Social anxiety disorder: causes, symptoms, diagnosis, and treatment

SAD, also known as social phobia, is characterised by excessive fear of embarrassment or humiliation in social situations, which in turn leads to marked distress or avoidance of these situations and functional impairment as described in DSM-IV-TR.

It is a common disorder with early onset, significant comorbidity and functional impairment (Meron Ruscia et al., 2008).

SAD has been ranked as one of the top ten chronic disorders - mental or physical - in terms of its effects on objective outcomes, such as days of work lost and reduced health-related quality of life (Alonso, 2004). According to the National Comorbidity Survey, SAD is the most reported anxiety disorder and has a lifetime prevalence of 12% (Kessler et al., 2005), with considerable coexisting psychiatric disorders, such as depression, anxiety, and substance-related disorders.Lifetime prevalence of social anxiety disorder among Turkish university students was 23% (Dilbaz 2006). Co-occurring SAD and depression carry a substantial risk of suicide, which further complicates treatment (Beesdo et al., 2007; Thase, 2007). SAD symptoms normally emerge during early adolescence and continue throughout adulthood; they affect women more often than men (Fehm et al., 2005).In clinical samples the ratio of male and female changes in the favour of males. (Dilbaz and G 2002). Trials suggest that social anxiety even below the diagnostic threshold is clearly associated with adverse outcomes like elevated risk for comorbid disorders and associated with impairment in diverse areas of life.

The condition involves an excessive fear of social or performance situations. The individual will often fear being embarrassed, or worry about being negatively evaluated by others. Anticipatory anxiety and situational avoidance are common, and the individual may endure social situations with a high level of discomfort. The scope of the anxiety may be focused on specific types of social situations or generalized to almost any social encounter.