Social Anxiety Disorder

Social Anxiety Disorder is a mental health condition that causes strong fear and anxiety in social situations. People with this disorder often worry a lot about being judged, embarrassed, or rejected by others. This fear can be so intense that it affects daily life, relationships, and opportunities.
 

Table of Contents | Jump Ahead

What Is Social Anxiety Disorder?

Types of Social Anxiety Disorder

Symptoms of Social Anxiety Disorder

Situations That Trigger Social Anxiety

Causes and Risk Factors

Diagnosis

Treatment Options

Self-Help Strategies

Living with Social Anxiety Disorder

Complications

Prognosis and Recovery

When to Seek Help

Social Anxiety in Different Populations

Cultural Considerations

Related Terms

References

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What Is Social Anxiety Disorder?

Also known as social phobia, social anxiety disorder is more serious than normal shyness or occasional nervousness. It involves ongoing, intense fear that impacts daily life significantly. People with this condition may feel anxious before, during, and after social events, sometimes worrying for days or weeks in advance. They might avoid social situations or endure them with great distress.

 

This fear usually centres on being negatively judged. A person might worry others see them as stupid, boring, awkward, or strange. It can affect many social scenarios or be specific, such as speaking in public or eating in front of people.

 

 

Types of Social Anxiety Disorder

Generalised Social Anxiety Disorder

• Multiple situations - Fear and anxiety occur in most social situations
• Broad impact - Affects many areas of your life, including work, school, and relationships
• Persistent worry - Constant concern about social interactions
• Severe impairment - Significantly limits your ability to function in daily life

 

Specific Social Anxiety Disorder

• Limited situations - Fear is focused on one or a few specific social situations
• Performance anxiety - Often involves performing in front of others
• Common examples - Public speaking, eating in public, using public restrooms, writing in front of others
• Less overall impact - May not affect other areas of your life as much

 

 

Symptoms of Social Anxiety Disorder

Emotional and Mental Symptoms

• Intense fear - Overwhelming anxiety about social situations
• Fear of judgment - Worrying that others will think negatively of you
• Fear of embarrassment - Concern about doing something humiliating
• Fear of rejection - Worrying that others won't like or accept you
• Anticipatory anxiety - Getting anxious days or weeks before social events
• Self-consciousness - Feeling like everyone is watching and judging you
• Perfectionism - Setting unrealistically high standards for your social performance

 

Physical Symptoms

• Blushing - Face turning red, especially when feeling embarrassed
• Sweating - Excessive sweating, particularly in social situations
• Trembling - Shaking hands, voice, or legs
• Rapid heartbeat - Heart pounding or racing
• Nausea - Feeling sick to your stomach
• Dizziness - Feeling lightheaded or unsteady
• Muscle tension - Tight or sore muscles, especially in neck and shoulders
• Difficulty breathing - Feeling short of breath or like you can't get enough air

 

Behavioural Symptoms

• Avoidance - Staying away from social situations or activities
• Safety behaviours - Doing things to feel safer in social situations (like always having a friend with you)
• Escape - Leaving social situations early when anxiety becomes too intense
• Procrastination - Putting off social activities or commitments
• Over-preparation - Spending excessive time preparing for social interactions
• Substance use - Using alcohol or drugs to cope with social anxiety

 

Cognitive Symptoms

• Negative self-talk - Harsh internal criticism about your social performance
• Catastrophic thinking - Imagining the worst possible outcomes in social situations
• Mind reading - Assuming you know what others are thinking about you
• All-or-nothing thinking - Seeing social interactions as either perfect successes or complete failures
• Rumination - Replaying social interactions over and over, focusing on perceived mistakes

 

 

Situations That Trigger Social Anxiety

Common Social Situations

• Meeting new people - Introductions, networking events, parties
• Public speaking - Presentations, speeches, speaking up in meetings
• Eating in public - Restaurants, cafeterias, social meals
• Dating - First dates, romantic interactions
• Job interviews - Employment interviews, performance reviews
• Classroom participation - Answering questions, giving presentations
• Social gatherings - Parties, weddings, family gatherings
• Using public facilities - Public restrooms, changing rooms

 

Performance Situations

• Speaking in public - Any situation where you're the centre of attention
• Performing - Music, theatre, sports competitions
• Testing situations - Taking exams, driving tests
• Work presentations - Meetings, client presentations, training sessions

 

Everyday Interactions

• Small talk - Casual conversations with acquaintances or strangers
• Phone calls - Making appointments, ordering food, business calls
• Shopping - Asking for help, returning items, dealing with salespeople
• Authority figures - Talking to bosses, teachers, doctors, police officers

