Social Anxiety Disorder: Associated Conditions and Therapeutic Approaches

Nasser A Alomari 1, Sohaila K Bedaiwi 2, Abdulrahman M Ghasib 3, Ammar J Kabbarah 4, Saad A Alnefaie 5, Nada Hariri 4, Munirah A Altammar 6, Abdulaziz M Fadhel 7, Fai M Altowairqi 4


 

Affiliations

19 December 2022

-

doi: 10.7759/cureus.32687

Abstract

Social anxiety disorder (SAD) is a highly distressing chronic psychiatric disorder characterized by persistent fear of social situations in anticipation of being judged negatively by others. As shyness mimics some of the symptoms of SAD, people suffering from this debilitating disease are often underdiagnosed. It can have a devastating impact on all areas of life including academic performance, social growth, relationship status, and work performance. In recent years, research on anxiety and related disorders has proliferated due to the increased use of cognitive-behavioral models. The understanding of SAD has evolved greatly from distinguishing it from shyness to implementing modalities to comprehend the sophisticated underlying mechanism of disease prevalence and progression as well as methods to treat it. This review summarizes the concept of SAD, its epidemiology, symptoms, and diagnostic tools. Frequent comorbidities including other psychiatric disorders are also discussed. Additionally, we examine the latest evidence related to treatment options including psychotherapy and pharmacotherapy as well as recommendations for managing SAD.

Keywords: behavioral therapy; mental health; obsessive compulsive disorder; panic disorder; social phobia.

Conflict of interest statement

The authors have declared that no competing interests exist.
 

Similar articles

Suicidal Ideation.

Harmer B, Lee S, Duong TVH, Saadabadi A.2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.PMID: 33351435 Free Books & Documents.

Social Anxiety and Fear of Causing Discomfort to Others: Diagnostic Specificity, Symptom Correlates and CBT Treatment Outcome.

Nishikawa Y, Laposa JM, Regev R, Rector NA.Behav Cogn Psychother. 2017 Jul;45(4):382-400. doi: 10.1017/S135246581700008X. Epub 2017 Mar 6.PMID: 28260554

Cognitive therapy compared with CBT for social anxiety disorder in adolescents: a feasibility study.

Creswell C, Leigh E, Larkin M, Stephens G, Violato M, Brooks E, Pearcey S, Taylor L, Stallard P, Waite P, Reynolds S, Taylor G, Warnock-Parkes E, Clark DM.Health Technol Assess. 2021 Mar;25(20):1-94. doi: 10.3310/hta25200.PMID: 33759742 Free PMC article. Clinical Trial.

Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder: Pilot Single-Arm Trial.

Matsumoto K, Sutoh C, Asano K, Seki Y, Urao Y, Yokoo M, Takanashi R, Yoshida T, Tanaka M, Noguchi R, Nagata S, Oshiro K, Numata N, Hirose M, Yoshimura K, Nagai K, Sato Y, Kishimoto T, Nakagawa A, Shimizu E.J Med Internet Res. 2018 Dec 17;20(12):e12091. doi: 10.2196/12091.PMID: 30559094 Free PMC article.

Treatment of Anxiety Disorders: A Systematic Review [Internet].

Swedish Council on Health Technology Assessment.Stockholm: Swedish Council on Health Technology Assessment (SBU); 2005 Nov. SBU Yellow Report No. 171/1+2.PMID: 28876726 Free Books & Documents. Review.

