What is Social Anxiety?

Learn more about social anxiety disorder, its symptoms, complications, and treatments.

Author: J. Flowers Health Staff

Social Anxiety Disorder (or Social Phobia)

Social Anxiety disorder or social phobia was previously considered an uncommon diagnosis. Contrary to this understanding, recent data from a National Institute of Mental Health Comorbidity Survey suggests as many as 7.1% of adults in the United States will experience social anxiety disorder.¹ Additionally, data from the same study shows as many as 13% of Americans will struggle with social anxiety in their lifetime.

Social anxiety disorder isn’t a diagnosis limited to adults. Other studies and statistics indicate that more than 9% of adolescents and teens (ages 13-18) have social anxiety.² Several of those diagnosed at a young age will struggle with social anxiety disorder symptoms and severe impairment linked to their social anxiety throughout their lives. Although social anxiety disorder is more common than many believe, most people don’t understand its symptoms or social anxiety treatment.

When Does It Happen?

Someone who struggles with a social anxiety disorder will experience intense fear of social situations. This could include everyday events or experiences such as talking with a co-worker, making a speech, or spending time in a public environment such as a restaurant or airport. Even simple day-to-day events like riding an elevator, eating in front of others, or waiting for the bus can spark overwhelming and uncontrollable fear and anxiety.

Social anxiety symptoms can (and frequently do) impact your one’s ability to function at work, at home, or as a part of their daily obligations and responsibilities. For some, severe social anxiety and resulting social anxiety attacks make it difficult to foster relationships, maintain friendships, participate in social functions or events, or be a part of anything that involves groups of people.

What Does It Feel Like?

People with a social anxiety diagnosis or who experience social anxiety symptoms fear humiliation and rejection. Often, the uncontrollable fear they experience in social settings will prompt them to actively avoid situations they worry could involve an activity that may lead to embarrassment. Someone with social anxiety will likely worry about a future event for weeks or months before it occurs.

Causes and Risk Factors of Social Anxiety

Signs of social anxiety disorder generally present in childhood in youth and adolescents who are very shy. Without social anxiety treatment, a social anxiety disorder can last for many years, well into adulthood, inhibiting one’s ability to meet or achieve their full potential. To date, a clear indication of the root causes of social anxiety is unknown. However, research suggests several possible causes and risk factors for social anxiety disorder like many other mental health conditions.³ The root cause of social anxiety could be one of three factors.

Inherited Traits

It’s not uncommon for social anxiety to “run in the family.” Therefore, if a parent or grandparent has social anxiety, it’s likely that children in the family will as well.

Brain Structure

Another potential cause of social anxiety in the DSM-5 is brain structure. The amygdala, the part of the brain responsible for elements of the fear response, may play a role in contributing to social anxiety disorder symptoms. People with an overactive amygdala may experience increased social anxiety in certain situations.

Environment

It’s also possible that social anxiety disorder is a learned behavior. This means one might develop social anxiety after experiencing something embarrassing. Also, parents who show signs of social anxiety or anxious behavior may have children who develop social anxiety. Another root cause of social anxiety might be an overcontrolling or overly protective parent/child relationship.

In addition to potential social anxiety causes, several factors unique to the individual might increase the risk of developing a social anxiety disorder. These include:

Family History

You’re at a greater risk of developing social anxiety if your biological parents or siblings have social anxiety.

Negative Experiences

Adverse experiences during childhood, including bullying, rejection, humiliation, etc., may increase social anxiety risk. Abuse, family conflict, or trauma may also increase risk.

Temperament

Shy, timid, or withdrawn children may experience increased social anxiety.

New Social or Work Demands

Events like meeting new people, work obligations, or giving a speech in front of a crowd can lead to social anxiety symptoms.

Having An Appearance or Condition That Draws Attention

Unfortunately, characteristics such as facial disfigurement, tremors, staggering, or other conditions that can decrease feelings of self-confidence or affect self-esteem can also trigger severe social anxiety in some people as events associated with embarrassment are often frequent.

