Social Anxiety Disorder: More Than Just a Little Shyness

James W. Jefferson, M.D.

Social anxiety is defined as a "marked and persistent fear of social or performance situations" and includes such symptoms as sweating, palpitations, shaking, and respiratory distress. Social anxiety is fairly common, occurring in as much as 13% of the population, and can be extremely disabling. It can be either specific (confined to 1 or 2 performance situations) or generalized, and can be diagnosed with a scale-based questionnaire. Social anxiety may coexist with other disorders, such as depression and dysthymia. The differential diagnosis for social anxiety includes panic disorder, agoraphobia, atypical depression, and body dysmorphic disorder. Treatment for social anxiety can be quite effective and consists of psychotherapy, pharmacotherapy (including such medications as beta-blockers, anxiolytics, antidepressants, and anticonvulsants), or a combination. This article details the prevalence, onset, disease impact, and etiology of social anxiety. Specific treatments, including both psychotherapy and pharmacotherapy, are presented in detail, along with other treatment considerations, such as comorbidity.

(Primary Care Companion J Clin Psychiatry 2001;3:4-9)

Received Jan. 12, 2001; accepted Feb. 5, 2001. From the Madison Institute of Medicine and the University of Wisconsin Medical School, Madison, Wisc.

Financial disclosure: Dr. Jefferson has received grant/research support from Abbott, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Lilly, Novartis, Organon, Janssen, Pfizer, Solvay, and Wyeth-Ayerst; has served as a consultant for GlaxoSmithKline, Novartis, Scios, and TAP; has received lecture honoraria from Bristol-Myers Squibb, Forest, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Pharmacia & Upjohn, Solvay, and Wyeth-Ayerst; is a minor stock shareholder in GlaxoSmithKline and Scios and principal in Healthcare Technology Systems, Inc.; and has received various other financial or material support from time to time from the pharmaceutical companies listed above.

Reprint requests to: James W. Jefferson, M.D., 7617 Mineral Point Rd., Suite 300, Madison, WI 53717 (e-mail: JeffJ@healthtechsys.com).