What Is Social Anxiety Disorder?

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Social anxiety disorder is a consistent fear of humiliation, negative judgement, or embarrassment in social situations. People with this disorder have such intense anxiety that it interferes with daily functioning or aspects of life, such as work or relationships. Social anxiety disorder used to be called social phobia. 

About 7% of the adult U.S. population has social anxiety disorder in any given year. The condition is the second most commonly diagnosed anxiety disorder, behind specific phobia.

Researchers don’t know for sure what causes social anxiety disorder, but risk factors such as a family history of social anxiety disorder or experiencing a traumatic social experience can increase the chances of developing it.

People with social anxiety disorder may spend weeks dreading certain functions or have physical symptoms such as nausea or a rapid heartbeat if they’re asked to speak in front of other people.

Fortunately, there is a range of treatment options. Healthcare providers may recommend therapy first followed by medication if symptoms continue.

Types of Social Anxiety Disorder

People with social anxiety disorder may fear different types of social situations. Because of this, researchers and healthcare providers typically separate people with the disorder into two groups.

Specific Social Anxiety Disorder

This type of social anxiety disorder is also called non-generalized social anxiety disorder. People with it tend to fear a limited range of social situations—usually ones that involve public speaking or performing, such as giving a presentation or acting in a play.

Generalized Social Anxiety Disorder

This is the more common type of social anxiety disorder. Generalized social anxiety disorder refers to an intense fear of almost all social situations. This type of social anxiety disorder typically begins earlier in life and tends to be more chronic and disruptive than specific social anxiety disorder.

Social Anxiety Disorder Symptoms

In general, people with social anxiety disorder feel severe anxiety at the prospect of being with unfamiliar people or of people scrutinizing them. These feelings, which are more intense than shyness or an introverted personality, most often develop in early childhood or adolescence but may also begin later in life.

People with social anxiety disorder might avoid certain places or worry for weeks—maybe months—before certain social events, even though they might know the fear may be irrational. Some experiences that may trigger anxiety include:

  • Meeting new people, especially people in authority
  • Being the center of attention, such as giving a speech or having to share something about yourself in a room full of people
  • Going to a social events that involve strangers
  • Attending parties
  • Eating in public
  • Using a public restroom

People with social anxiety often skip social events altogether, but it’s not always feasible to avoid the events. If you do have to attend an anxiety-inducing event or do something you consider embarrassing spur of the moment, such as talk about yourself, you may experience a range of physical symptoms, such as:

  • Blushing
  • Sweating
  • Trembling
  • Rapid heart rate
  • Rigid body posture
  • Nausea
  • Soft spokenness
  • Avoidance of eye contact

Children with social anxiety disorder may show different or additional symptoms. These include crying or throwing tantrums, as well as refusing to participate in class or peer activities like sports or birthday parties.

Anxiety Signs and Symptoms

What Causes Social Anxiety Disorder?

Social anxiety disorder occurs when a person has extreme anxiety about interacting with or being observed by others. Researchers don’t know the exact cause of social anxiety disorder, but they believe it results from a combination of factors.

One of them is having a genetic predisposition to developing the condition, which often runs in families. For one study, researchers who followed hundreds of sets of twins for more than a decade found that having genetic ties to the disorder increases your likelihood of social anxiety disorder.

Researchers also believe that certain personal experiences can bring on social anxiety disorder. These include:

  • Having a parent that models anxious behavior in or before social situations
  • Having an overprotective or abusive parent
  • Experiencing a stressful social experience during childhood, like being bullied or clamming up during a public performance

Research has shown that people with social anxiety disorder may have an overactive amygdala, the part of the brain that releases stress hormones. But it’s unclear whether this causes the condition or develops as a result of it. Women are more likely than men to have the condition.

How Is Social Anxiety Disorder Diagnosed?

Social anxiety disorder often goes undiagnosed or gets misdiagnosed as depression. Most people with social anxiety disorder don’t seek treatment because they mistakenly believe their symptoms are just a part of their personality, not a medical condition that can be treated.

If you suspect you have social anxiety disorder, talk to a healthcare provider. They’ll likely ask for a detailed history of your symptoms. They may also review any other health conditions and examine you to rule out a physical issue.