 

 

Causes and Risk Factors

Biological Factors

• Genetics - Having family members with social anxiety or other anxiety disorders
• Brain structure - Overactive amygdala (fear centre of the brain)
• Neurotransmitters - Imbalances in brain chemicals like serotonin and GABA
• Temperament - Being born with a shy or inhibited temperament

 

Psychological Factors

• Learned behaviour - Observing anxious behaviour in family members
• Negative experiences - Being bullied, teased, rejected, or humiliated
• Parenting style - Overprotective, critical, or controlling parenting
• Perfectionism - Setting unrealistically high standards for yourself
• Low self-esteem - Negative beliefs about your worth and abilities

 

Environmental Factors

• Traumatic social experiences - Public embarrassment, rejection, or humiliation
• Cultural factors - Growing up in cultures that emphasise social conformity
• Social media - Constant comparison with others online
• Life transitions - Starting a new school, job, or moving to a new place
• Chronic stress - Ongoing stress that makes you more vulnerable to anxiety

 

Risk Factors

• Age - Often begins in childhood or adolescence
• Gender - Slightly more common in women than men
• Family history - Having relatives with anxiety disorders
• Personality traits - Being naturally shy, sensitive, or introverted
• Medical conditions - Conditions that affect appearance or speech
• Substance use - Using alcohol or drugs to cope with social situations

 

 

Diagnosis

Social Anxiety Disorder is diagnosed by mental health professionals using specific criteria from the DSM-5-TR.

Diagnostic Criteria

• Marked fear or anxiety - Intense anxiety about one or more social situations
• Fear of negative evaluation - Worry about being judged, embarrassed, or rejected
• Social situations avoided or endured with distress - Either avoiding social situations or experiencing intense anxiety during them
• Out of proportion - Fear is excessive compared to the actual threat
• Persistent - Symptoms last for six months or more
• Significant impairment - Symptoms interfere with daily functioning
• Not due to substances or medical conditions - Symptoms aren't caused by drugs, medications, or medical problems

 

Assessment Process

• Clinical interview - Detailed discussion of your symptoms and experiences
• Social anxiety questionnaires - Standardised tools like the Social Phobia Inventory (SPIN)
• Behavioural observation - How you act during the interview itself
• Medical evaluation - Ruling out medical conditions that could cause similar symptoms
• Family history - Information about anxiety or mental health conditions in your family

 

Differential Diagnosis

Social anxiety disorder needs to be distinguished from:

• Normal shyness - Temporary nervousness that doesn't significantly impair functioning
• Panic disorder - Panic attacks that aren't specifically related to social situations
• Generalised anxiety disorder - Worry about many different things, not just social situations
• Autism spectrum disorder - Social difficulties due to communication challenges rather than fear of judgment

 

 

Treatment Options

Social Anxiety Disorder is highly treatable. Most people experience significant improvement with proper treatment.

Psychotherapy

Cognitive Behavioural Therapy (CBT)

• Most effective treatment - Strong research support for social anxiety
• Identifies negative thoughts - Helps you recognise unrealistic or unhelpful thinking patterns
• Challenges distorted thinking - Teaches you to question and change negative thoughts
• Behavioural experiments - Tests your fears in real-life situations
• Homework assignments - Practice new skills between therapy sessions

 

Exposure Therapy

• Gradual exposure - Slowly facing feared social situations in a controlled way
• Hierarchy of fears - Starting with less scary situations and working up to more difficult ones
• In-vivo exposure - Practising in real-life social situations
• Imaginal exposure - Visualising social situations before facing them in real life
• Response prevention - Learning not to use safety behaviours or avoidance

 

Acceptance and Commitment Therapy (ACT)

• Accepting anxiety - Learning to accept anxious feelings rather than fighting them
• Values-based action - Focusing on what's important to you despite anxiety
• Mindfulness skills - Staying present rather than getting caught up in anxious thoughts
• Psychological flexibility - Developing the ability to adapt to different situations

 

Social Skills Training

• Communication skills - Learning effective ways to communicate with others
• Assertiveness training - Standing up for yourself in appropriate ways
• Conversation skills - Practising small talk and deeper conversations
• Nonverbal communication - Understanding body language and social cues
• Role-playing - Practising social interactions in a safe environment

 

Medications

Antidepressants

SSRIs (Selective Serotonin Reuptake Inhibitors):

• Sertraline (Zoloft) - FDA-approved for social anxiety disorder
• Paroxetine (Paxil) - Also FDA-approved for social anxiety disorder
• Fluoxetine (Prozac) - Often effective for social anxiety
• Escitalopram (Lexapro) - Commonly prescribed for anxiety disorders