Symptoms of Social Anxiety

Emotional and Behavioral Symptoms

Many people, regardless of age, feel uncomfortable or shy in social situations. Therefore, these behaviors or actions aren’t necessarily signs of social anxiety disorder for some people. Social anxiety typically presents with a combination of symptoms. Most people will experience emotional, behavioral, and physical symptoms to varying degrees.⁴

The intensity and severity of symptoms will vary from person to person. For example, someone with severe social anxiety may experience panic attacks, whereas someone with mild social anxiety may not. Although social anxiety symptoms may differ, common signs of social anxiety may include any or all of the following:

Experiencing worry or fear for days or weeks before an event.
Fearing others will notice when you’re fearful or anxious.
Needing substances (drugs or alcohol) to face a social situation or engage with others.
Fear of events or circumstances where others might judge you in negative ways.
Intense fear and anxiety at social functions or during public events.
Skipping school or calling out sick to work because of anxiety.
Intense fear of or worry about social situations.
Fearing conversation or interaction with strangers.
Worry about self-embarrassment or humiliation.
Anxiety about an upcoming activity or event that has caused anxiety before.

Physical Symptoms

Social anxiety disorder can also manifest in unpleasant, sometimes painful physical symptoms. As with emotional and behavioral symptoms, these can vary in intensity based on the person or the situation. Typical examples may be:

Blushing
Excessive sweating
Stomach upset
Nausea
Vomiting
Trembling
Difficulty regulating your breathing
Feeling faint or dizzy
Rapid heartbeat,
“Drawing a blank” when you try to speak,
Muscle aches
Difficulty speaking or “getting the words out”

Avoiding Common Social Situations

Another symptom of social anxiety is actively avoiding social situations. Someone with mild or severe social anxiety will often go out of their way to avoid any situation or event that could lead to embarrassment, humiliation, or anxiety. Simple day-to-day events can be complex and seemingly impossible to manage without seeking social anxiety treatment. Someone with social anxiety will struggle to participate in “normal” everyday events such as:

Eating in public
Going to work or school
Shopping in a store
Dating or actively seeking personal relationships
Arriving at an event after others, so there are people already in the room
Using a public restroom
Starting conversations with strangers (or familiar people)
Attending social functions or events
Making eye contact with others
Socializing with or interacting with strangers or someone relatively unknown

Complications Caused by Social Anxiety Disorder

Without social anxiety therapy, ongoing social anxiety symptoms can lead to overwhelming challenges. Chronic anxiety can lead to significant struggles with work, relationships, and simply day-to-day enjoyment of life. In addition, social anxiety can cause a range of emotional, behavioral, and developmental challenges for children and adults alike. Examples of these struggles may include:

Trouble being assertive
Poor social skills
Hypersensitivity to criticism
Drug or alcohol abuse and addiction
Difficulties with academic or employment achievement
Difficulties with social relationships
Increased isolation
Low self-esteem and negative self-image
Suicide attempts or suicide

In addition, other mental health challenges, especially addiction (substance use disorders) and severe depression, often co-occur with social anxiety disorder.

Diagnosing Social Anxiety Disorder

Diagnosing social anxiety disorder is a process that typically involves a visit to your primary care provider or a mental health provider who understands the science and symptoms of social anxiety. Unfortunately, no “social anxiety test” can offer a precise diagnosis. Instead, diagnosing social anxiety disorder in adults or teens is based on several factors.

First, you’ll meet with your primary care provider or a mental health provider for a physical exam and to discuss your symptoms. It’s essential for your treatment providers to understand your symptoms and how they impact your day-to-day life. It’s also necessary to know when your symptoms are most likely to occur. A physical exam is vital to help assess whether any underlying medical condition or medication may trigger your anxiety symptoms instead of social anxiety disorder.

During this assessment process, your provider will review a list of situations that could lead to anxiety for someone with social anxiety disorder. They’ll discuss with you whether these situations make you anxious to learn more about the severity of your condition. You’ll also complete several self-reporting questionnaires to provide further information about your symptoms.

The DSM-5

The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition or DSM-5 provides a list of specific criteria medical and mental health providers look to when assessing for or diagnosing social anxiety disorder. These criteria help providers establish a precise diagnosis before social anxiety treatment begins. These criteria can also help rule out other underlying factors such as medication side effects or co-occurring mental health struggles. The five primary criteria for social anxiety disorder listed in the DSM include:⁵

A constant fear of social situations
Feeling anxious or panicky before a social interaction
A realization that your fears are unreasonable
Anxiety that disrupts daily living
Fear or anxiety that can’t be linked to or explained by a medical condition or co-occurring disorder

Treatment for Social Anxiety Disorder

Unfortunately, it’s not possible to cure social anxiety. However, overcoming social anxiety is possible with treatment and support from a skilled mental health provider like J. Flowers Health. The best treatment for you will vary depending on your unique symptoms and the severity of your condition; however, the most successful treatment programs for social anxiety generally include a combination of therapy, social anxiety medication, and lifestyle changes.

