Do You Have Social Anxiety Disorder During Pregnancy?

Also known as social phobia, social anxiety disorder is a condition that is characterized by the development of anxiety –which really means fear– in connection with social interactions, or due to the anticipation of potential judgment by others, or embarrassment. Social anxiety disorder occurs in about 7 percent of adults in the United States, so it frequently coincides with pregnancy. Along with anxiety, the affected person can suffer spells of sweating, shakiness, shortness of breath, nausea, or palpitations (heart is racing or feels like it’s skipping beats). The severity of the anxiety attacks can range from feeling of being uncomfortable but able to adapt, to panic, to the extreme that the person cannot function in school or work or some particular task. The person may not want to eat with other people or with strangers or use public restrooms. If you suffer from social anxiety disorder, you probably actually want to participate in social situations, but the anxiety prevents you from joining in. This can lead you to isolate yourself. This slows the development of your social skills even more so you fall into a viscous cycle.

Social anxiety disorder is a clinical diagnosis. This means that no laboratory tests or imaging scans are needed. Patients are assessed by a mental health professional based on patient history, performance in school or work, interaction with peers and family. In the context of the historical information and performance, patients with suspected social anxiety disorder are interviewed and assessed to determine whether they meet the following criteria for diagnosis of the condition as listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V):

  1. Fear or anxiety specific to social settings, in which a person feels noticed, observed, or scrutinized. In a adult, this could include a first date, a job interview, meeting someone for the first time, delivering an oral presentation, or speaking in a class or meeting.
  2. The individual fears that she will display their anxiety and experience social rejection,
  3. Social interaction consistently provokes distress,
  4. Social interactions are either avoided, or endured painfully and reluctantly
  5. Fear and anxiety are grossly disproportionate to the actual situation
  6. Fear, anxiety, or other distress around social situations are present for at least six months
  7. The anxiety or fear causes personal distress and impairment of functioning in one or more domains, such as interpersonal or occupational functioning
  8. Fear or anxiety cannot be attributed to a medical disorder, substance abuse, or adverse effects of medication effects or
  9. Fear or anxiety cannot be attributed to another mental disorder
  10. Fear or anxiety cannot be attributed to another condition that may cause the person to be excessively self-conscious.

As for potential problems during pregnancy, social anxiety can prevent a pregnant woman from going for her routine medical examinations, and from taking labor and delivery classes in large groups. However, there are no direct consequences for the baby, unless the social anxiety involves a fear or discomfort in being close to infants.

Treatment of social anxiety may include selective serotonin reuptake inhibitors (SSRIs) medications, such as paroxetine, fluoxetine, sertraline, and citalopram or norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine. Studies are ongoing regarding how these drugs affect the fetus. Evidence also suggests that sertraline and citalopram are safer choices for the fetus compared with paroxetine and fluoxetine. If you have just been diagnosed and are not yet taking medications, your doctor can recommend and prescribe a drug that carries a lower risk of complications for the baby. If you already are taking a medication, you and your doctor may discuss the possibility of tapering down the usual dose to see how low a dose you can tolerate without your anxiety returning. But, generally, if a medication is working well for you in keeping you from suffering from social anxiety, it is a good idea to continue the medication through pregnancy.

As for women who are breastfeeding, among the SSRIs that are given for social anxiety, sertraline is a safe choice to take if you are nursing. This is because the amount of the drug entering breast milk is very small and there is no evidence connecting the medication to problems in infants.

In addition to medications, behavioral therapies are available for treating social anxiety disorder. One type of behavioral therapy that has been proven quite effective is cognitive behavioral therapy (CBT). Another type of behavioral therapy that is effective is called exposure therapy, which is also called systematic desensitization. In this therapy, the person is placed into situations that gradually increase the amount of whatever it is that makes the person anxious. If you fear heights, for instance, you may be asked to stand on a block until you are comfortable, and then on two blocks, then more blocks, then at the top of a stairwell, and so on. If you fear social interactions in groups, you may be led to interact with a few people, and the exposure therapy would gradually increase the number of people in your social situations. Another behavioral therapy involves connecting the feared stimulus with a relaxing event, which gradually gets you to feel more relaxed about the feared situation.

Finally, mindfulness meditation has been shown to reduces anxiety and depression during pregnancy. Learn more about it in this The Pulse blog.

If you have been diagnosed with social anxiety disorder, it means there are serious symptoms that can have negative consequences for you and your baby. Thus, you should take it seriously as you would any other condition, and accept behavioral therapy, medications, mindfulness meditation, or any combination.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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