About Social Anxiety

Overview

Social anxiety disorder, also known as social phobia, is a mental health condition characterized by a persistent fear of social or performance situations. Individuals with social anxiety fear being observed or judged by others and worry that they will act in a way that is embarrassing or humiliating. This fear can make it difficult for them to engage in social interactions, meet new people, and attend social events.

Social anxiety disorder can be crippling and impact various aspects of a person's life, including work, school, and relationships. It is one of the most common anxiety disorders, affecting approximately 12% of Americans during their lifetime. It is more than just shyness and can cause significant mental distress. Symptoms of social phobia may include fear of humiliation, difficulty with eye contact, blushing, trembling, sweating, and avoidance of social situations.

Causes and Risk Factors

Social anxiety disorder is a complex condition with various causes and risk factors.

Causes of social anxiety:

Genetic factors: Research suggests that anxiety disorders, including social anxiety, can run in families. This indicates a possible genetic component at play.
Environmental factors: Stressful or traumatic events, such as abuse, violence, the death of a loved one, or extended illness, may increase the risk of developing an anxiety disorder. Previous experiences of bullying, humiliation, or rejection can also contribute to social anxiety.
Parenting styles: Overprotective parenting has been linked to an increased risk of social anxiety in children. This style of parenting may lead to dependence and a lack of confidence in adolescents.

Non-modifiable risk factors of social anxiety cannot be changed or controlled. These include:

Gender: Social anxiety disorder is more common in females than males.
Age: While social anxiety typically starts early in life during adolescence or teenage years, it can affect people of all ages.
History of depression: Having a history of depression may also increase the risk of developing social anxiety.

Modifiable risk factors of social anxiety can be influenced or changed. These include:

Social media use: Some studies suggest that too much use of social media can trigger social anxiety. Social media platforms can make social comparison easier and lead to poor mental health and feeling unhappy with life among young adults.
Communication capacity: Difficulties in interpersonal communication can contribute to social anxiety. This includes both online communication on social media and face-to-face interactions.
Previous experiences of social frustration: Negative experiences like bullying or cyberbullying have been associated with higher levels of social anxiety.
Social support: Having a strong network of supportive relationships can help reduce the risk.
Education level: Lower levels of education have been associated with an increased risk of social anxiety. Access to quality education and opportunities for learning can play a role in reducing this risk.
Residence: Living in rural areas has been found to be a modifiable risk factor for social phobia. Addressing this by improving access to mental health resources and support in rural communities can help reduce the risk.

Symptoms

Social anxiety disorder can have various symptoms that can affect both the body and the mind. The symptoms can vary depending on the severity of the condition and how long a person has been experiencing it. Here are some of the common symptoms of social anxiety disorder:

Early Symptoms:

Blushing, sweating, trembling
Feeling nauseous
Increased heart rate
Mind going blank
Panic attacks or feelings of panic
Fear of experiencing anxiety or seeming anxious in front of others
Intense fear of judgment from others
Dread or fear in social situations, especially with strangers
Feeling self-conscious, embarrassed, or awkward in front of others
Difficulty speaking or maintaining eye contact
Avoiding situations that might trigger anxiety

Later Stages or Higher Severity Symptoms:

Rigid body posture and speaking with a soft voice
Sensitivity to criticism and negative self-talk
Low self-esteem
Difficulty making or maintaining eye contact
Avoidance of social situations and people they don't know, even when they want to interact with them
Fear of being embarrassed in public
Constant worrying about everyday social situations
Ruminating over mistakes: Continuously replaying social interactions and focusing on perceived mistakes

In severe or chronic cases, social anxiety disorder can lead to the development of other conditions such as depression or substance use disorders. It can also greatly disrupt daily life, including school, work, and relationships. Without treatment, individuals may not reach their full potential at school or work as they may avoid participating in group tasks, speaking in front of groups, or seeking promotions.

Diagnosis

To diagnose social anxiety disorder, doctors typically perform a combination of examinations, tests, and procedures. These may include:

Physical examination: A doctor may conduct a physical examination to rule out any underlying health conditions that could be causing or contributing to the symptoms of social anxiety.
Laboratory tests: In some cases, doctors may order laboratory tests to further investigate the individual's overall health and rule out any medical conditions that could be mimicking or worsening social anxiety symptoms.
Mental health assessment: A doctor may refer the person to a mental health practitioner, such as a psychologist or psychiatrist, for a comprehensive assessment. This assessment involves discussing the individual's symptoms, medical history, and personal experiences related to social anxiety.
Diagnostic criteria: Mental health practitioners use the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to diagnose mental health conditions, including social anxiety disorder. The DSM-5 outlines specific diagnostic criteria that must be met for a formal diagnosis of social anxiety disorder.

