What is Social Anxiety Disorder?

Most people feel discomfort or nervous in certain social situations, such as giving a presentation or going on a date. Depending on a person’s personality traits or their life experiences, his or her comfort level in social situations may vary. However, social anxiety disorder (aka social phobia) is more than feeling shy or nervous. For most people, this normal discomfort does not prevent them from engaging in social activities or participating in social events.

Persons with Social Anxiety Disorder (SAD), on the other hand, experience significant anxiety and fear when it comes to social activities. For some individuals with SAD, doing everyday things in front of others, such as eating or drinking can cause intense anxiety and fear. Persons with SAD also experience strong feelings of embarrassment and self-consciousness in everyday interactions, as well as a fear of being judged, humiliated, or rejected. These intense fears of being scrutinized or judged by others leads to avoidance of social situations and significantly interferes with the person’s daily routine and functioning at work, school, and other day to day activities. The high levels of anxiety caused by SAD often feel like they are beyond the person’s ability to control.

Social anxiety disorder typically begins in the early to mid-teens, although it can begin in childhood or later in adulthood as well. The onset can either be gradual or a sudden onset triggered by a specific event.

Situations that cause intense anxiety and fear may differ from person to person with SAD. For some individuals, the social anxiety is specific to performance situations (performance type social anxiety disorder), such as giving a speech, playing a sport, or performing on stage. For others, while they may be able to give a speech in class, the thought of going to a party will cause extreme social anxiety. Some individuals may do fine speaking with others one to one, whereas engaging in a group of people may be too overwhelming. No matter what social situations cause social anxiety, a key feature of this disorder is that the level of anxiety, fear, and activity avoidance significantly impairs the person’s functioning and quality of life.

The following are examples of everyday experiences that may cause significant anxiety for a person with social anxiety disorder:

• Going to work or school
• Dating
• Interaction and speaking to people unfamiliar people or strangers
• Attending parties or social gatherings
• Starting conversations
• Eating or drinking in front of others
• Using a public restroom
• Returning an item to the store
• Entering a room in which people are already seated

According to the DSM-V, criteria for social anxiety disorder include:

• Persistent fear or anxiety specific to social settings, in which a person feels noticed, observed, or scrutinized
• Fear of displaying one’s anxiety and experiencing social rejection because of it
• Social interactions are either avoided, or painfully and reluctantly endured
• The anxiety is excessively out of proportion to the actual situation
• Distress around social situations persists for six months or longer
• The intense anxiety and fear cause impairment of functioning in one or more daily activity domains, such as in relationships or work/school functioning

What are the signs and symptoms of Social Anxiety Disorder?

Signs and symptoms of anxiety disorder include emotional, cognitive (negative thinking), physical, and behavioral symptoms.

Emotional symptoms:

• Intense anxiety is social situations
• Fear of:
  • Situations in which you believe you may be judged
  • Being embarrassing or humiliating yourself
  • Interacting or talking with strangers
  • Others noticing you look anxious
  • Physical symptoms that may cause you embarrassment, such as blushing, having a shaky voice or trembling, or sweating

Cognitive Symptoms:

• Expecting the worst possible consequences from a negative experience during a social situation
• Misinterpreting others’ behavior, e.g. believing someone is frowning or staring when he/she is not
• Believe someone is judging you negatively when he/she is not

Physical symptoms:

• Blushing
• Racing heart
• Trembling
• Sweating
• Upset stomach or nausea
• Trouble catching your breath
• Dizziness or lightheadedness
• Feeling that your mind has gone blank
• Muscle tension

Behavioral symptoms:

• Avoiding social situations to a degree that limits your activities or disrupts your life
• Staying quiet or hiding in the background in order to escape notice and embarrassment
• Needing to bring a buddy along with you wherever you go
• Using substances (e.g., drinking alcohol before social situations in order to soothe your nerves

What causes social anxiety disorder?

Like most mental health conditions, social anxiety disorder likely arises from a complex interaction of biological and environmental factors. Possible causes include:

Biological Factors:

Genetics: Anxiety disorders tend to run in families, however, in SAD it is unclear how much is due to genetics and inherited traits versus the environment and learned behaviors.

Temperament: Children who tend to be more shy, timid, or restrained when facing new situations or people may be at greater risk for developing SAD.

Brain structure: Researchers have found several parts of the brain to be involved in fear and anxiety. One brain structure in particular, the amygdala, has been shown to play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, which could cause increased anxiety in social situations.

