2013-05-22

NICE clinical guideline 159 :Social anxiety disorder: recognition， assessment and treatment

guidance.nice.org.uk

This guidance updates and replaces the section of NICE technology appraisal guidance 97 (published February 2006) that deals with phobia. Social anxiety disorder (previously known as 'social..显示全部 >>

This guidance updates and replaces the section of NICE technology appraisal guidance 97 (published February 2006) that deals with phobia. Social anxiety disorder (previously known as 'social phobia') is one of the most common of the anxiety disorders. Estimates of lifetime prevalence vary but according to a US study， 12% of adults in the US will have social anxiety disorder at some point in their lives， compared with estimates of around 6% for generalised anxiety disorder (GAD)， 5% for panic disorder， 7% for post-traumatic stress disorder (PTSD) and 2% for obsessive compulsive disorder. There is a significant degree of comorbidity between social anxiety disorder and other mental health problems， most notably depression (19%)， substance-use disorder (17%)， GAD (5%)， panic disorder (6%)， and PTSD (3%). Social anxiety disorder is persistent fear of or anxiety about one or more social or performance situations that is out of proportion to the actual threat posed by the situation. Typical situations that might be anxiety-provoking include meeting people， including strangers， talking in meetings or in groups， starting conversations， talking to authority figures， working， eating or drinking while being observed， going to school， going shopping， being seen in public， using public toilets and public performances such as public speaking. Although worries about some of these situations are common in the general population， people with social anxiety disorder worry excessively about them at the time and before and afterwards. They fear that they will do or say something that they think will be humiliating or embarrassing (such as blushing， sweating， appearing boring or stupid， shaking， appearing incompetent， looking anxious). Social anxiety disorder can have a great impact on a person's functioning， disrupting normal life， interfering with social relationships and quality of life and impairing performance at work or school. People with the disorder may misuse alcohol or drugs to try to reduce their anxiety (and alleviate depression). Children may show their anxiety in different ways from adults: as well as shrinking from interactions， they may be more likely to cry， freeze or have tantrums. They may also be less likely to acknowledge that their fears are irrational when they are away from a social situation. Particular situations that can cause difficulty for socially anxious children and young people include participating in classroom activities， asking for help in class， joining activities with peers (such as attending parties or clubs)， and being involved in school performances.