Harvard Mental Health Letter

Treating social anxiety disorder

Social anxiety disorder (also known as social phobia) is one of the most common psychiatric disorders. Although sometimes dismissed as shyness, social anxiety disorder can cause crippling fear that interferes with school attendance, work performance, and relationships. It affects about 7% of Americans in any given year, and about 12% at some point in their lives. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) lists criteria for diagnosing social anxiety disorder and describes how the disorder may manifest differently in children and adults. About half of the people with this disorder experience anxiety only in specific situations, particularly those involving some type of public performance such as speaking in front of people. Others have the generalized form, experiencing fear in almost any social situation. Although many people occasionally get nervous at parties or at other public events, what distinguishes social anxiety disorder is the severity of distress and impairment that result. For example, research suggests that youths with this disorder are more likely than peers to drop out of high school. Adults with social anxiety disorder are more likely than others to miss work. Even intimate relationships are affected — one reason that people with social anxiety disorder are less likely than others to marry. Yet because the symptoms are often dismissed as trivial, only about half of people with social anxiety disorder ever receive treatment — typically after experiencing symptoms for at least 10 years before seeking help. That's unfortunate, because both psychotherapy and medication can help reduce symptoms for most people.
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