Environmental Factors:

Learned Behaviors: SAD may also be learned. Parents who model anxious behaviors in social situations or are overprotective of their children may “teach” anxious behaviors to their children (similar to how parents who act fearful of bugs can cause fear and anxiety for bugs in their children).

Negative Events: In addition to learned associations, social anxiety may develop from negative experiences. For example, children who experience bullying, ridicule, or rejection may be at a higher risk to develop SAD. In addition, children who experience other negative events in life, such trauma or abuse, may be more prone to SAD.

When to Seek Help?

It may be hard to know whether your symptoms of discomfort in social situations meet the criteria to be diagnosed with social anxiety disorder and warrant working with a professional. The key question to ask yourself is whether your symptoms of anxiety and distress significantly affect your daily activities and quality of life. If you find that you are avoiding situations that impact your relationships, work/school, or other activities, you should consider reaching out to a behavioral health expert to assist you. The good news is that there are a number of evidenced based treatments for social anxiety disorder that are highly effective and can assist you in reducing your anxiety and improve your functioning and quality of life.

How is social anxiety disorder treated?

Social anxiety disorder is generally treated with psychotherapy (talk therapy), medication, or both.

Psychotherapy:

Psychotherapy (talk therapy) is an effective treatment for SAD. The most common modalities used to treat SAD are cognitive behavioral therapy and exposure-based modalities.

Cognitive behavioral therapy (CBT) is especially useful for treating social anxiety disorder. CBT teaches you different ways of thinking, behaving, and reacting to situations that help you feel less anxious and fearful. It can also help you learn and practice social skills.

Exposure-based cognitive behavioral therapy is also used to treat social anxiety disorders, you gradually work up to facing the situations you fear most. This can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others. Practicing exposures to social situations is particularly helpful to challenge your worries.

Medication:

Several types of medications are available and used to treat and manage symptoms of social anxiety disorder.

Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) are in the antidepressant category but are often used to successfully treat persistent symptoms of anxiety, including social anxiety. They are often the first type of drug prescribed for SAD. It typically takes several weeks for these medications to start working, so do not give up and stick with it. In addition to SSRIs, other categories of antidepressants may be prescribed including serotonin and norepinephrine reuptake inhibitors (SNRI).

Anti-anxiety medications: Antianxiety medications may be prescribed for short-term use. These medications, called benzodiazepines, are very powerful and begin to work right away to reduce your level of anxiety. However, they can be habit-forming and sedating, hence why they are typically prescribed for only short-term use.

Beta blockers: These medications work by blocking some of the uncomfortable physical symptoms caused by anxiety, such as increased heart rate or sensation of a pounding heart, tremors/shaky voice, and sweating. They do this by blocking the stimulating effect of epinephrine (adrenaline). They work best when used infrequently, so they are often prescribed for persons who have performance anxiety type to use when they have to perform, such as giving a speech. They are not recommended for general treatment of SAD.

Healthy Coping Skills You Can Work on At Home:

Although SAD generally requires help from a behavioral health expert there are things you can do at home to help with anxiety management:

• Exercise on a regular basis
• Get enough sleep
• Eat a healthy, well-balanced diet
• Learn and practice relaxation strategies
• Limit caffeine
• Avoid alcohol to calm nerves
• Tap into social support (friends and family you feel comfortable with)
• Practice participating in social situations with people with whom you feel comfortable
• Join a reputable support group

What happens if Social Anxiety Disorder is Left Untreated?

If left untreated, SAD can significantly interfere with your quality of life and functioning at work, school, and in relationships. Individuals with long-lasting SAD may begin to suffer from low self-esteem, have low employment and academic achievement, engage in unhealthy coping skills to manage symptoms of anxiety, such as substance abuse, or develop other significant co-occurring mental health disorders. such as Major Depressive Disorder.

How Teletherapy Can Help with Social Anxiety Disorder:

Teletherapy is a convenient way to meet with a psychotherapist to conduct psychotherapy for social anxiety disorder. When working with a licensed therapist via telehealth, you will engage in the same evidenced based treatment interventions that occur in in-person treatment, including learning how to manage symptoms of anxiety, recognize and change negative thoughts about yourself and others, engage in exposure based activities, and develop skills to help you gain confidence in social situations.

Learn more about our Telehealth Services >

* If you feel you are experiencing a crisis that needs immediate attention or you believe you are a danger to yourself or others, please go to your nearest emergency room OR call 911 or the National Suicide Prevention Hotline: 1-800-273-8255.*

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