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors):

• Venlafaxine (Effexor) - Extended-release form is FDA-approved for social anxiety
• Duloxetine (Cymbalta) - Sometimes used for social anxiety

 

Anti-Anxiety Medications

Benzodiazepines:

• Clonazepam (Klonopin) - Sometimes used for social anxiety
• Lorazepam (Ativan) - May be used for specific social situations
• Short-term use - Usually prescribed for brief periods due to dependence risk
• As-needed basis - Often used only for specific social events

 

Beta-Blockers

• Propranolol (Inderal) - Helps with physical symptoms of anxiety
• Performance anxiety - Particularly helpful for public speaking or performing
• Blocks physical symptoms - Reduces rapid heartbeat, sweating, and trembling
• Situational use - Often taken before specific anxiety-provoking events

 

Combination Treatment

• Therapy plus medication - Often more effective than either treatment alone
• Comprehensive approach - Addresses both thoughts/behaviours and brain chemistry
• Individual needs - Treatment plan tailored to your specific symptoms and preferences

 

 

Self-Help Strategies

Challenging Negative Thoughts

• Identify thinking errors - Notice when you're mind-reading, catastrophizing, or all-or-nothing thinking
• Question your thoughts - Ask yourself if your fears are realistic or helpful
• Develop balanced thoughts - Create more realistic and helpful ways of thinking
• Use evidence - Look for proof that supports or contradicts your anxious thoughts

 

Gradual Exposure

• Start small - Begin with less threatening social situations
• Practice regularly - Consistent exposure is more effective than occasional attempts
• Stay in the situation - Don't leave until your anxiety starts to decrease
• Celebrate progress - Acknowledge your courage in facing feared situations

 

Relaxation Techniques

• Deep breathing - Slow, diaphragmatic breathing to reduce physical anxiety
• Progressive muscle relaxation - Tensing and relaxing different muscle groups
• Mindfulness meditation - Staying present and accepting anxious feelings
• Visualisation - Imagining yourself succeeding in social situations

 

Lifestyle Changes

• Regular exercise - Physical activity reduces overall anxiety levels
• Adequate sleep - Good sleep helps you cope better with stress and anxiety
• Limit caffeine - Caffeine can increase anxiety and physical symptoms
• Avoid alcohol - While it might seem to help initially, alcohol often worsens social anxiety over time

 

 

Living with Social Anxiety Disorder

Building Social Skills

• Practice conversation starters - Prepare topics for small talk
• Learn active listening - Focus on what others are saying rather than your own anxiety
• Join social groups - Find groups based on your interests or hobbies
• Volunteer - Helping others can reduce self-focus and build confidence
• Take classes - Learn new skills while meeting people with similar interests

 

Managing Work and School

• Communicate with supervisors - Consider discussing accommodations if needed
• Practice presentations - Rehearse in front of friends or family before important presentations
• Join professional organisations - Build networking skills in a structured environment
• Seek support - Use employee assistance programs or student counselling services

 

Maintaining Relationships

• Educate loved ones - Help family and friends understand social anxiety
• Set realistic expectations - Don't expect to overcome social anxiety overnight
• Ask for support - Let others know how they can help you
• Practice with trusted people - Use safe relationships to build social confidence

 

Dating and Relationships

• Start with friendship - Build relationships gradually rather than jumping into romance
• Choose comfortable settings - Meet in places where you feel more relaxed
• Be honest - Consider sharing your social anxiety with potential partners
• Focus on connection - Remember that good relationships are built on mutual understanding

 

 

Complications

If Left Untreated

• Increased avoidance - Avoiding more and more social situations over time
• Depression - Social isolation can lead to feelings of sadness and hopelessness
• Substance abuse - Using alcohol or drugs to cope with social anxiety
• Academic problems - Difficulty participating in class or completing group projects
• Career limitations - Avoiding jobs or promotions that require social interaction
• Relationship difficulties - Trouble forming and maintaining close relationships

 

Co-occurring Conditions

• Depression - Very common alongside social anxiety disorder
• Other anxiety disorders - Generalised anxiety, panic disorder, or specific phobias
• Substance use disorders - Alcohol or drug abuse as a way to cope
• Eating disorders - Sometimes related to fear of eating in front of others
• Body dysmorphic disorder - Excessive worry about physical appearance

 

 

Prognosis and Recovery

What to Expect

• Highly treatable - Most people with social anxiety disorder can improve significantly with treatment
• Gradual improvement - Recovery usually happens slowly over time
• Individual variation - Some people improve quickly, while others need longer treatment
• Lifelong management - May need ongoing strategies to maintain improvement

