Socially Anxious
A Publication of the Continued Research of Social Anxiety Disorder
Updated: July 15, 2007

What is Social Anxiety?
Social anxiety ranges from the serious fear (metus gravis) to the negligible fear (metus levis) of social situations.

How Many People Suffer from Social Anxiety Disorder?
Social anxiety affects an unknown amount of the population, however many doctors and scientific organizations have made estimates based on their research. Three common are “number of individuals suffering from social anxiety disorder at any given moment,” “number of individuals suffering from social anxiety disorder in the span of 1 year,” and “number of individuals suffering from social anxiety disorder in the span of their lives.” By analyzing all of the available estimates, I have determined the most accurate figures, shown below.

Suffering from SAD at Any Given Moment (United States, based on 2007 population)
Over 21 million (SP/SAA)

Suffering from SAD in a given year (United States, based on 2007 population)
At least 11.1 million (NMHA)

Suffering from SAD in Their Lifetime (United States, based on 2007 population)
About 39 million (Gillian Friedman, M.D.)
More than 39 million (SP/SAA)
Between 39 and 42 million (The Social Anxiety Institute)

Dr. Mark Barad, an assistant professor of psychiatry and biobehavioral sciences at UCLA, said in 2004 that only 19,000,000 Americans were affected by a variety of anxiety disorders each year, including social anxiety.[1]

Dr. Barad’s figure appears to be substantiated by NMHA’s statement that more than 19,000,000 Americans are affected by anxiety disorders each year.[2] However, it’s unclear in which year the NMHA made that estimate and without a percentage the statement is misleading, since the population grows each year.

On 21 May 2007 Eli Lilly and Company cited a National Mental Health Association (NMHA) Web page statement from on or before 17 January 2007 that stated “approximately 6.5 million Americans are diagnosed with generalized anxiety disorder each year,”[3] however, when I accessed the same cited NMHA Web page on 12 June 2007, it only stated “about 2.8% of the U.S. population (4 million Americans) has GAD during a year's time.”[4] I’m curious as to when 2.8% of the U.S. population equaled only 4 million, because the US population surpassed 300 million in 2007. So NMHA’s figure of 2.8% adjusted for today’s population means that 8.4 million Americans suffer from GAD as of 2007.

Another statement by NMHA reads: “At least 3.7% of the U.S. population (approximately 5.3 million Americans) has social phobia in a given year.”[5] NHMA’s figure of 3.7% adjusted for today’s population means that 11.1 million Americans suffer from social anxiety disorder in a given year.

In Gillian Friedman, M.D.’s article about social anxiety disorder, she states that social phobia affects “about 13% of the population at some time during their lives,”[6] but does not specify a particular population.

The Social Phobia/Social Anxiety Association does not specify which government or which year, but cites that the “latest government epidemiological data show social phobia affects over 7% of the population at any given time.”[7] In the same paragraph, a second statistic offered by the SP/SAA is that more than 13% of people suffer from a social anxiety disorder in the span of their lives.

The Social Anxiety Institute cites “epidemiological studies” in the United States when it says that 7-8% of people suffer from social anxiety at a given time. It does not say which epidemiological studies and it does not specify social anxiety disorder. In the same paragraph, the Institute goes on to give 13-14% as the percentage of people who suffer from social anxiety disorder at some time during their lives.[8]

Social Anxiety Symptoms
Some of these symptoms I experience myself, some my friends say they experienced and some I learned through research.

Autonomic Symptoms
Autonomic symptoms are those symptoms controlled by the autonomic nervous system.

• blushing or red face
• dry mouth and throat
• irregular heartbeat (palpitations)
• rapid heartbeat (tachycardia)
• rise in body temperature
• sweating (diaphoresis)
• twitching

Behavioral Symptoms
• avoiding social situations
• awkwardness in social situations
• difficulty making eye contact
• stuttering or stammering

Cognitive Symptoms
• anticipating negative outcomes from social situations
• inferiority complex
• mind going blank
• wanting to avoid social situations

Emotional Symptoms
• becoming angry or irritable
• disappointment in oneself

Psychosomatic Symptoms

Somatic Symptoms
Somatic symptoms are those physical symptoms that mimic medical problems.

• chest pain
• choking sensation
• diarrhea
• dizziness (vertigo)
• fainting
• fatigue
• headache
• hyperventilation
• nausea/queasiness
• numbness or tingling (paresthesia)
• shortness of breath (dyspnea)
• stomach ache
• tense muscles
• vomiting

Social Anxiety Causes
Juster & Heimberg note the existence of “social phobics who often harbor vague, unrealistic, and sometimes perfectionistic goals for themselves in social situations.”

During stressful social situations where social anxiety is felt, the lower area of the brain that connects with the spinal cord becomes activated and helps to release norepinephrine into the blood. When the norepinephrine binds to the adrenergic receptors, this results in a rise in body temperature, sweating, and a rapid heartbeat.

Social Anxiety Disorder Treatments

Psychotherapy for Social Anxiety Disorder

Cognitive-Behavioral Group Therapy (CBGT)
Cognitive-behavioral therapy for social anxiety attempts to re-structure an individual’s behaviors through the use of group therapy.

Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy for social anxiety attempts to re-structure an individual’s behaviors through therapy.

Computerized Cognitive-Behavioral Therapy (CCBT)
Also known as computerised cognitive behavioural therapy in the UK.

Eye Movement Desensitization and Reprocessing Therapy (EMDR Therapy)

Hypnotherapy

Neuro-Linguistic Programming (NLP)

Pharmacotherapy for Social Anxiety Disorder (Anxiolytics)

Antidepressants
Antidepressants have been shown to help patients suffering from all types of anxiety, including social anxiety and social phobia (social anxiety disorder). Types of antidepressants include monoamine oxidase inhibitors (also known as MAO inhibitors or MAOIs), norepinephrine dopamine reuptake inhibitors (NDRIs), selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

Monoamine Oxidase Inhibitors (MAOIs)
Also known as MAO inhibitors, MAOIs attach themselves to enzymes called monoamine oxidases.

Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)

Wellbutrin XL® (bupropion hydrochloride) [United States]
Wellbutrin XL® is an extended-release bupropion hydrochloride.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Also known as MAO inhibitors, MAOIs attach themselves to enzymes called monoamine oxidases.

Effexor® (venlafaxine hydrochloride) [United States]
Effexor® is a serotonin-norepinephrine reuptake inhibitor (SNRI) for adults. Wyeth® states on their Effexor XR® Web site that Effexor XR® “is not approved for use in children and teenagers.” I would conclude this is almost certainly because “antidepressants increased the risk of suicidal thinking and behavior in children and teenagers,” as Wyeth® states.

Effexor XR® (venlafaxine hydrochloride) [United States]
Effexor XR® is the extended release version of Effexor® that results in a more consistent concentration of the drug in the blood plasma. A study by DeVane determined that this lower concentration might have made venlafaxine hydrochloride more tolerable, since there were fewer incidences of nausea.

Tricyclic Antidepressants (TCAs)

Anafranil® (clomipramine hydrochloride) [United States]
Anafranil® is a tricyclic antidepressant (TCA) that also functions as a serotonin-norepinephrine reuptake inhibitor (SNRI).

Benzodiazepines

Klonopin® (clonazepam) [United States]
Klonopin® is an anxiolytic benzodiazepine derivative.

Organizations Dealing with Social Anxiety Disorder
This section serves not only as a listing of non-commercial organizations, but also as my assessment of these organizations. I have not provided hyperlinks to these organizations’ Web sites unless one of their executives has specifically asked me to do so.

Anxiety Disorders Association of America
www.adaa.org

Anxiety Disorders Association of Manitoba
www.adam.mb.ca

Anxiety Network International
www.anxietynetwork.com

Social Anxiety Institute
www.socialanxietyinstitute.org

Association for the Advancement of Behavior Therapy
800-685-AABT
www.aabt.org

Bibliography

[1] University of California. “Biology Of Fear: UCLA Study Finds Properties Of Yohimbe Tree Bark Hold Promise For Revolutionizing Treatment Of Anxiety Disorders,” updated 5 April 2004, <http://www.biopsychiatry.com/yohimbine/research.html> (cited 11 June 2007), para 6.

[2] National Mental Health Association. “Anxiety Disorders,” <http://www1.nmha.org/camh/anxiety/> (cited 12 June 2007), para 1.

[3] Eli Lilly and Company. “Data Suggest Cymbalta® Improved Functioning in Patients With Generalized Anxiety Disorder,” <http://newsroom.lilly.com/ReleaseDetail.cfm?ReleaseID=244673> (cited 12 June 2007), para 14.

[4] National Mental Health Association. “Generalized Anxiety Disorder,” <http://www1.nmha.org/camh/anxiety/gad.cfm> (cited 12 June 2007), para 3.

[5] National Mental Health Association. “Social Phobia,” <http://www1.nmha.org/camh/anxiety/social.cfm> (cited 12 June 2007), para 5.

[6] Gillian Friedman, M.D. “Social Anxiety Disorder,” <http://www.abilitymagazine.com/anxiety_disorder.html> (cited 15 July 2007), para 1.

[7] Social Phobia/Social Anxiety Association. “Social Phobia/Social Anxiety Fact Sheet,” <http://www.socialphobia.org/fact.html> (cited 15 July 2007), para 2.

[8] The Social Anxiety Institute. “Social Anxiety Home Page,” <http://socialanxiety.us/> (cited 16 July 2007), para 5.

[9] Harlan R. Juster and Richard G. Heimberg, “Cognitive Behavioral Group Therapy for Social Phobia,” <http://www.apa.org/divisions/div12/rev_est/cbgt_social.html> (cited 3 June 2007), para 3.

[10] Wyeth Pharmaceuticals, Inc., “EFFEXOR XR®,” <http://www.effexorxr.com/> (cited 3 June 2007), para 5.

[11] DeVane CL, "Immediate-release versus controlled-release formulations: pharmacokinetics of newer antidepressants in relation to nausea," 2003, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14700450> (cited 3 June 2007).

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