearful anticipation•Irritability•Sensitivity to noise•Restlessness•Poor concentration•Worrying thought

Clinical features

Gastrointestinal•Dry mouth•Difficulty in swallowing•Epigastric discomfort•Excessive wind•Frequent or loose motionsRespiratory•Constriction in the chest•Difficulty inhaling

Clinical features

Cardiovascular•Palpitations •Discomfort in chest•Awareness of missed beatsGenitourinary•Frequent or urgent micturition•Failure of erection•Menstrual discomfort•Amenorrhoea

Clinical features

Muscle tension• Tremors• Head ache• Aching musclesHyperventilation• Dizziness• Tingling in the extremities• Feeling of breathlessnessSleep disturbance• Insomnia• Night terror

ICD-10 Diagnostic Criteria

• Either of the following must be present. ▫ marked fear of being the focus of attention, or fear of behaving in a way that will be

embarrassing or humiliating; ▫ marked avoidance of being the focus of attention, or of situations in which there is fear of

behaving in an embarrassing or humiliating way. • These fears are manifested in social situations, such as eating or speaking in public,

encountering known individuals in public or entering or enduring small group situations (e.g., parties, meetings, classrooms).

• At least two symptoms of anxiety in the feared situation as defined in agoraphobia, Criterion B, must have been manifest at some time since the onset of the disorder, together with at least one of the following symptoms: ▫ blushing or shaking; ▫ fear of vomiting; ▫ urgency or fear of micturition or defecation.

• Significant emotional distress is caused by the symptoms or by the avoidance, and the individual recognizes that these are excessive or unreasonable.

• Symptoms are restricted to, or predominate in, the feared situations or contemplation of the feared situations.

• Most commonly used exclusion clause. The symptoms listed in Criteria A and B are not the result of delusions, hallucinations, or other disorders such as organic mental disorders, schizophrenia and related disorders, mood [affective] disorders, or obsessive-compulsive disorder, and are not secondary to cultural beliefs.

Treatment

• Both psychotherapy and pharmacotherapy are useful in treating social phobias

• Effective drugs for the treatment of social phobia include (1) selective serotonin reuptake inhibitors (SSRIs), (2) the benzodiazepines, (3) venlafaxine and (4) buspirone

• The benzodiazepines alprazolam and clonazepam are also efficacious

• Cognitive, behavioral, and exposure techniques are also useful in performance situations.

• Psychotherapy for the generalized type of social phobia usually involves a combination of behavioral and cognitive methods

• Relaxation training

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Course and Prognosis

•Social phobia tends to have its onset in late childhood or early adolescence.

• Social phobia tends to be a chronic disorder.

• The disorder can profoundly disrupt the life of an individual over many years.

•This can include disruption in school or academic achievement and interference with job performance and social development.

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Thank You

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