A diagnosis means you meet the criteria for social anxiety disorder issued by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which establishes the definition of mental health disorders. The DSM-5 criteria for social anxiety disorder are:

  • Extreme fear or anxiety about one or more social situations that involve possible scrutiny by others
  • The social situations almost always provoke anxiety
  • Anxiety is out of proportion to the actual threat posed by the social situation
  • Social situations are avoided or endured with intense fear or anxiety
  • Anxiety causes significant distress or impairs functioning
  • Anxiety lasts for at least six months
  • Anxiety isn’t caused by substance abuse or another medical condition or mental disorder

Treatments for Social Anxiety Disorder

The goal of treatment is to reduce symptoms for better functioning leading up to and during social situations. A healthcare provider will make recommendations based on symptoms and their severity but will likely discuss two potential categories of treatment.

Psychological Therapies

Healthcare providers tend to try therapy first, especially among children. There are at least two types:

Cognitive behavioral therapy (CBT): This involves talking to a mental health professional to learn new ways of thinking about and responding to anxiety-provoking situations. Part of the treatment may include systematic desensitization or exposure therapy, a form of CBT in which patients are taught how to relax in social situations and then asked to gradually practice the techniques in real life.

Social skills training: For this type of therapy, people practice being in social situations through role play. They may do this in a group setting.

Online Therapy for Anxiety to Meet Your Every Need

Medication

Healthcare providers may suggest medication in addition to therapy. The most commonly prescribed medications are:

  • Antidepressants: The most common antidepressants used to treat social anxiety disorder are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinerphrine reuptake inhibitors (SNRIs). These take a few weeks to kick in and may cause minor side effects, such as headaches and nausea.
  • Beta-blockers: These drugs control anxiety symptoms like sweating and rapid heart beat. They’re often the go-to choice for people who specifically fear speaking or performing in front of people. 
  • Benzodiazepines: These powerful sedatives begin working right away, but some people might build up a tolerance and therefore increase their dependence on them. That’s why healthcare providers often recommend taking them only for short spurts.

How To Prevent Social Anxiety Disorder

There’s no proven way to prevent social anxiety disorder itself from developing, but it is possible to reduce the odds of experiencing anxiety if you have the disorder.

Therapies and medications you take as part of your treatment plan may keep anxiety at bay by helping you identify and change harmful thought processes, as well as by altering the way they physically react to social situations.

Introducing certain lifestyle habits can also help. For example, research has shown that regular exercise may boost mood and reduce anxiety levels. Other lifestyle changes that may ward off anxiety include: 

  • Eating three meals a day
  • Getting adequate sleep
  • Reducing or avoiding caffeine and alcohol

Related Conditions

Research suggests that most people with social anxiety disorder also have another anxiety disorder, such as generalized anxiety disorder or panic disorder. Some people develop an anxiety disorder before they develop social anxiety disorder, while for others the reverse happens. One disorder that children may develop alongside social anxiety disorder is selective mutism, which is an inability to speak in certain situations.

Some people with social anxiety disorder may have other mental health disorders, such as depression. There’s also a higher chance of someone with social anxiety disorder having avoidant personality disorder, a mental health issue in which people feel deeply inferior to other people and avoid social situations because of it.

People with social anxiety disorder may depend on drugs and alcohol to help them cope with their condition or make social interaction more tolerable. This is especially true for people who have the generalized version of the disorder.

Living With Social Anxiety Disorder

If you have the disorder, you may feel lonely or socially isolated. Social anxiety disorder can have other profound effects on a person, interfering with aspects of life such as:

  • Friendships and romantic relationships
  • Educational achievement
  • Earnings
  • Ability to do day-to-day activities, such as buying groceries or getting a haircut

Although some social anxiety disorder symptoms may change over time, the disorder is unlikely to go away without treatment. Fortunately, treatment can significantly reduce symptoms and improve quality of life.

People with social anxiety disorder can help manage their condition by educating themselves about it, talking to friends and family about their feelings, and engaging in anxiety-busting activities such as meditation or exercise.