Is that nervous feeling social anxiety disorder, or is it simply a case of being shy?

Rhode Island Hospital researcher Kristy L. Dalrymple, PhD, of the department of psychiatry, explores the variances between the two, and discusses the differing beliefs of over, and under-, diagnosis of social anxiety disorder (SAD) and its treatment options in a paper published in the Expert Review of Neurotherapeutics.

"There are many differing opinions about social anxiety disorder and the best treatment," Dalrymple said. "Should it be treated with medication, behavioral therapy, or both? The significant increase in the prescription of antidepressant medications (which often are used to treat SAD) over the past several years -- an increase of 400 percent -- should be considered when determining the best approach. Are we simply medicating, or are we helping patients to truly improve their quality of life?"

SAD is defined as a fear of embarrassment or humiliation in social situations to the point that these situations often are avoided or endured with a significant amount of distress. Studies have shown that it is the fourth most common mental disorder in the U.S., with a prevalence rate as high as 13 percent in the general population of Western countries, and as high as 30 percent within those who are seeking mental health treatment. It also has been well documented in previous studies that those who suffer from social anxiety disorder often suffer from other psychiatric disorders as well, such as mood, other anxiety and substance use disorders.

SAD can have a significant impact on an individual's personal and professional life. It is associated with lower levels of educational attainment, single marital status and unemployment. It also is associated with fewer days worked and reduced work productivity, and as a result, with substantial economic costs.

One of the barriers to treatment is the ability to accurately diagnose SAD, as those who suffer from the disorder may be reluctant to admit it due to the fear of humiliation, or embarrassment about seeking help. Despite decades of research, no definitive cause has been identified, and further study is warranted.

"Despite its prevalence, social anxiety disorder has not received the same attention from the public or mainstream media as other disorders, such as obsessive compulsive disorder," Dalrymple said. "Due to its social and economic impact, it merits further study in order to help researchers and clinicians determine possible causes, and the best treatment.

"This isn't about overcoming shyness," she continued. "This is about helping our patients who suffer from a disorder that prevents them from living a happy and healthy life."