Social Anxiety Disorder

Learn More About Social Anxiety Disorder

Social anxiety disorder is characterized by significant anxiety or fear during performance or social situations. In the US, it is estimated that approximately 12.1% of adults develop this disorder at some point during their lives. Also referred to as social phobia, it can cause you to avoid social situations and interactions due to the fear of them triggering your symptoms. 

Causes of Social Anxiety

Experts do not fully understand what causes social anxiety disorder, but they believe that it involves a combination of biological, psychological, genetic, and environmental factors. 

Some evidence shows that there may be a genetic predisposition to developing this disorder. If a close family member has anxiety, you might be at an increased risk

Brain chemical imbalances may contribute to social anxiety disorder. Your mood, emotional response to social stimuli, and anxiety levels may be affected by dysregulation of these brain chemicals.

Certain environmental factors might increase your risk of this disorder. These factors could include childhood trauma, neglect, adversity, abuse, or other adverse life events. 

Cognitive factors, such as maladaptive thinking patterns, negative self-beliefs, or irrational thoughts regarding social situations, may be involved. Individuals with this disorder may experience various cognitive distortions, such as overgeneralizing or catastrophizing, resulting in avoidance behaviors and increased anxiety.

People with certain personality traits might be at a higher risk for developing social anxiety disorder. Examples include shyness, perfectionism, introversion, and low self-esteem. Those with these traits could have heightened sensitivity to criticism or social evaluation, making them more vulnerable to this disorder. 

Social Anxiety Symptoms

Those with this disorder often experience a range of physical, emotional, and behavioral symptoms. Individuals may have an extreme fear of evaluation. This means that they are afraid of being criticized or judged. It is common to avoid social situations in these cases. For example, people may avoid attending social events or parties, refuse to use public restrooms, and avoid eating in front of others. 

Physical symptoms may occur with social anxiety disorder. These may include sweating, rapid heartbeat, dizziness, muscle tension, trembling, blushing, nausea, shortness of breath, and gastrointestinal discomfort. 

This disorder may cause negative self-perception. Clients might believe that they are inferior, unworthy, or inadequate. These issues could result in them constantly berating or criticizing themselves. 

Social anxiety disorder can interfere with a person’s social skills. It can make it difficult to maintain conversations, engage in small talk, or make eye contact. This disorder can also have a negative impact on interpersonal relationships, including romantic relationships, friendships, or professional connections.

Anticipatory anxiety is another issue. When you have an upcoming social event, you may experience anxiety related to it for the days or weeks leading up to it. For some people, this could make it difficult to function normally. 

The symptoms of social anxiety can vary greatly in severity and fluctuate over time. For some people, the symptoms can become so severe that it is difficult for them to be in any occupational or social setting. 

Possible Complications

There is a risk for social anxiety disorder, especially if the condition goes undiagnosed and untreated for a prolonged period of time. 

Issues at work or in school may occur as a result of this disorder. For example, people may have difficulty pursuing new career opportunities or taking part in academic group projects.

It is not uncommon for this disorder to coexist with other mental health conditions. Such conditions might include depression, avoidant personality disorder, and generalized anxiety disorder. This condition may also increase the risk of substance misuse issues

Some people experience issues with their physical health due to the chronic anxiety and stress that can occur with social anxiety disorder. Examples may include sleep disturbances and frequent headaches. 

Diagnosing Social Anxiety

To diagnose this disorder, a qualified healthcare professional will take your medical history, evaluate your symptoms comprehensively, and conduct a psychological assessment. They will use the DSM-5 to make a diagnosis since it outlines the specific criteria someone has to meet to be diagnosed with social anxiety disorder. 

To diagnose this disorder, a person should have intense anxiety and fear in performance and social situations. This should last for a minimum of six months. You should also have impairment or distress as a result of your symptoms and exhibit avoidance behaviors. 

To rule out other conditions, your healthcare professional may perform medical testing, such as imaging or laboratory tests. For example, some medications may cause side effects that are similar to some of the symptoms of this disorder. 