References

  1.  
    1. Schneier F, Goldmark J. Schneier F, Goldmark J: social anxiety disorder. Anxiety disorders and gender. Project: Investigation of the underlying brain circuits in social anxiety disorder, OCD, and anorexia nervosa. [ Dec; 2022 ]. 2015. https://www.researchgate.net/publication/283836688_Social_Anxiety_Disorder pp. 49–67.https://www.researchgate.net/publication/283836688_Social_Anxiety_Disorder
  2.  
    1. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Arch Gen Psychiatry. 2005;62:593–602. - PubMed
  3.  
    1. The impact of anxiety disorders on educational achievement. Van Ameringen M, Mancini C, Farvolden P. J Anxiety Disord. 2003;17:561–571. - PubMed
  4.  
    1. Impact of generalized social anxiety disorder in managed care. Katzelnick DJ, Kobak KA, DeLeire T, et al. Am J Psychiatry. 2001;158:1999–2007. - PubMed
  5.  
    1. Psychiatric disorders and dissatisfaction with social relationships: does type of relationship matter? Whisman MA, Sheldon CT, Goering P. J Abnorm Psychol. 2000;109:803–808. - PubMed
  6.  
    1. Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study. Wittchen HU, Fuetsch M, Sonntag H, Müller N, Liebowitz M. Eur Psychiatry. 2000;15:46–58. - PubMed
  7.  
    1. American Psychiatric Association. Journal of Family Practice. Vol. 48. Washington, D.C.: American Psychiatric Publishing; 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th ed; pp. 514–519.
  8.  
    1. The impact of social skills training for social anxiety disorder: a randomized controlled trial. Beidel DC, Alfano CA, Kofler MJ, Rao PA, Scharfstein L, Wong Sarver N. J Anxiety Disord. 2014;28:908–918. - PMC - PubMed
  9.  
    1. Gender differences in social anxiety disorder: a review. Asher M, Asnaani A, Aderka IM. Clin Psychol Rev. 2017;56:1–12. - PubMed
  10.  
    1. Social anxiety disorder. Leichsenring F, Leweke F. N Engl J Med. 2017;376:2255–2264. - PubMed
  11.  
    1. Social anxiety disorder--beyond shyness. Shields M. https://www.proquest.com/openview/d7cd33d95fdd12c572328b9a692ec5f6/1?pq-.... Health Rep. 2004;15:45–61. - PubMed
  12.  
    1. Henderson L, Zimbardo P. Social Anxiety. Vol. 1. Amsterdam, Netherlands: Elsevier; 2010. Shyness, social anxiety, and social anxiety disorder; pp. 65–92.
  13.  
    1. The history, epidemiology, and differential diagnosis of social anxiety disorder. Moutier CY, Stein MB. https://www.psychiatrist.com/wp-content/uploads/2021/02/13892_history-ep... J Clin Psychiatry. 1999;60 Suppl 9:4–8. - PubMed
  14.  
    1. Dimensional assessment of DSM-5 social anxiety symptoms among university students and its relationship with functional impairment. Dell'Osso L, Abelli M, Pini S, et al. Neuropsychiatr Dis Treat. 2014;10:1325–1332. - PMC - PubMed
  15.  
    1. Brief form of the Social Phobia and Anxiety Inventory (SPAI-B) for adolescents. Garcia-Lopez L, Hidalgo MD, Beidel DC, Rodriguez JO. Eur J Psychol Assess. 2008;24:150–156.
  16.  
    1. Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. Connor KM, Davidson JR, Churchill LE, Sherwood A, Foa E, Weisler RH. Br J Psychiatry. 2000;176:379–386. - PubMed
  17.  
    1. Anxiety disorders: a review of current literature. Thibaut F. Dialogues Clin Neurosci. 2017;19:87–88. - PMC - PubMed
  18.  
    1. Biological markers for anxiety disorders, OCD and PTSD: a consensus statement. Part II: neurochemistry, neurophysiology and neurocognition. Bandelow B, Baldwin D, Abelli M, et al. World J Biol Psychiatry. 2017;18:162–214. - PMC - PubMed
  19.  
    1. Social anxiety disorder: more than just a little shyness. Jefferson JW. Prim Care Companion J Clin Psychiatry. 2001;3:4–9. - PMC - PubMed
  20.  
    1. Aging and panic disorder: phenomenology, comorbidity, and risk factors. Sheikh JI, Swales PJ, Carlson EB, Lindley SE. https://pubmed.ncbi.nlm.nih.gov/14729565/ Am J Geriatr Psychiatry. 2004;12:102–109. - PubMed
  21.  
