Social Anxiety Disorder Definition Characterized by intense and disappropriate fear and/or anxiety of social situations in which they may be judged. Epidemiology • • • • One of most common psychiatric conditions 13% lifetime prevalence Peaks in adolescence and early adulthood More common in females Types • • Performance only Paruresis - Shy bladder syndrome - Inability to urinate in the presence of others Clinical features • • • • • Blushing, palpitations and sweating during social interactions Anticipatory anxiety Avoidance of fear and/or anxiety triggers Driven by a fear of embarrassment If in children: - Refuse to speak at social events, crying, clinging to caregiver etc. - Happen in both peer and adult setting. Diagnosis DSM-V • • • • • • • • Must meet all of the following criteria: ➔Significant fear or anxiety related to social situations in which judgment may be involved e.g. meeting new people, giving a speech. Fera of behaving in ways that lead to negative judgement Fear or anxiety that is almost always triggers by social situations. Avoidance or intense anxiety in social situations Fear or anxiety disproportionate to threat Symptoms persist or at least 6 months Symptoms cause significant distress or functional impairment Symptoms not attributed to a better explained substance use ot another psychiatric or medical condition. DDx • • • Other anxiety disorders Shyness as a personality trait Medical conditions that cause embarrassment features e.g. incontinence, tremors. Management • • • Psychotherapy and pharmacology therapy can be given in isolation or combined Psychotherapy: - CBT ➔Most effective type ➔When combined with pharmacotherapy results in a more rapid and long lasting improvement than CBT alone. Pharmacology: - Social anxiety disorder: ➔SSRIs e.g. paroxetine ➔SNRI e.g. venlafaxine ➔Alternatives: benzodiazepines, phenelzine - Performance only: ➔Beta blockers e.g. propranolol ➔Benzodiazepines e.g. clonazepam