Social anxiety disorder is an anxiety disorder characterized by the intense fear of being negatively evaluated, judged, or rejected in various social or performance-based settings. People struggling with social anxiety disorder experience excessive worry about how others will perceive them. They may fear being seen as stupid, ugly, or awkward. They may worry about offending someone unintentionally. They often assume that, no matter the context, people are automatically judging them.
It’s no surprise that this anxiety often causes avoidance of social interactions. People may turn down work opportunities or decline to attend weddings, dates, or parties. When a social situation cannot be avoided, the individual often experiences a pervasive sense of distress. This anxiety makes it difficult to enjoy the social function. Even when the individual can take a moment to have fun, they often find themselves ruminating over potential social mistakes after leaving the event.
Social anxiety disorder can manifest in different situations. Some people experience it in all social settings. Others may have concentrated anxiety in just one or a few situations. Some examples of these troubling situations include:
- Public speaking
- Interacting with strangers
- Making phone calls
- Attending parties
- Using public restrooms
- Eating in public
- Making eye contact
- Initiating conversations
- Entering a room
- Speaking to authority
- Taking exams
- Being the center of attention
Social anxiety disorder often results in excess shame and guilt. The individual usually recognizes the excessive worry but often feels powerless in stopping or reducing it. As a result, he or she may feel like something is seriously wrong, which can trigger self-deprecating thoughts and feelings. Unfortunately, if untreated, this vicious cycle often tends to perpetuate social anxiety.
Symptoms
People with social anxiety disorder tend to exhibit some or all of the following symptoms:
- Experiencing recurrent anxiety related to social or performance situations
- Experiencing intense anxiety when being exposed to the feared situation
- Identifying that the fear is excessive or disproportionate
- Avoiding stressful events altogether
- Experiencing anxiety that others will notice symptoms of nervousness and discomfort
- Experiencing avoidance, anxiety, or distress in a way that interferes with other areas of functioning (occupational, academic, relationships)
- Persistent anxiety that lasts at least 6 or more months
Many people also experience physical symptoms indicating anxiety. These symptoms may include:
- Blushing
- Shortness of breath
- Nausea and upset stomach
- Trembling and shaking of the voice
- Increased heart rate
- Hot flashes
- Sweating
- Fainting
- Panic attacks
It is important to note that these symptoms can also indicate the presence of another mental illness. For example, social anxiety disorder often coexists with conditions like depression, substance use disorders, eating disorders, and ADHD.
Causes
Researchers have not discovered a single root cause for social anxiety disorder. Instead, the condition likely manifests from a variety of factors.
Genetic: Anxiety disorders run in families. Individuals with anxiety can unknowingly pass down this condition generationally. This trend may be a result of both genetic and psychological variables.
Trauma: Aversive experiences like physical, sexual, or emotional abuse may increase the susceptibility for someone developing social anxiety disorder. Trauma inherently challenges an individual’s sense of safety in the world. When people feel unsafe, they may be more hypervigilant, paranoid, and skeptical of other people and situations.
Neurochemical: Research on brain chemistry indicates that deficits in serotonin and dopamine may contribute to social anxiety disorder. Serotonin supports regulating emotions and mood, and dopamine helps regulate pleasure. If there are imbalances in the brain, the individual may be more vulnerable to anxiety.
Treatments
Although there isn’t a cure for social anxiety, proper diagnosing, treating, and managing can help people cope with their symptoms and live full and meaningful lives.
Psychotherapy
Individual therapy provides a safe and supportive environment for people who want to work on their social anxiety. There are numerous types of therapy options available, and particular methods will work better for some people than others.
Cognitive-Behavioral Therapy (CBT): CBT is an evidence-based theoretical orientation that can treat social anxiety disorder. In CBT, clients learn how to identify and challenge irrational or distorted thoughts. They also learn healthier coping strategies for managing their anxiety when it arises. Many therapists help clients gradually work up to facing their feared situations. This exposure helps desensitize clients, which promotes more empowerment in daily living.
Group Therapy: Anxiety support groups can be helpful for individuals to discuss their symptoms, practice new skills, and receive feedback from their peers. While group formats vary, most groups include a combination of education, practical skills, and open-ended processing. Groups may be open, which means clients can enter the group at any time, or they may be closed, which means that they have a set start and end date.
Medication
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) like Prozac, Zoloft, and Celexa help treat persistent symptoms associated with social anxiety disorder. Most clients start at the lowest dose, and they may gradually increase their dose if symptoms do not improve.
Benzodiazepines: Benzodiazepines like Xanax, Klonopin, or Ativan can help reduce anxiety symptoms. That said, these medications are typically only prescribed for short-term use, as they are sedative and can be habit-forming.
Final Thoughts
Social anxiety disorder can be frustrating, scary, and confusing for individuals and their loved ones. People may feel hopeless about their condition; they may worry that they’ll never feel comfortable in certain social settings.
Recovery is attainable. No matter the circumstances, it is possible to manage even the most intense symptoms. Anxiety doesn’t have to define anyone; with the right treatment, it is possible to increase confidence and comfort within oneself and around others.