    1. Risk factors for the onset of panic disorder and other panic attacks in a prospective, population-based study. Keyl PM, Eaton WW. Am J Epidemiol. 1990;131:301–311. - PubMed
  22.  
    1. Late onset panic disorder: evidence from a study of patients with chest pain and normal cardiac evaluations. Beitman BD, Kushner M, Grossberg GT. Int J Psychiatry Med. 1991;21:29–35. - PubMed
  23.  
    1. Panic disorder. Roy-Byrne PP, Craske MG, Stein MB. Lancet. 2006;368:1023–1032. - PubMed
  24.  
    1. Cackovic C, Nazir S, Marwaha R. StatPearls. Vol. 430973. Treasure Island, FL: StatPearls Publishing; 2022. Panic Disorder. - PubMed
  25.  
    1. Panic disorder: current research and management approaches. Kim YK. Psychiatry Investig. 2019;16:1–3. - PMC - PubMed
  26.  
    1. Panic attack as a risk factor for severe psychopathology. Goodwin RD, Lieb R, Hoefler M, Pfister H, Bittner A, Beesdo K, Wittchen HU. Am J Psychiatry. 2004;161:2207–2214. - PubMed
  27.  
    1. Panic disorder: a review of treatment options. Ziffra M. Ann Clin Psychiatry. 2021;33:124–133. - PubMed
  28.  
    1. Clinical practice. Generalized anxiety disorder. Stein MB, Sareen J. N Engl J Med. 2015;373:2059–2068. - PubMed
  29.  
    1. Generalized anxiety disorder: prevalence, burden, and cost to society. Wittchen HU. Depress Anxiety. 2002;16:162–171. - PubMed
  30.  
    1. Worry content reported by older adults with and without generalized anxiety disorder. Diefenbach GJ, Stanley MA, Beck JG. Aging Ment Health. 2001;5:269–274. - PubMed
  31.  
    1. Generalized anxiety disorder: nature and course. Wittchen HU, Hoyer J. https://www.psychiatrist.com/jcp/anxiety/generalized-anxiety-disorder-na... J Clin Psychiatry. 2001;62:15–19. - PubMed
  32.  
    1. Obsessive-compulsive disorder. Stein DJ, Costa DL, Lochner C, et al. Nat Rev Dis Primers. 2019;5:52. - PMC - PubMed
  33.  
    1. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016. Mental Illness. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health . - PubMed
  34.  
    1. Emotion dysregulation in generalized anxiety disorder: a comparison with social anxiety disorder. Turk CL, Heimberg RG, Luterek JA, Mennin DS, Fresco DM. Cogn Ther Res. 2005;29:89–106. - PubMed
  35.  
    1. Brock H, Hany M. StatPearls. Treasure Island, FL: StatPearls Publishing; 2020. Obsessive-Compulsive Disorder. - PubMed
  36.  
    1. Obsessive-compulsive disorder in children and adolescents. Krebs G, Heyman I. Arch Dis Child. 2015;100:495–499. - PMC - PubMed
  37.  
    1. The relationship between obsessive-compulsive disorder and anxiety disorders: a question of diagnostic boundaries or simply severity of symptoms? Vigne P, Simões BF, de Menezes GB, et al. Compr Psychiatry. 2019;94:152116. - PubMed
  38.  
    1. Recognition and treatment of obsessive-compulsive disorder. Eddy MF, Walbroehl GS. https://www.aafp.org/pubs/afp/issues/1998/0401/p1623.html. Am Fam Physician. 1998;57:1623–1628. - PubMed
  39.  
    1. Obsessive-compulsive disorder. Veale D, Roberts A. BMJ. 2014;348:0. - PubMed
  40.  
    1. A review of acute stress disorder in DSM-5. Bryant RA, Friedman MJ, Spiegel D, Ursano R, Strain J. Depress Anxiety. 2011;28:802–817. - PubMed
  41.  
    1. Posttraumatic stress disorder: current insights in diagnostics, treatment and prevention (Article in Dutch) Lok A, Frijling JL, van Zuiden M. https://pubmed.ncbi.nlm.nih.gov/29328008/ Ned Tijdschr Geneeskd. 2018;161:0. - PubMed
  42.  
    1. Post-traumatic stress disorder: differential diagnosis and management. Hamner MB, Robert S. Curr Psychosis Ther Rep. 2004;2:109–115.
  43.  
    1. Post-traumatic stress disorder. Bisson JI. BMJ. 2007;334:789–793. - PMC - PubMed
  44.  
    1. Hazlett-Stevens H, Craske MG. Handbook of Brief Cognitive Behaviour Therapy. Vol. 1. New York, NY: John Wiley & Sons Ltd; 2002. Brief cognitive-behavioral therapy: definition and scientific foundations; pp. 3–7.
  45.  
    1. First-line treatment: a critical appraisal of cognitive behavioral therapy developments and alternatives. Arch JJ, Craske MG. Psychiatr Clin North Am. 2009;32:525–547. - PubMed
  46.  
    1. Long-term outcomes of cognitive behavioural therapy for social anxiety disorder: a meta-analysis of randomised controlled trials. Kindred R, Bates GW, McBride NL. J Anxiety Disord. 2022;92:102640. - PubMed
  47.  
    1. Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Otte C. Dialogues Clin Neurosci. 2011;13:413–421. - PMC - PubMed
  48.  
    1. Child/Adolescent Anxiety Multimodal Study (CAMS): rationale, design, and methods. Compton SN, Walkup JT, Albano AM, et al. Child Adolesc Psychiatry Ment Health. 2010;4:1. - PMC - PubMed
  49.  
    1. Treating social anxiety disorder with CBT: impact on emotion regulation and satisfaction with life. Jazaieri H, Goldin PR, Gross JJ. Cogn Ther Res. 2017;41:406–416.
  50.  
    1. Cognitive behavioral therapy for social anxiety disorder: predictors of treatment outcome in a quasi-naturalistic setting. Butler RM, O'Day EB, Swee MB, Horenstein A, Heimberg RG. Behav Ther. 2021;52:465–477. - PubMed
  51.  
    1. Cognitive therapy for social anxiety disorder in adolescents: a development case series. Leigh E, Clark DM. Behav Cogn Psychother. 2016;44:1–17. - PMC - PubMed
  52.  
    1. Impact of cognitive behavioral therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs: randomized clinical trial. Goldin PR, Ziv M, Jazaieri H, Hahn K, Heimberg R, Gross JJ. JAMA Psychiatry. 2013;70:1048–1056. - PMC - PubMed
  53.  
    1. Brief cognitive behavior therapy in patients with social anxiety disorder: a preliminary investigation. Pinjarkar RG, Sudhir PM, Math SB. Indian J Psychol Med. 2015;37:20–25. - PMC - PubMed
  54.  
    1. Effectiveness of cognitive behavioral therapy on social anxiety disorder: a comparative study. Behera N, Samantaray NN, Kar N, Nayak MR, Chaudhury S. Ind Psychiatry J. 2020;29:76–81. - PMC - PubMed
  55.  
    1. The treatment of social anxiety disorder. Rodebaugh TL, Holaway RM, Heimberg RG. Clin Psychol Rev. 2004;24:883–908. - PubMed
  56.  
    1. Treatment of anxiety disorders. Bandelow B, Michaelis S, Wedekind D. Dialogues Clin Neurosci. 2017;19:93–107. - PMC - PubMed
  57.  
    1. Pharmacotherapy of anxiety disorders: current and emerging treatment options. Garakani A, Murrough JW, Freire RC, Thom RP, Larkin K, Buono FD, Iosifescu DV. Front Psychiatry. 2020;11:595584. - PMC - PubMed
  58.  
    1. The efficacy of selective serotonin reuptake inhibitors in adult social anxiety disorder: a meta-analysis of double-blind, placebo-controlled trials. Hedges DW, Brown BL, Shwalb DA, Godfrey K, Larcher AM. J Psychopharmacol. 2007;21:102–111. - PubMed
  59.  
    1. Propranolol for the treatment of anxiety disorders: systematic review and meta-analysis. Steenen SA, van Wijk AJ, van der Heijden GJ, van Westrhenen R, de Lange J, de Jongh A. J Psychopharmacol. 2016;30:128–139. - PMC - PubMed
  60.  
    1. The selective serotonin reuptake inhibitor paroxetine is effective in more generalized and in less generalized social anxiety disorder. Stein DJ, Stein MB, Goodwin W, Kumar R, Hunter B. Psychopharmacology (Berl) 2001;158:267–272. - PubMed
  61.  
    1. Selective serotonin reuptake inhibitors in the treatment of social phobia. Van Ameringen M, Mancini C, Oakman JM, Farvolden P. CNS Drugs. 1999;11:307–315.
  62.  
    1. Qualitative review of SNRIs in anxiety. Silverstone PH. https://pubmed.ncbi.nlm.nih.gov/15600378/ J Clin Psychiatry. 2004;65:19–28. - PubMed
  63.  
    1. Use of benzodiazepines in social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder. Davidson JR. https://pubmed.ncbi.nlm.nih.gov/15078116/ J Clin Psychiatry. 2004;65:29–33. - PubMed
  64.  
    1. Schneier FR, Bragdon LB, Blanco C, Liebowitz MR. The Wiley Blackwell Handbook of Social Anxiety Disorder. Vol. 1. New York, NY: John Wiley & Sons; 2014. Pharmacological treatment for social anxiety disorder; pp. 521–546.

Page Navigation