In this blog post, you will learn what constitutes social anxiety disorder as well as common symptoms, treatments, and ways you can offer support.
Have you or a loved one experienced severe distress in a social situation? Maybe you were at a cocktail party and felt like people were judging you for something you said. Or you were overcome with nausea, sweating, and heart palpitations when you were late for class and everyone was already seated.
When symptoms like this interfere with work, school, or other daily activities, a person may be diagnosed with social anxiety disorder.
What is Social Anxiety Disorder?
Social anxiety disorder, or social phobia, is a debilitating disorder characterized by excessive fear of embarrassment or judgement in social situations. Social anxiety disorder, also called social phobia, is different from everyday shyness and nervousness, so it is important to understand the distinction.
Chronic fear and avoidance of situations that disrupt daily functioning are a few of many components that classify social anxiety as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Causes of Social Anxiety Disorder
There is no single factor that leads to the development of social anxiety disorder. Usually, it involves a complex interplay between genetics, stressful experiences, and differences in brain structure.
Anxiety typically runs in families; however, it is unclear if this is inherited genetically or learned through experiences modelled by anxious parents.
Some people develop social anxiety after a particularly embarrassing or unpleasant situation such as bullying. Others may have parents who are anxious in social situations or are overprotective.
The amygdala is an area in the brain that controls our responses to fearful events or stimuli. People with social anxiety disorder usually have an overactive amygdala, and this can lead to physical and behavioural responses from normally harmless situations.
When Do People Commonly Get Diagnosed with Social Anxiety Disorder?
Social anxiety disorder affects approximately 15 million Americans and is usually diagnosed during adolescence. Women are more likely to develop social anxiety disorder compared to men, however, men seek treatment at a higher rate. Unfortunately, fewer than 5% of patients seek treatment right away, and more than 75% of patients wait longer than 10 years before seeking help.
Symptoms may become more severe during stressful life events, but long-term treatment is necessary even during periods when symptoms are mild.
Behavioural Symptoms of Social Anxiety Disorder
- Fear of judgement by peers
- Worrying about embarrassing yourself in front of others
- Fear of interacting with unfamiliar people
- Fear of embarrassment from blushing, sweating, or having a shaky voice
- Avoidance of speaking to people out of fear of judgement
- Avoidance of situations where you are the centre of attention
- Spending a significant amount of time after a social situation analyzing what you said or did
- Children with social anxiety disorder may cry excessively, have temper tantrums, cling to their parents, or refuse to speak
Someone with social anxiety disorder may find it extremely difficult to perform seemingly mundane tasks such as making eye contact, interacting with strangers, attending parties, or using a public restroom.
Physical Symptoms of Social Anxiety Disorder
- Rapid heartbeat
- Shortness of breath
- Dizziness or lightheadedness
- Muscle tightness and tension
Diagnosis of Social Anxiety Disorder
Your doctor will need to perform a thorough physical examination and have an in-depth discussion with you regarding your symptoms. You may be given a self-report questionnaire to rate your anxiety in certain situations. Ultimately, your doctor will decide if you meet the DSM-5 criteria for social anxiety disorder.
DSM-5 criteria include but are not limited to:
- Persistent, intense fear or anxiety about specific social situations out of fear of judgement or humiliation
- Avoidance of anxiety-provoking situations or enduring them with severe anxiety
- Anxiety or fear that is not explained by a medical condition, prescribed medication, or drug use
- Anxiety that is disproportionate to the situation and interferes with daily living
What are the Triggers for Someone with Social Anxiety Disorder?
A person diagnosed with social anxiety disorder may experience a sudden onset of symptoms during activities such as eating in front of others, needing to make eye contact, or being the centre of attention.
Some other common triggers include:
- Going on dates
- Interviewing for a job
- Going to school or work in anticipation of interactions
Treatment for Social Anxiety Disorder
Although there is no cure for social anxiety disorder, there are many effective treatments that can significantly improve a patient’s quality of life. Psychotherapy and pharmaceutical drugs are the most common treatments for social anxiety disorder.
Psychotherapy or talk therapy
Psychotherapy, or talk therapy, is very effective for both individuals and groups. Patients learn to recognize and change negative thought patterns to gain confidence in the social situations that cause distress.
Exposure therapy is a form of psychotherapy where patients face the fearful situations head-on to develop positive coping skills. Role-playing is also a useful tool for patients to practice how they would behave in a stressful social situation.
Art therapy is another outlet that social anxiety disorder patients use to process the many emotions they are experiencing. Drawing pictures that relate to how they feel can be a very effective representation of social anxiety to help begin processing and coping. Take a look at some examples here.
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed therapeutics for social anxiety disorder. Paroxetine (brand name Paxil) or sertraline (brand name Zoloft) may be prescribed. In addition, Venlafaxine (brand name Effexor), which is part of another class of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs), can be given to patients with social anxiety disorder.