Therapies

Psychotherapy or behavioral therapies are proven effective in helping reduce the intensity of social anxiety symptoms. As a part of therapy, individuals learn more about the root causes of their social anxiety and how to develop confidence in social settings to reduce how frequently and how severely social anxiety interferes with their lives. The most common forms of psychotherapy are behavioral therapies such as cognitive-behavioral therapy and exposure therapy.

CBT and Exposure Therapy

Cognitive-behavioral therapy or CBT is considered one of the most effective forms of psychotherapy for anxiety and many other mental health conditions. Exposure therapy encourages participants to gain the courage to face the situations that bring them the most anxiety. This can help develop confidence, reduce anxiety, and improve coping skills that can be useful when faced with an anxiety-producing situation in the future.

Both types of therapy work well in individual or group settings. At the beginning of an anxiety treatment program, individual therapy sessions help participants start their journey towards feeling comfortable in a group setting.

As you work through your treatment plan, group therapy occurs more frequently. The goal is to introduce potentially anxiety-inducing situations to help individuals develop the confidence and comfort they need to relate to others and participate in social interactions. Because these interactions occur in a safe and supported setting, it’s easier to “start slow” and work towards more significant social interactions without experiencing anxiety.

Medications

Medication for social anxiety is often used as a supplement to comprehensive therapy. Social anxiety medication comes in several forms. The first drug most providers try when addressing persistent social anxiety symptoms is selective serotonin reuptake inhibitors or SSRIs.

SSRIs

SSRI drugs affect the brain’s chemical structure by slowing the speed at which the neurotransmitter serotonin is absorbed. Serotonin is the chemical that is responsible for regulating mood and anxiety. Commonly prescribed SSR medications for anxiety include Paroxetine (Paxil) and Sertraline (Zoloft).

SNRIs

Another common social anxiety medication is serotonin and norepinephrine reuptake inhibitors or SNRIs. These drugs affect the speed of serotonin absorption but also norepinephrine absorption. Norepinephrine is another brain chemical also responsible for symptoms commonly linked to anxiety, including irritability and sadness. A popular SNRI is venlafaxine (Effexor).

Beta-Blockers

Another widely prescribed medication for social anxiety is beta-blockers. Beta-blockers are medications that work by stimulating the release of epinephrine or adrenaline. This can help temporarily manage specific social anxiety symptoms. However, beta-blockers are not often recommended as a general or long-term social anxiety medication.

Other Medications

Depending on your symptoms, your provider may recommend other medications, including antidepressants and anti-anxiety medications, including benzodiazepines. Unfortunately, many mental health medications take time to work. For some, it can take between three and four weeks to feel the initial effects of the medication and up to two or three months for the medicine to work fully. As a result, finding the “right” medication for you can be a process of trial and error.

It’s also important to remember that medication, while beneficial in some cases, isn’t meant for everyone. As you begin treatment to overcome social anxiety disorder, you’ll work closely with your provider to determine if medication should be part of your treatment plan. In some cases, such as co-occurring addiction and social anxiety, the addictive nature of certain medications means the drug isn’t a suitable treatment option.

At-Home Treatments

In addition to help from a qualified mental health provider, you can try lifestyle changes and techniques at home to help reinforce coping skills and promote anxiety reduction. These include avoiding caffeine, getting plenty of sleep, avoiding substances such as drugs or alcohol, and eating a healthy, well-balanced diet. Including exercise and physical activity into your routine is also highly beneficial.

If you or a loved one struggles with social anxiety, seeking help from a qualified mental health provider is the first step towards learning how to manage your symptoms. Without help and treatment, social anxiety can be crippling and lead to ongoing, debilitating challenges in all facets of one’s life. As a part of therapy, you’ll learn about the root causes of anxiety. Treatment will also provide the tools needed to cope with anxiety-producing or “triggering” situations in the future. Learning and practicing these tools in the safe and supported setting of a treatment center offers a sense of safety and security that is vital to beginning the recovery process.

Healing with J. Flowers Health Institute

Anxiety disorders, including social anxiety, aren’t curable. However, like many other mental health challenges, therapy can minimize the struggles and challenges they present through a skilled treatment center like J. Flowers Health. If you’re ready to overcome social anxiety, contact us today to learn how our programs can help. Members of our caring and compassionate admissions team are here to answer your questions and help you get started towards a future free from anxiety.