Social Anxiety Disorder
It’s normal to feel shy in social situations. But some people feel a level of social anxiety that interferes with their ability to interact with others. These feelings can be part of social anxiety disorder (SAD), a mental health condition that can cause people to avoid others because they fear being judged or humiliated.
What is social anxiety?
Social anxiety shouldn’t be confused with shyness, nervousness, or even loneliness. Broadly speaking, social anxiety is the experience of feeling uncertain and self-conscious in social interactions. Some people experience social anxiety in all social situations, while others only experience it in specific situations, such as meeting new people.
What is social anxiety disorder?
Social anxiety disorder is a chronic, intense, and persistent fear of everyday social interactions. SAD causes irrational anxiety and excess fear of being around others, being watched, being judged, embarrassed, and humiliated. Some people with SAD may also worry about offending others. This anxiety and self-consciousness can have a significant impact on someone’s work, routine, school, and relationships (American Psychiatric Association, 2013).
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Symptoms of social anxiety
People with social anxiety may experience emotional, behavioral, and physical symptoms. Symptoms, which often occur in social settings, can range from feeling mildly distressing to completely debilitating.
Common emotional and behavioral symptoms can include:
- Intense fear and anxiety during social interactions
- Avoiding situations where you fear being the center of attention or being judged
- Worrying that others will notice your anxious symptoms
- Persistent fear of embarrassing yourself in front of others
- Anticipating failure or humiliation in social situations
- Expecting the worst possible consequences from a negative social experience
- Excessively analyzing how you interacted with others
- Avoiding eye contact with others
Common physical symptoms can include:
- Racing heartbeat
- Muscle tension or rigid body stance
- Shaking or trembling
- Chest tightness
- Headaches or migraines
- Sensations of numbness
- Panic attacks
- Feeling as if the mind goes blank
- Difficulty speaking
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What causes social anxiety?
The exact cause of social anxiety is unknown. Its causes can differ from person to person, but it may be a result of several factors. SAD typically develops during late childhood and early adolescence and can be caused by genetic, neurobiological, and temperamental factors. Environmental factors can also contribute (Norton & Abbott, 2017).
While anxiety disorders tend to run in families, it’s unknown if genetics or learned behaviors can increase a person’s chances of developing SAD. Increased anxiety in social situations may be a result of an overactive amygdala, the section of the brain associated with emotions. Neurological issues and an imbalance of mood-regulating hormones, such as dopamine, serotonin, and glutamate, may also contribute to SAD. It’s also possible that SAD is a learned behavior. This could develop as the result of an embarrassing or unpleasant social situations (such as bullying) or from having parents who modeled anxious behavior or enforced an overprotective or controlling parenting style.
How are social anxiety and social anxiety disorder diagnosed?
A clinician can diagnose social anxiety disorder by assessing symptoms and reviewing a patient’s medical history.
Mental health clinicians may diagnose SAD based on how your emotional, behavioral, and physical symptoms align with the criteria in the Diagnostic and Statistical Manual of Mental Disorders. A clinician can help determine whether you’re experiencing persistent fear, anxiety, and avoidance that is disproportionate to the threat of social situations, disrupts your daily life and cannot be explained by other health conditions.
Social anxiety is highly treatable. Treatment options include therapy and medication. Some people with SAD may benefit from one type of treatment, while others may require a combination.
A clinician may also recommend additional remedies, such as mindfulness, meditation, breathing exercises, yoga, a balanced diet, and good sleep habits.
When to seek treatment
Signs that it might be time to seek treatment for SAD include:
- Symptoms that disrupt daily life and routines
- Anxiety that impacts performance at work, social life, or romantic relationships
- Low self-esteem
Therapy can help patients identify the origins of their social anxiety and learn healthy coping mechanisms to reduce symptoms.
Cognitive behavioral therapy (CBT) can help patients learn to manage and replace negative and anxious thoughts. Acceptance and commitment therapy (ACT) teaches people to use mindfulness, acceptance, and behavioral strategies to cope with negative feelings. Exposure therapy can help people gradually confront and become comfortable with social situations. Group therapy can teach people social skills and techniques in a supportive, compassionate setting.
Commonly prescribed medications for SAD include selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Norton, A. R., & Abbott, M. J. (2017). The Role of Environmental Factors in the Aetiology of Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature. Behaviour Change, 34(2), 76–97. https://doi.org/10.1017/bec.2017.7