Anti-anxiety medications such as benzodiazepines may also be prescribed to reduce anxiety as-needed. Benzodiazepines are typically used only in acute anxiety situations because they have addictive potential.
Beta-blockers, which block the effects of the hormone epinephrine, are sometimes prescribed to reduce heartrate and blood pressure. This class of medication, however, is usually used only in particular situations as a preventative measure. For example, someone might take a beta-blocker prior to a public presentation to reduce symptoms of voice/hand shaking and rapid heartrate.
Typically, a medication regimen for social anxiety disorder is a trial-and-error process, and patients must work with closely their doctor to find the right type and dose.
Complications of Untreated Social Anxiety Disorder
Social anxiety disorder can be detrimental to a person’s life if left untreated. It can heavily interfere with work, school, or relationships. People are at risk of developing the following negative outcomes:
- Low self-esteem
- Negative self-talk
- Low academic and professional achievement
- Substance abuse
- Suicidal ideation or suicide attempts
- Development of other mental health disorders such as major depressive disorder or a substance use disorder
**If you or someone you know are having thoughts of suicide get help immediately.
Prevention of Social Anxiety Disorder
Someone who is experiencing early symptoms of anxiety or any of the symptoms described above should seek help as early as possible. Other ways to prevent the onset of social anxiety disorder include:
- Keeping a journal to track and identify your thoughts
- Avoiding using substances such as alcohol or drugs to alleviate anxiety
How to Support Someone with Social Anxiety Disorder
If someone close to you is experiencing debilitating social anxiety or has already been diagnosed with social anxiety disorder, make sure to support and listen to them. If they are anticipating an upcoming stressful social situation, helping them plan an exit strategy is better than avoiding the situation altogether. Symptoms of social anxiety disorder can be markedly improved with the effort of supportive friends to foster constructive social connections. This can help the patient experience the benefits of close friendships and relationships. Positive encouragement may gradually reduce their fear of embarrassment and judgement by peers.
Overall, this article should have given you a comprehensive overview of what it means to suffer from social anxiety disorder. You should now be aware of common signs and symptoms as well as effective treatment options.
Want to Learn More? Social Anxiety Disorder Books:
The following books will give you even more information on the nuances of social anxiety disorder:
Social Anxiety: Clinical, Developmental, and Social Perspectives
This book gives a detailed examination of the differences between social anxiety disorder and shyness, and also delves into the subtypes of the disorder. It includes perspectives from clinicians, social developmental psychologists, and behavioral geneticists and covers key areas of social anxiety disorders that other sources leave out. For example, perfectionism and changes in the treatment landscape are often not discussed in conventional sources.
Cognitive Behavioral Therapy for Social Anxiety Disorder (Practical Clinical Guidebooks)
Clinical psychologist Stefan Hofmann and Professor of Psychological and Brain Sciences Michael Otto discuss how current CBT treatments are not as effective as they can be. They create an organized treatment plan that utilizes interventions to strengthen certain CBT strategies and use many case studies as examples.
Overcoming Social Anxiety and Shyness: A Self-Help Guide Using Cognitive Behavioral Techniques
This guide includes a step-by-step approach for people with social anxiety disorder to work at home on improving their symptoms. It encourages CBT techniques and interactive exercises for patients to restructure their thought patterns.
Environmental factors and stressful life experiences such as childhood trauma can lead to the development of social anxiety disorder. Physical, sexual, or emotional abuse during childhood are common predictors of social anxiety disorder later in life.
The short answer is yes. Social anxiety is a mental health condition that is defined by an intense, chronic fear of being judged. This type of debilitating fear can interfere with school, work, and other routine daily activities. Often people with social anxiety disorder struggle with forming and maintaining friendships.
No, but it definitely can be managed. Researchers are currently working hard to find an effective cure for social anxiety disorders as well as other mental health disorders.
The most effective treatment for social anxiety disorder to date is a combination of cognitive behavioural therapy (CBT) and medication. A typical patient needs 12-16 therapy sessions to see improvement in symptoms. The goal of CBT and medication is to help patients develop the confidence and coping skills to face the fearful situations that are plaguing them. Once these skills are developed, patients can then enter themselves to these situations equipped with effective tools to manage their anxiety.
Social anxiety doesn’t discriminate. Many celebrities suffer even though they seem fearless on the big screen. Some notable examples are Kim Basinger, Johnny Depp, Nicole Kidman, Jonathan Knight, and Barbara Streisand.
Questions or comments? Post below!
Social Anxiety Disorder. Mayo Clinic. August 29th, 2017.
Social Anxiety Disorder. Anxiety and Depression Association of America. 2010.
Gender Differences in social anxiety disorder: A review. (2017). Asher M., Asnaani A., Aderka IM. Clinical Psychology Review.
Social Anxiety Disorder: Symptoms, Causes, and Treatments. Psycom. June 18th, 2019.