Case Study: Social Anxiety Disorder in a College Student

Client: Sarah Jones (name changed to protect confidentiality)

Presenting Concerns: Sarah, a 19-year-old college freshman, presented with symptoms of social anxiety disorder (SAD). She reported feeling intense anxiety in social situations, fearing scrutiny and judgment from others. These anxieties significantly impacted her academic and social life, making it difficult to attend classes, participate in discussions, or make friends.

Symptoms: Sarah described experiencing several symptoms consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for SAD [1]. These included:

• Excessive fear of social situations where she might be scrutinized by others (e.g., public speaking, class discussions)
• Fear of embarrassing herself or humiliating herself
• Avoidance of social situations due to these fears
• Physical symptoms like blushing, trembling, or sweating in social situations
• Difficulty concentrating due to social anxiety
• The fear of social situations interferes with her daily routine, academic performance, or work (or social opportunities)
• The fear is not better explained by another mental disorder (e.g., panic disorder, body dysmorphic disorder)

Background: Sarah has always been a shy individual, but her anxieties worsened significantly upon entering college. The large class sizes, unfamiliar social environment, and pressure to perform academically triggered her anxieties around social interactions. She started avoiding classes, group projects, and social events, leading to feelings of isolation and loneliness.

Treatment Options: Treatment for SAD typically involves a combination of psychotherapy and medication [2]. Here are some recommended treatment options for Sarah:

• Cognitive-behavioral therapy (CBT): CBT has been established as the first-line treatment for SAD [2]. It helps Sarah identify and modify negative thought patterns that contribute to her social anxiety. Through CBT techniques like exposure therapy, Sarah can gradually confront her feared social situations in a safe and controlled environment.
• Social skills training: This therapy equips Sarah with skills to navigate social interactions more confidently. She can learn communication skills, assertiveness techniques, and strategies for managing social anxiety symptoms (e.g., relaxation techniques).
• Medication: Selective serotonin reuptake inhibitors (SSRIs) may be considered, particularly if Sarah’s anxiety is severe or interferes significantly with her daily life. Medication can help manage symptoms like excessive worry and physical symptoms of anxiety.

Prognosis: With comprehensive treatment, including CBT and social skills training, Sarah has a good prognosis for managing her SAD and improving her social functioning. Early intervention is crucial to prevent long-term complications like depression and substance abuse that can be associated with untreated SAD.