What is Social Anxiety Disorder? Signs, Symptoms, and Treatment

According to the NIH, approximately 1 in 8 adults experience social anxiety disorder (SAD) at some point in their life [1]. 

SAD is more than just feeling nervous before speaking in public or attending a social event. It’s a chronic mental health condition that involves an overwhelming and persistent fear of social situations where one might be judged or scrutinized by others. While occasional nervousness is normal, individuals with SAD experience intense fear that significantly impacts their daily lives [1]. 

Suppose you struggle with intense nervousness around social situations. In that case, identifying the symptoms, triggers, and causes of social anxiety as well as exploring effective self-help strategies and treatments will help support your mental wellness.

What is Social Anxiety Disorder (SAD)?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), SAD is defined as a marked and persistent fear of one or more social or performance situations in which you might be exposed to possible scrutiny by others [2]. If you struggle with social anxiety disorder, you might worry about being humiliated, judged, or negatively evaluated in front of others so much that you avoid social situations. These fears can become so disruptive that they interfere with work, school, relationships, and your overall daily life. 

Social Anxiety vs. Shyness 

While many people may feel shy or nervous in unfamiliar social situations, social anxiety is much more intense and persistent. Shyness usually doesn’t lead to significant distress or avoidance of social interactions, but if you have social anxiety, the fear can be overwhelming and lead to complete avoidance of social settings. 

Types of Anxiety Disorders Related to Social Situations

Social anxiety can manifest in different types of anxiety. Here are the general types of anxiety you may experience or be diagnosed with related to social situations. 

Social Anxiety Disorder 

People with social anxiety disorder experience intense fear and anxiety in social situations. This chronic mental health condition can cause people to struggle with functioning in social situations such as at school, work, and spending time with loved ones. 

Generalized Anxiety Disorder (GAD)  

Generalized anxiety disorder involves feeling excessive worry every day, across a wide range of situations and events. This means you are constantly worrying and can’t control it, affecting your daily life. 

Specific Phobia Disorder 

This condition includes feeling fear or anxiety about a specific situation or thing. This can range from social phobias such as the fear of public speaking, or fear of crowds, but can also include specifiers such as the fear of: animals, natural environments, blood-injection-injury, blood, injections and transfusions, other medical care, injury, situational, and many others. Specific social phobias entail more targeted fears, such as performing on stage or eating in front of others [2]. 

Separation Anxiety Disorder 

This condition causes people to excessively fear or worry about being separated from their loved ones or their home. This can include intense distress when separated, fear of being lost or kidnapped, or nightmares around separation. 

Panic Disorder 

Panic disorder causes people to have frequent and unexpected panic attacks. They are a sudden wave of fear, a feeling of losing control, or intense discomfort when there is no clear external trigger.  

Agoraphobia 

Agoraphobia is the fear of being trapped, helpless, or embarrassed. This can manifest as an intense fear of being in situations where escape might not be possible or where help is not available.

Related: What is Anxiety? 

Signs and Symptoms of Social Anxiety Disorder 

Social anxiety disorder symptoms are often categorized into emotional, physical, behavioral, and cognitive manifestations [3, 4, 5]. 

Emotional Symptoms 

Emotional symptoms of SAD can manifest in various ways. You might experience intense fear of social situations, meaning you feel an overwhelming sense of dread before social interactions, especially those involving strangers or authority figures.

If you struggle with SAD, you might experience excessive self-consciousness, or a constant worry about how others perceive you, leading to a fear of making mistakes and difficulty maintaining healthy personal relationships. Additionally, you might struggle with fear of judgment or embarrassment, which manifests as a profound concern about being criticized or embarrassed in front of others [3].

Physical Symptoms 

With social anxiety disorder, you might notice a rapid heart rate due to the body reacting to social stress and creating feelings of panic. Additionally, you might notice sweating and trembling, which are difficult to control in social settings. You might also experience nausea, dizziness, or lightheadedness in social situations, which only intensify your sense of fear and anxiety [4]. 