 

Factors That Help Recovery

• Early treatment - Getting help sooner leads to better outcomes
• Consistent therapy - Regular attendance and active participation in treatment
• Medication compliance - Taking medications as prescribed
• Practice - Regularly facing feared social situations
• Support system - Having an understanding family and friends
• Healthy lifestyle - Good sleep, exercise, and stress management

 

Long-term Outlook

With proper treatment, many people with social anxiety disorder:

• Experience significant reduction in anxiety symptoms
• Develop confidence in social situations
• Build satisfying relationships and social connections
• Pursue career and educational opportunities they previously avoided
• Enjoy social activities and experiences

 

 

Prevention

Early Intervention

• Address childhood shyness - Help shy children develop social skills and confidence
• Prevent bullying - Create safe environments at home and school
• Build self-esteem - Encourage children's strengths and interests
• Model healthy social behaviour - Show children how to interact confidently with others

 

Building Resilience

• Develop coping skills - Learn healthy ways to manage stress and anxiety
• Practice social skills - Regular social interaction builds confidence
• Challenge negative thinking - Learn to question unrealistic or unhelpful thoughts
• Maintain social connections - Keep up relationships even when feeling anxious

 

 

When to Seek Help

Signs You Should Get Help

• Avoiding important activities - Missing work, school, or social events due to anxiety
• Significant distress - Social anxiety is causing you considerable emotional pain
• Interfering with goals - Anxiety is preventing you from pursuing your dreams or ambitions
• Using substances to cope - Drinking alcohol or using drugs to manage social situations
• Depression - Feeling sad, hopeless, or losing interest in activities
• Suicidal thoughts - Having thoughts about hurting yourself

 

Types of Professionals

• Psychologists - Provide therapy and psychological testing
• Psychiatrists - Medical doctors who can prescribe medications
• Licensed clinical social workers - Provide therapy and case management
• Licensed professional counsellors - Provide individual and group therapy

 

Getting Started

• Talk to your primary care doctor - They can provide referrals to mental health professionals
• Contact your insurance company - Find out what mental health services are covered
• Look for specialists - Find providers who have experience treating social anxiety disorder
• Consider online therapy - Telehealth options may feel less intimidating initially

 

 

Social Anxiety in Different Populations

Children and Adolescents

• Common onset - Often begins in childhood or early adolescence
• School impact - May affect academic performance and peer relationships
• Selective mutism - Some children stop speaking in certain social situations
• Family involvement - Parents and family are important in treatment

 

College Students

• Major life transition - College presents many new social challenges
• Academic impact - May affect class participation and group projects
• Social opportunities - Missing out on important social experiences
• Campus resources - Many colleges offer counselling and support services

 

Adults in the Workplace

• Career limitations - May avoid jobs requiring social interaction or leadership
• Networking difficulties - Trouble building professional relationships
• Meeting anxiety - Fear of speaking up in meetings or presentations
• Performance reviews - Anxiety about evaluation and feedback

 

Older Adults

• Life transitions - Retirement, loss of spouse, or health changes can worsen social anxiety
• Social isolation - May become increasingly isolated over time
• Medical appointments - Anxiety about interacting with healthcare providers
• Technology barriers - Difficulty adapting to new forms of social communication

 

 

Cultural Considerations

Cultural Differences

• Expression of anxiety - Different cultures may express social anxiety in different ways
• Social expectations - Cultural norms about social behaviour vary widely
• Family involvement - Some cultures emphasise family support more than individual treatment
• Stigma - Attitudes toward mental health treatment vary across cultures

 

Treatment Adaptations

• Culturally responsive therapy - Adapting treatment to fit cultural values and beliefs
• Language considerations - Providing treatment in the person's preferred language
• Religious and spiritual factors - Incorporating faith-based approaches when appropriate
• Community resources - Connecting with cultural or religious communities for support

 

 

Related Terms

• Generalised Anxiety Disorder - Persistent worry about many different things
• Panic Disorder - Recurrent panic attacks
• Specific Phobias - Intense fear of specific objects or situations
• Selective Mutism - Inability to speak in certain social situations
• Avoidant Personality Disorder - Pervasive pattern of social inhibition

 

 

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

National Institute of Mental Health. (2023). Social Anxiety Disorder: More Than Just Shyness. https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness

Anxiety and Depression Association of America. (2023). Social Anxiety Disorder. https://adaa.org/understanding-anxiety/social-anxiety-disorder

Mayo Clinic. (2023). Social anxiety disorder (social phobia). https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561

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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions about mental health concerns.