To determine the stage or severity of social anxiety disorder, additional examinations, tests, and procedures may be used:

Medical assessments: Medical assessments, such as the Social Phobia Scale and Post-Event Rumination Scale, can provide insights into the severity of social anxiety symptoms experienced by an individual.
Questionnaires and scales: Various questionnaires and scales are used to assess different aspects of social anxiety disorder. These provide additional information about the individual's symptoms, avoidance behaviors, depression levels, and overall quality of life. These may include:
- Liebowitz Social Anxiety Scale (LSAS)
- Brief Fear of Negative Evaluation Scale (BFNE)
- Social Avoidance and Distress Scale (SADS)
- Personal Attitude Scale-II (PAS)
- Outcome Probability Questionnaire (OPQ)
- Outcome Cost Questionnaire (OCQ)
- Beck Depression Inventory (BDI)
- Quality of Life Inventory (QOLI)

Treatment Options

The goals of treatment for social anxiety are to help individuals manage their symptoms, gain confidence, and overcome their anxiety. Treatment options include:

Psychotherapy:

Cognitive Behavioral Therapy (CBT): This is a common and effective treatment for social anxiety disorder. CBT aims to help individuals recognize and change negative thoughts or beliefs about social situations. It also focuses on changing behaviors or reactions to situations that trigger anxiety.
Exposure Therapy: This approach involves gradually facing feared social situations with the guidance of a therapist in a safe environment. The goal is to help individuals confront their fears and learn that they can handle these situations without experiencing overwhelming anxiety.
Gestalt Therapy: This therapy has been found to be effective in reducing anxiety in elementary school children. It focuses on the whole person, helping them become more aware of their thoughts, feelings, and behaviors in the present moment.
Trauma Therapy: People who have social anxiety due to a traumatic experience may benefit from trauma therapy. This can include trauma-focused CBT and eye movement desensitization and reprocessing (EMDR). These therapies help address the memories that are causing the phobia.

Medications:

Antidepressants: Certain types of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can be prescribed to manage the symptoms of social anxiety disorder. These medications work by balancing chemicals in the brain that affect mood and anxiety.
Anti-anxiety medications: Benzodiazepines and beta blockers (which are also used to lower blood pressure) are examples of medications that may be used to relieve symptoms of social anxiety. They can help reduce physical symptoms like rapid heartbeat and trembling.

Other Treatments:

Complementary and Alternative Treatments: Some individuals may find relief from social anxiety through complementary and alternative treatments. These may include relaxation techniques like focused attention and breathing exercises, yoga, meditation, physical exercise, or stress relief techniques.

It's important to note that treatment plans may vary for each individual, and healthcare professionals may recommend a combination of therapies or medications based on the severity of symptoms and individual needs.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.

Progression or Complications

The natural progression of social anxiety can vary from person to person. Without treatment, the symptoms of social anxiety disorder can continue or even get worse, causing major disruptions in the person's work and social life.

Complications commonly associated with social anxiety disorder include:

Low self-esteem: Social anxiety can contribute to negative self-perception and low self-esteem. The fear of judgment from others can lead to feelings of inadequacy and self-doubt.
Depression: Social anxiety disorder is often linked to depression. The constant fear and avoidance of social situations can take a toll on a person's mental health and lead to feelings of sadness and hopelessness.
Substance misuse: Some individuals may turn to substances such as alcohol or drugs as a way to cope with their social anxiety symptoms. This can further exacerbate their mental health issues and lead to additional problems.
Suicidal ideation: In severe cases, social anxiety disorder can contribute to thoughts of suicide or self-harm. It is crucial to take these thoughts seriously and seek help immediately if you or someone you know is experiencing them.

Need help Now?

If you, or someone you know, may be in danger or are concerned about safety, call 911.

If you or someone you know are struggling or in crisis with anxiety, depression or suicidal thoughts, help is available. Call or text 988 or chat 988lifeline.org/chat to connect with trained crisis counselors.