Behavioral Symptoms 

Behavioral symptoms can manifest due to social anxiety disorder. You might avoid social situations, gatherings, parties, or even everyday interactions like making phone calls. You might also have difficulty making eye contact or speaking softly, appearing quiet and withdrawn. You might also experience rigid body posture, feeling physically tense, or having awkward body language.  

Cognitive Symptoms 

SAD can also present cognitive symptoms. You might experience negative self-talk, constantly put yourself down, or anticipate failure. You might also overthink, analyze every word and action during or after social interactions, or experience rumination [5]. 

Common Triggers for Social Anxiety 

Social anxiety can be triggered by a variety of situations, including [5]: 

• Public speaking 
• Meeting new people 
• Dating 
• Eating or drinking in public 
• Using public restrooms 
• Interactions in the workplace  
• Performance-related situations like sports or music 

Causes and Risk Factors 

Understanding the causes and risk factors of social anxiety can help you seek the most effective treatment possible. 

Biological Factors 

Research suggests that social anxiety can run in families, indicating a genetic predisposition. Additionally, changes in brain regions associated with fear and anxiety, such as the amygdala, may play a role in developing SAD [2]. 

Environmental Factors 

Traumatic childhood experiences, such as bullying or overprotective parenting, can increase the risk of developing social anxiety disorder. Additionally, negative encounters in social settings may lead to an ongoing fear of similar situations [7]. 

Psychological Factors 

If you are more introverted or a perfectionist, you may be more prone to developing social anxiety. Over time, if you struggle with SAD, you might develop patterns of avoidance or negative thinking that reinforce your anxiety. 

Sociocultural Influences 

Pressure to conform to societal norms or standards of success can exacerbate social anxiety, and the constant comparison to others on digital social media platforms can heighten feelings of inadequacy [5].

Related: What Causes Mental Illness?

How is Social Anxiety Disorder Diagnosed?

Social Anxiety Disorder is diagnosed using criteria in the DSM-5, which outlines the frequency, intensity, and duration of symptoms [2]. In addition to clinical interviews, assessments may include self-report questionnaires and behavioral observations to better understand the severity of the disorder. 

It’s important to differentiate social anxiety from other mental health conditions, such as [2]: 

• Other anxiety disorders (e.g., generalized anxiety disorder, panic disorder). 
• Mood disorders, like depression. 
• Autism spectrum disorders, where social difficulties may be a symptom but not the primary cause of distress. 

Impact of Social Anxiety Disorder on Daily Life 

Social anxiety might affect various aspects of your life: 

Academic and Professional Implications 

Difficulty participating in class, meetings, or public speaking events can hinder academic or career success. Additionally, missed opportunities for promotion or career advancement could occur due to social fears. 

Relationship Challenges 

If you have SAD, you might struggle to make and maintain friendships and have difficulty forming romantic relationships due to fear of judgment [3]. 

Personal Well-being 

Social anxiety can lead to lowered self-esteem, increasing the risk of developing depression and other mental health issues. 

Physical Health Consequences 

Chronic stress from ongoing anxiety can weaken the immune system, potentially making you more susceptible to illness. Additionally, if you have SAD, you might turn to substances as a way to cope, which negatively impacts your mental and physical wellness [7]. 

Self-Help Strategies for Managing Social Anxiety 

Alongside professional treatment, there are many self-help strategies that can help you manage social anxiety: 

Self-Care to Manage Anxiety 

You could also practice self-care by developing self-compassion, reinforcing positive self-talk, and developing a healthy lifestyle with regular exercise, a balanced diet, and good sleep hygiene. Additionally, it might be helpful to join support groups or social skills classes to build confidence or engage in anxiety management apps or online resources to learn coping techniques for managing anxiety [3, 5]. 

Support Systems to Encourage Social Interactions 

Having a supportive network can help tremendously to overcome social anxiety. It’s helpful for family and friends to educate themselves about the mental health condition and encourage treatment for their loved ones.

