Psychiatry
Social Anxiety Disorder
사회불안장애
Excessive, persistent fear of social situations
- How common
- Lifetime 12%
- Typical age
- Onset in adolescence
What is it?
Amygdala hyperactivity, dysregulated social-threat circuits, reduced reward circuit response to positive social cues.
Commonly affected: Amygdala, insula, ACC
How it develops
- Genetic/temperamentBehavioral inhibition, critical parenting
- Amygdala hyperactivityHyperreactive to faces/gaze
- Cognitive distortions"Being judged, humiliated" beliefs
- Avoidance reinforcementShort-term relief, long-term entrenchment
Symptoms
- Excessive social fearFear of being evaluated
- AvoidanceAvoids social/performance situations
- Physical symptomsBlushing, sweating, trembling, palpitations
- Anticipatory anxietyWorry days in advance
- Functional impairmentAcademic/work/relationship impact
How it is examined
- DSM-5 SAD≥6 months + avoidance/distress + functional impairment
- LSASLiebowitz Social Anxiety Scale
- Differentiate AVPDPervasive vs situational avoidance
Imaging
Not diagnostic; fMRI shows amygdala hyperactivity.
- Amygdala hyperactivity
Altered insular/ACC activity.
- Insular activation
Non-surgical care
- SSRI/SNRIEscitalopram, paroxetine, venlafaxine
- CBT (exposure central)Graded social exposure, cognitive restructuring
- Beta-blocker (performance)Propranolol - pre-performance
- Group CBTReal-world social exposure format
- Short-term benzodiazepineAcute/specific situations (dependence risk)
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Treatment-resistant
Procedures that may be discussed
- MAOI (phenelzine)
- Combination
- ACT
Outlook
60–80% improve with CBT+SSRI; tends to be chronic.