AssessmentsSocial anxiety disorder
Social anxiety disorder
USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 15-year old girl with type 1 diabetes mellitus and hypothyroidism comes to the emergency department because of sweating, shaking, and palpitations. One hour earlier, she had been standing in front of her peers preparing to deliver a speech for a class assignment. She states that she suddenly started to fear that she would make a mistake and her classmates would start laughing at her. Onset of symptoms began shortly after. A thyroid-stimulating hormone (TSH) level is measured at 4.0 µU/mL, and a blood glucose level is measured at 90 mg/dL. Which of the following is the most likely diagnosis?
Content Reviewers:Rishi Desai, MD, MPH
Say it’s your first day at a new job. Maybe you’re nervous or jittery. You want to make a good impression.
Those feelings are pretty normal, and may actually help you be more alert and careful.
But after a few weeks, once you’re used to the job, and you know your coworkers, that nervousness usually diminishes, right?
Well, for some people that initial anxiety is really high, and stays really high over time.
For those people, the fear of being judged negatively by new people might be so daunting that it affects their ability to do their job well.
In fact, the idea of having to be somewhere where they may be scrutinized by others might make them not want the job or avoid looking for work in the first place.
This describes social anxiety disorder.
It’s unclear what causes social anxiety disorder, but it’s thought to be a combination of genetic and environmental factors; first degree relatives of people with anxiety disorders have between two and six times the risk of having some form of social anxiety, and people who have experienced neglect or abuse are also more likely to develop social anxiety.
The DSM-5 defines social anxiety disorder as the fear of acting in a certain way that could be negatively evaluated by others.
Social anxiety disorder causes intense distress that significantly interferes with someone’s normal routine, occupational or academic functioning, or with their social activities and relationships.
What’s more is that this fear or anxiety is persistent, lasting for 6 or more months.
The main cause for distress in individuals with social anxiety disorder is the fear that their behavior will be judged negatively by others.
For example, one person might get really anxious while making small talk with acquaintances, or meeting new people.
Another person might get performance anxiety, and not feel able to give a presentation, or give a toast at a friend’s wedding.
With the exception of some cases in which the individual is below a certain age or intellectual level, social anxiety disorder is usually considered an ego-dystonic condition, meaning people who have the disorder usually understand that their anxiety is unwarranted.
Unfortunately, that awareness sometimes just causes even more anxiety, because they’ll fear others will be able to tell how anxious they are, and that they’ll judge them for it.
In order to reduce their social inhibitions, some people with social anxiety use drugs and alcohol, and that can lead to dependency and addiction.