Social Anxiety Disorder
Social anxiety disorder is a persistent, intense fear of social or performance situations, defined per DSM-5-TR.
Symptoms
Marked fear or anxiety in social situations where one might be scrutinized -- meeting new people, public speaking, eating in front of others -- lasting 6 months or longer and causing avoidance or significant distress.
Causes and risk
Genetics, temperament (behavioral inhibition in childhood), and negative or traumatic social experiences all contribute; 20-70% of people with social anxiety disorder also experience depression at some point.
How it is evaluated
Diagnosis follows DSM-5-TR criteria, focused on the fear being out of proportion to actual threat and persisting for 6 months or more.
Treatment
CBT and SSRIs/SNRIs are first-line, per a JAMA review and Canadian clinical practice guidelines; benzodiazepines are generally discouraged.
When to seek care
Given the high rate of comorbid depression, any thoughts of self-harm should prompt immediate crisis support -- call 911 or the 988 Suicide and Crisis Lifeline.