Additionally, mental health support groups, both in-person and online, provide a sense of connection with others who understand the struggle of living with social anxiety. Lastly, workplace accommodations, such as flexible schedules or reduced social expectations, can help alleviate anxiety at work [4, 7]. 

Breaking the Stigma Around Social Anxiety 

Despite its prevalence, social anxiety is often misunderstood. Recognize that social anxiety is not a sign of weakness but a legitimate mental health condition. Educating the public and encouraging open conversations about mental health is important for reducing stigma and promoting treatment. Social anxiety is treatable, and many individuals experience significant improvement with consistent treatment [3].

Related: Destroying the Stigma of Mental Health Disorders

How is Social Anxiety Disorder Treated?

At Clear Behavioral Health, we take a holistic approach to treating social anxiety disorder, focusing on personalized treatment plans that incorporate mindfulness, group therapy, and evidence-based therapy techniques, including cognitive behavioral therapy (CBT) and exposure techniques. Our multidisciplinary team of mental health professionals provides continuous care, helping you or your loved one build resilience and experience lasting social confidence. 

Cognitive Behavioral Therapy (CBT) 

At Clear, our providers are experts in a range of treatment modalities, including CBT, to ensure that you receive evidence-based and affective care for your social anxiety. CBT is a highly effective approach for treating social anxiety, which focuses on identifying and challenging negative thought patterns that fuel anxiety. It also encourages gradual exposure to feared social situations, helping you build confidence and enhance interaction abilities.  

Medication Management 

At every level of care, we offer medication management, which can help you regain a sense of equilibrium. We will help you find an anti-anxiety medication that works for you and complements your treatment. Selective serotonin reuptake inhibitors (SSRIs) as well as serotonin norepinephrine reuptake inhibitors (SNRIs) can help balance serotonin levels, reducing anxiety symptoms. Additionally, beta-blockers are often used for performance anxiety to control physical symptoms like rapid heartbeat [3]. 

Group Therapy 

At Clear, we believe in fostering peer support and social networks for ongoing mental health care. Our group therapy sessions provide a safe space for you to practice social skills and share experiences with others facing similar challenges. 

Mindfulness and Relaxation Techniques 

We’re dedicated to providing holistic treatment options to ensure you receive comprehensive care. For instance, we implement mindfulness practices, such as deep breathing and progressive muscle relaxation, which can help reduce the physical symptoms of anxiety [5]. As well as many other holistic treatments included in our anxiety treatment program.

Overcoming Social Anxiety Disorder

Social anxiety disorder can significantly impact your life, but with the right treatment and support, it’s possible to overcome its challenges. At Clear Behavioral Health, we are committed to providing personalized, compassionate care for those struggling with social anxiety.

We provide our comprehensive anxiety treatment program throughout the Los Angeles, California area, including Santa Clarita, Van Nuys, and El Segundo. We also offer anxiety treatment for teens through our teen outpatient program, and our virtual intensive outpatient program (IOP) is a great option for those looking for a more accessible treatment. If you or someone you know is struggling with social anxiety, don’t hesitate to reach out for support — help is available today. 

References

1. National Institute of Mental Health (n.d.). Social anxiety disorder.  https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder  
2. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787  
3. Mayo Clinic (2021). Social anxiety disorder (social phobia). https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561 
4. National Alliance on Mental Illness (2017). Anxiety Disorders. https://www.nami.org/about-mental-illness/mental-health-conditions/anxiety-disorders/  
5. National Institute of Mental Health (2022). Social anxiety disorder: more than just shyness. https://www.nimh.nih.gov/sites/default/files/documents/health/publications/social-anxiety-disorder-more-than-just-shyness/social-anxiety-disorder-more-than-just-shyness.pdf  
6. Brook, C. A., & Schmidt, L. A. (2008). Social anxiety disorder: a review of environmental risk factors. Neuropsychiatric disease and treatment, 4(1), 123–143. https://doi.org/10.2147/ndt.s1799 
7. Anxiety & Depression Association of America (n.d.) Social anxiety disorder. https://adaa.org/understanding-anxiety/social-anxiety-disorder