Social anxiety disorder: Causes, symptoms, and treatment

Social anxiety disorder or social anxiety is an excessive emotional discomfort, fear, or worry about social situations. The individual is worried about being evaluated or scrutinized by other people, and there is a heightened fear of interactions with others.

Social anxiety disorder is sometimes referred to as social phobia. A phobia is an irrational fear of certain situations, objects, or environments.

It is estimated that 7 percent of adults in the United States have experienced social anxiety over the last year and that 12.1 percent of the same population will do so at some point in their lives.

Fast facts on social anxiety

People with social anxiety disorder are disproportionately nervous in social situations.

Symptoms can include abdominal discomfort, lightheadedness, and a ‘negative loop’ of feeling anxious about any anxious feelings. Panic attacks may also occur.

It is more common in females than males.

Treatment can include psychotherapy and medication.

What is social anxiety disorder?

Social anxiety
Social anxiety can involve a fear of being judged by others.

A person with social anxiety disorder may be extremely fearful of embarrassment in social situations. This fear can affect personal and professional relationships.

Social anxiety often occurs early in childhood as a normal part of social development and may go unnoticed until the person is older. The triggers and frequency of social anxiety vary depending on the individual.

Many people feel nervous in certain social situations, such as when giving a presentation, going out on a date, or taking part in a competition. This is normal and would not qualify as social anxiety disorder.

Social anxiety becomes a medical condition when everyday social interactions cause excessive fear, self-consciousness, and embarrassment.

Trivial, everyday tasks, such as filling in a form with people around and eating in public places or with friends, may become highly stressful for somebody with social anxiety.

Symptoms

There may be physical, emotional, and behavioral symptoms. Social anxiety can affect daily tasks, including school life, work, and other activities.

Behavioral and emotional signs and symptoms include:

avoiding situations where the individual feels they may be the center or focus of attention

fear of being in situations with strangers

dread concerning how they will be presented to others

excessive fear of embarrassment and humiliation, being teased and criticized, or other people noticing that a person with social anxiety disorder looks anxious

a fear of being anxious that makes the anxiety worse

fear of meeting people in authority

severe anxiety or panic attacks when experiencing the feared situation

refraining from certain activities or talking to people because of a fear of embarrassment

a blank mind in social situations that cause anxiety

Children with possible social anxiety disorder tend to be worried about being embarrassed in front of peers but not adults.

Physical signs and symptoms include:

heart palpitations

abdominal pain

avoiding eye contact

blushing

weeping, tantrums, clinging to parents, or isolation in children

clammy and cold hands

confusion

crying

diarrhea

difficulty talking, sometimes including a shaky voice

dry mouth and throat

excessive sweating

muscle tension

nausea

shaking and trembling

walk disturbance, in which the individual becomes so worried about how they walk that they lose balance or maybe stumble when passing a group of people

An individual with social anxiety disorder may also:

be over-sensitive to criticism

have low self-esteem

have poor social skills

not be assertive

talk negatively about themselves, with inaccurate and self-defeating thoughts

Individuals with social anxiety disorder sometimes underachieve at school or work to avoid the attention of being promoted or having to participate in group tasks. In severe or chronic cases of social anxiety, the person may develop other psychological conditions, such as depression.

A person with social anxiety disorder may find the following situations extremely difficult to face:

being introduced to and talking to new people

going into a room where the people are already settled

making eye contact

ordering a meal in a restaurant

starting a conversation

using a public telephone or public restroom

writing in front of other people

People with social anxiety disorder usually know that their anxiety is irrational. However, in many cases, the anxiety persists and does not get better without appropriate treatment.

Happy girl dance
Stimulating positive thoughts before a potentially intimidating social encounter, such as by listening to music you love, will help to nurture positive emotions during the encounter.

One of the factors that make symptoms of social anxiety worse is the fear of becoming anxious itself.

The more anxious a person feels about social situations, the less likely it is they will expose themselves to the social situations.

Being exposed to social situations, however, is necessary to overcome anxiety, and the less a person exposes themselves to social interaction, the more extreme the anxiety becomes.

It is important to break the cycle of anxious thoughts. There are steps proven to help prepare a person for social interactions that may feel nervous ahead of having to face them.

These include:

Stimulating positive thoughts before social engagements: Activities that make you happy can release feel-good chemicals in the brain that relax you during potentially stressful encounters. Listen to music you love, watch a little TV, or play video games. Maybe engage in some mild exercise or meditation.

Reframing negative thought processes: Telling yourself you are a shy person will reinforce current anxieties about talking to people or being in public. Thoughts fuel behavior patterns. A technique carried out in cognitive behavioral therapy involves guiding patients through the reframing process.

Writing down these thought processes can help. For example, “I am a shy person” can become “I acted like a shy person at the gathering.” It helps people to know they can change how they perceive themselves and how they feel others see them.

Not relying on alcohol or narcotics: Not only can these form a dependency later on in life, but they also do not help the problem at the core of the social anxiety. Try to manage negative feelings in social situations without chemicals or follow a medically supported course of medications prescribed by a doctor.

While some cases of social anxiety can be so severe that these steps will not resolve the condition without treatment, they can help a person approach social interaction with a positive mindset.

Diagnosis

A doctor, often a primary care physician, may carry out a physical evaluation, as well as a basic psychiatric examination. The physical exam helps the doctor rule out any physical causes for the symptoms.

A GP will probably refer the individual to a mental health professional, usually a psychiatrist or psychologist.

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