Approach to treating social anxiety disorder in adults
- Murray B Stein, MD, MPH
Murray B Stein, MD, MPH
- Editor-in-Chief — Psychiatry
- Section Editor — Anxiety Disorders
- Professor of Psychiatry and Family Medicine & Public Health
- University of California San Diego
- Charles T Taylor, PhD
Charles T Taylor, PhD
- Assistant Professor of Psychiatry
- University of California San Diego
Social anxiety disorder (SAD), also known as social phobia, is a condition marked by extreme fear of situations that involve possible scrutiny by others. The individual is concerned that embarrassment or humiliation will result, and so he or she avoids such situations, or endures them with intense anxiety.
SAD is a prevalent condition, estimated to affect between 4 and 10 percent of the adult United States population over a 12-month period. SAD typically begins in childhood or adolescence and, untreated, can be associated with the subsequent development of major depression, substance abuse, and other mental health problems. The disorder can be associated with extensive functional impairment and reduced quality of life .
This topic describes our approach to selecting treatments for SAD (algorithm 1) and performance-only SAD (algorithm 2). The epidemiology, pathogenesis, clinical manifestations, assessment, and diagnosis of SAD are discussed separately, as are the efficacy, side effects, and administration of individual psychotherapies and medications for SAD. (See "Social anxiety disorder in adults: Epidemiology, clinical manifestations, and diagnosis" and "Psychotherapy for social anxiety disorder in adults" and "Pharmacotherapy for social anxiety disorder in adults".)
NEWLY DIAGNOSED PATIENTS
Decision to treat — Not all patients with social anxiety disorder (SAD) require immediate treatment. Young adults, in particular, may benefit from education about their disorder and may need time to reflect on the extent to which social anxiety and avoidance have negatively impacted their lives. It is not unusual for a newly diagnosed patient with SAD to be surprised that these symptoms can diminish or resolve with treatment as opposed to being an inalterable aspect of their self. The need for treatment of SAD is rarely an emergency. Most patients have had SAD for many years, and the decision to seek a diagnosis may have taken a long time.
After the diagnosis of SAD is established, if the patient prefers to meet further before deciding about treatment, the clinician and patient can further discuss the need for treatment in the context of a longitudinal evaluation of the extent to which social anxiety has impacted the individual’s quality of life, as well as consideration of future life goals and how those may be affected by social anxiety and avoidance. Once a mutual decision is reached that treatment is indicated, the next step involves discussion of treatment options.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- NEWLY DIAGNOSED PATIENTS
- Decision to treat
- SAD versus SAD, performance only
- Choosing between psychotherapy and medication
- - Patient preference for psychotherapy
- Comparative efficacy
- - Patient preference for medication
- TREATMENT RESPONSE
- Response to CBT
- - Robust response
- - Poor or partial response
- Response to SSRI/SNRI
- - No SUD history
- - SUD history
- MEDICATION RESISTANT
- SAD, PERFORMANCE ONLY
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS