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Social Anxiety Disorder

FAQ

* Will social anxiety disorder damage my health?
* Is it good advice to avoid what bothers you?
* Which social anxiety disorder medication is best?
* Do social anxiety disorder medications help get a
person's life back in order?
* Must a person change their lifestyle while taking
social anxiety disorder medication?
* Will I ever outgrow social anxiety disorder?
* Are any of the social anxiety disorder medications
addictive?
* What if my social anxiety disorder occurs only on rare
occasions such as at a special event where I am
performing?
* Can traumatic events cause social anxiety disorder?
* How can I tell if I have depression?
* Should I use alcohol to control my anxiety when I go to
parties or other social situations?
* Can social anxiety medications affect an unborn or
breast-feeding child?
* Are families affected by an individual's social anxiety
disorder?
* How can families and friends help people with social
anxiety disorder


Will social anxiety disorder damage my health?

Many people with social anxiety disorder have suffered
anxiety in social situations for decades without
apparent injury to their health or development of the
high blood pressure, ulcers, asthma or other physical
disorders that are commonly (but erroneously) thought
to result from stress.

It is our strong impression that social anxiety disorder
alone does not cause physical illnesses and does not
shorten people's lives. It's not uncommon, however, for
individuals with social anxiety disorder to believe that
alcohol reduces their anxiety. Long-term overuse of
alcohol is a complication of social anxiety that can
damage your health.

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Is it good advice to avoid what bothers you?

No For social anxiety disorder, such antiexposure can
actually make a person's social anxiety, anticipatory
anxiety and avoidance behaviors worse. In addition, it
may interfere with otherwise effective treatments.

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Which social anxiety disorder medication is best?

There is no "best" medication; it varies from person to
person. Factors that influence the choice of a
medication include both the patient's and the clinician's
past experience with the medication, the side effects
profile and its compatibility with associated medical
problems or medications. At present, only paroxetine
(Paxil®) has received FDA approval for the treatment of
social anxiety disorder. However, there is sufficient
research evidence to support the value of other SSRIs
as well as MAOIs, benzodiazepines and gabapentin.
Beta-blockers are helpful for treating performance
anxiety but not for generalized social anxiety disorder.
(See How is it treated? for more information.)

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Do social anxiety disorder medications help get a
person's life back in order?

While medications can help reduce symptoms of social
anxiety, they are not "cure-alls." Personal problems
resulting from social anxiety symptoms may continue to
exist and unrelated life problems are unlikely to be
helped by these medications. Psychotherapy or other
forms of counseling may be helpful in dealing with
such difficulties, but it is important that such adjunctive
therapy be undertaken within the context of social
anxiety disorder so as not to conflict with the primary
treatment.

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Must a person change their lifestyle while taking social
anxiety disorder medication?

A healthy lifestyle, including proper diet and exercise,
can benefit any course of treatment. But, most social
anxiety medications require few special adjustments by
most people. In general, any diet is compatible with
these except for the MAOIs. Certain foods and
beverages must be avoided if you are taking an MAOI.
(Consult your doctor)

Social anxiety medications should not interfere with
exercise. Although fluid replacement is important
during and after exercise, extra salt is seldom needed.
Vitamin or mineral supplements neither help nor hinder
treatment with social anxiety medications and thus are
optional.

It is best to ask your doctor's advice about drinking
alcohol. Some people may consume alcoholic
beverages in small amounts if they wish. However,
ability to drive and to operate hazardous machinery may
be dangerously impaired by the combination of alcohol
and social anxiety medications. Remember that
overuse of alcohol can be a complication of social
anxiety.

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Will I ever outgrow social anxiety disorder?

Social anxiety disorder usually begins in adolescence
and is often most severe in the late teens and the 20s.
In 25% of individuals it begins in early childhood. Most
people learn early how to avoid stressful social
situations, thereby temporarily decreasing their anxiety.
Over time, though, this leads to relative social isolation.
Research indicates that social anxiety disorder, when
left untreated, tends to become chronic. For a few there
may be some improvement with age, but rarely does it
disappear completely. With treatment, however, social
anxiety symptoms can improve dramatically.

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Are any of the social anxiety disorder medications
addictive?

The only class of social anxiety medications that could
be of concern are the benzodiazepines, and this would
be a problem for only a very few people (those who
have a history of drug and/or alcohol abuse). Most
people who take benzodiazepines use them in the
prescribed amounts for an appropriate medical
indication. It is important to realize that physical
dependence (not addiction) is common with regular
use of benzodiazepines. If they are stopped too rapidly,
unpleasant physical withdrawal symptoms can occur.
Following a discontinuation program recommended by
your doctor can help you avoid these problems.

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What if my social anxiety disorder occurs only on rare
occasions such as at a special event where I am
performing?

This problem is relatively common, especially among
professional performers. The treatment for
performance-type social anxiety disorder differs from
generalized social anxiety disorder. The first line of
treatment is gradual exposure therapy. A good example
of a successful program that accomplishes this
exposure therapy is the Toastmasters International
program (www.toastmasters.org). Some people prefer
to treat their performance anxiety with medication.
Beta-blockers, such as propranolol, can be taken 1 to 2
hours before the special event. They slow down a rapid
heart rate and decrease both sweating and the butterfly
feeling in the stomach. Beta-blockers do not directly
decrease anxiety, but rather block the physical
symptoms. It is important to take a test dose of a
beta-blocker prior to the day of the performance to be
sure that no unexpected side effects occur.

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Can traumatic events cause social anxiety disorder?

Traumatic events seem to increase the risk of
developing social anxiety disorder. People with social
anxiety disorder are twice as likely to have experienced
trauma as a child. Many people who experience
traumatic events develop posttraumatic stress disorder
(PTSD) and they are much more likely to develop
depression or social anxiety. However, many people
with social anxiety disorder have never experienced a
traumatic event. Trauma may be a trigger in some
people who have a predisposition for social anxiety
disorder. To learn more about PTSD, visit the PTSD
site.

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How can I tell if I have depression?

Clinical depression is one of the most common
medical problems. Approximately 8% of men and 16%
of women will experience an episode of major
depression during their lifetime. At any point in time,
more than 30% of people with social anxiety disorder
suffer from depression, and more than 50% will have
depression at some point in their life. Depression is a
serious problem that can dramatically decrease quality
of life, functioning at work and home and when serious,
can increase risk of suicide.

Depression is not just a problem of low mood. Many
people who have depression find that loss of interest in
usually enjoyable activities is the prominent feature.
Other common problems are difficulty with sleep (too
little or too much), change in appetite, fatigue, difficulty
concentrating, anxiety, thoughts of death and low
self-esteem.

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Should I use alcohol to control my anxiety when I go to
parties or other social situations?

Using alcohol to decrease anxiety in social situations is
a common strategy for individuals with social anxiety
disorder. Unfortunately, alcohol creates a false sense
of relief from symptoms. In many situations, at work or
during a performance, for example, drinking alcohol is
inappropriate at best and may cause substantial
impairment in functioning and judgement. In addition,
people who have social anxiety disorder are at an
increased risk of developing alcohol abuse or
dependence, which is often worse than the social
anxiety disorder itself.

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Can social anxiety medications affect an unborn or
breast-feeding child?

The use of medications during pregnancy and
breast-feeding is a complicated issue. It is known that
these medicines cross from the mother's blood to the
fetus so it is important to discuss possible risks with
your doctor to determine whether the dosage of the
particular medication you are on should be lowered or
temporarily discontinued. In general, the most
commonly used medications for social anxiety
disorder, the SSRIs, have a good safety record when
taken during pregnancy.

Birth defects have occurred occasionally in babies
whose mothers have taken social anxiety medication
during pregnancy but whether the medication actually
caused the abnormalities is difficult to know (even
without any exposure to medicines, a small percentage
of babies will be born with malformations).

With regard to breast-feeding, all of the social anxiety
medications will pass into breast milk and, as a result,
small amounts will reach the infant. While unlikely, it is
possible that a breast-fed infant could experience mild
side effects from some of these medications.

In general, to be on the safe side, you should discuss
with your doctor the potential risks and benefits of any
medication you might be taking during pregnancy or
while breast-feeding. The most conservative approach
would be to avoid all medicines at these times unless
the severity of the social anxiety disorder made this
impossible. Remember that behavior therapy can be
an effective treatment for social anxiety disorder, and it
could be an attractive alternative to medication during
pregnancy and breast-feeding.

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Are families affected by an individual's social anxiety
disorder?

In addition to sharing the somewhat increased risk of
developing social anxiety disorder, family members
may be asked (or even coerced) to give up social
activities or to attend them alone, leaving the socially
anxious person at home. However, permitting the
affected family member to avoid appropriate family
functions and responsibilities may actually make the
problem worse. Those who give up social contacts are
missing the possible benefits of naturally occurring
behavior therapy. Once the process of leaving the
socially anxious family member out of social
interactions starts, however, it can become so habitual
that family members often view the arrangement as
"just the way we do things in our family."

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How can families and friends help people with social
anxiety disorder?

Some individuals with social anxiety seek reassurance
from family members about their condition. They may
ask for reassurance that the situation won't be
stressful. They may ask whether others can tell that
they are anxious or see them trembling, sweating,
blushing, etc.

Family members naturally want to reassure the affected
person, but unfortunately that can be counterproductive.
Because socially anxious individuals do experience
anxiety and physical symptoms, and truly may be more
noticeable because of it, such reassurance can seem
hollow. It may even undermine the effective
components of behavior therapy, which include
repeated exposure to the phobic situation and
remaining in it until the anxiety symptoms subside
(habituation).

However, family and friends can help correct overly
negative assessments of a performance and support
even the smallest positive steps. Encouragement to
confront social situations is supportive; the
counterproductive reassurance we've just covered is
not. All of us benefit from support and encouragement
as we struggle with troubles in life, and this is certainly
true for people with social anxiety disorder.

You should be aware that some people with social
anxiety disorder become reassurance
"junkies,"seeking their regular "fix" of reassurance. As
with other addictions, the fix doesn't last long and soon
they are back for another fix. Like other addictive
substances, reassurance eventually makes their
overall condition worse. It is important not to be harsh
or sarcastic in the process of withholding reassurance.
It may be helpful to have a neutral statement that can be
repeated in a monotone voice each time the situation
comes up. Statements such as, "The instructions are
that I'm not to reassure" are often beneficial. (Practicing
neutral statements aloud with others before using them
with the patient is often helpful.) While withholding
reassurance may sound uncaring, it's important to
remember that you're actually using a behavior therapy
approach that has been shown to be helpful.


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