As part of the diagnostic process, professionals may use different questionnaires, standardized screening tools and rating scales to determine the severity of your symptoms. These may be repeated during the treatment process to track changes to see how you are responding to treatment. In some cases, they might suggest that you keep a journal of your symptoms to get a better idea about how they are affecting your daily life. 

Social Anxiety Treatment Options

Treating this disorder often involves combining several treatment methods, including psychotherapy, lifestyle modifications, medication and support services.


Exposure therapy and cognitive behavior therapy are commonly used to treat social anxiety disorder. These are often used together to help people to manage their symptoms.

Cognitive behavioral therapy helps you learn how to identify specific emotions, behaviors, and thoughts that are causing your distress. This allows you to explore these feelings more deeply and then reframe them so that they become helpful. Some research suggests that this psychotherapy is the most beneficial for treating social anxiety disorder. 

Exposure therapy is a component of cognitive behavioral therapy. When you are undergoing this therapy, you will experience gradual and systematic exposure to performance or social situations that are known to cause you anxiety and fear. This makes it possible to confront them in an environment that is safe. As a result, you can work toward overcoming avoidance behaviors, decreasing anxiety and building confidence. 


Selective serotonin reuptake inhibitors are usually the first type of medication that a healthcare professional prescribes for this disorder. They might also consider serotonin and norepinephrine reuptake inhibitors. Your provider may start with a low dose and then gradually increase it, depending on symptom improvement. It can take time to notice a noticeable improvement in your symptoms. 

Certain other medications might be considered, depending on your symptoms, their severity, and how well you are responding to your current treatment regimen. These include other antidepressant medications, beta blockers, and anti-anxiety medicines. 

Lifestyle Modifications

You can use different lifestyle modifications along with prescribed treatments. Just make sure to talk to your healthcare professional about these first so that they are aware of what you are doing at home to help better manage your condition. 

Work on reducing your stress since stress may worsen your symptoms. Strategies that may help with this include getting regular exercise, practicing mindfulness and engaging in meditation. 

Make sure that you are getting enough sleep. Inadequate sleep could contribute to your symptoms getting worse. If you are experiencing sleep troubles, talk to your provider. You can also work on establishing a regular sleep schedule. This could be especially helpful if your social anxiety is causing insomnia.

It is also important to avoid alcohol and to avoid or limit caffeine. Both of these substances could increase your risk of experiencing anxiety symptoms.

Reach out to individuals you trust. Even just talking on the telephone can help you practice being in social situations. However, if it is just one trusted person, this puts less pressure on you. 

Support Services

Support services can work along with your prescribed treatment regimen to help you better manage your social anxiety. These services might include peer counseling, support groups and community-based programs. Utilizing these services helps you to know that you are not alone and that other people are also living with this disorder. This can help reduce feeling isolated and help you gain additional coping strategies and insights. 

Outlook for Social Anxiety

Factors like access to treatment, symptom severity and how well you respond to treatment ultimately affect the outlook. However, with a proper and prompt diagnosis and treatment, people can experience significant improvement in their quality of life and symptoms. 

Preventing Social Anxiety Disorder

There is no way to fully prevent this disorder. However, there are some steps that you can take to reduce your risk. This is especially important if you have any of the risk factors of social anxiety disorder. 

As soon as you start to notice symptoms, make an appointment with a healthcare professional. This could help decrease the chances of your symptoms becoming more severe. 

Keep a daily journal where you can track any symptoms you are having and what is happening in your life. This could help you better identify what causes your symptoms and what makes them worse or better.

It is also important to work toward finding balance in your life. You need to make time for the activities that you enjoy and balance time for these with time to attend to your responsibilities. 

Professional Help for Social Anxiety

Social anxiety can be debilitating, but it is a common mental health disorder. If you are struggling with the symptoms, it is imperative to seek help as soon as possible. There are options to help alleviate your symptoms so that you can better navigate a variety of social situations and interactions. 

For additional help and resources, you can reach out to the National Depression Hotline. Our specialists can provide immediate support and intervention for those experiencing a crisis. We can also provide you with information about local resources for social anxiety treatment and support. This hotline is confidential and free. Call today to get the help you need for your social anxiety disorder.


Medically Reviewed By:

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

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