Social anxiety

Social anxiety

What is Social Anxiety Disorder? (Social Phobia)

Social Anxiety Disorder, also known as social phobia, is a type of anxiety disorder characterized by excessive fear, anxiety, discomfort, and self-consciousness in social settings. While it is normal for people to feel anxious in some social settings, individuals with social anxiety disorder (social phobia) have a heightened fear of interaction with others in a variety of social interactions and worry they will be scrutinized by others. This intense anxiety causes impairment in functioning and interferes significantly with the individual’s life and relationships.

People with social anxiety typically know that their anxiety is irrational, is not based on fact, and does not make rational sense. Nevertheless, thoughts and feelings of anxiety persist and are chronic in nature.

Common Triggers

People with social anxiety commonly experience significant worry and distress in the following situations:

  • Eating in front of other people
  • Speaking in public
  • Being the center of attention
  • Talking to strangers
  • Going on dates
  • Meeting new people
  • Interviewing for a new job
  • Going to work or school
  • Meeting other people’s eyes
  • Making phone calls in public
  • Using public restrooms


An individual may experience physical, emotional, and behavioral symptoms of social anxiety disorder. These symptoms can significantly affect the individual’s daily life and relationships.

Physical Symptoms

  • Rapid heat-beat
  • Dizziness
  • Muscle tension or twitches
  • Stomach trouble
  • Blushing
  • Trembling
  • Excessive sweating
  • Dry throat and mouth

Emotional Symptoms

  • High levels of anxiety and fear
  • Nervousness
  • Panic attacks
  • Negative emotional cycles
  • Dysmorphia concerning part of their body (most commonly the face)

Behavioral Symptoms

  • Avoiding situations where the individual thinks they may be the center of attention
  • Refraining from certain activities because of a fear of embarrassment
  • Becoming isolated; the individual may quit their job or drop out of school
  • Excessive drinking or substance abuse

DSM-5 Diagnostic Criteria

Your healthcare provider will diagnose social anxiety disorder from a description of your symptoms and behavioral patterns. During your appointment, you will be asked to explain what symptoms you are having and discuss situations in which these symptoms present themselves. The diagnostic

criteria for social anxiety disorder, as outlined in the DSM-5, include:

  • Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others lasting for 6 months or more.
  • Fear of acting in a way that will reveal anxiety symptoms that will be negatively evaluated by others. In children, the anxiety must occur when the child is among peers and not just adults.
  • The social situations almost always cause fear and anxiety.
  • The social situations are avoided or endured with intense fear.
  • The fear or anxiety is out of proportion to the actual threat posed by the situation.

Causes and Risk Factors

The exact cause of social anxiety disorder (social phobia) is unknown. However, current research suggests it may be caused by a combination of environmental factors and genetics. While there is no causal relationship between childhood maltreatment or other early-onset psychological adversity and the development of social anxiety disorder, they can be considered risk factors.

Individuals prone to behavioral inhibition (the tendency to experience distress and withdraw from unfamiliar situations, people, or environments) and fear of judgement are also predisposed to social anxiety disorder. Genetics may also play a role in the development of social anxiety as these behavioral traits are strongly genetically influenced.

What’s more, social anxiety disorder is a heritable condition—first-degree relatives have a two to six times greater chance of having social anxiety disorder.

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Treatment Options

Social anxiety disorder is a fully treatable condition that can be overcome with effective therapy, commitment, and patience. We recommend locating a specialist in your area to find a treatment pathway that works best for you.  Some treatment options your doctor may suggest include:

Cognitive-Behavioral Therapy (CBT)

A huge body of research has shown cognitive-behavioral therapy (CBT) to be a markedly successful treatment for those suffering with social anxiety disorder (social phobia). The American Psychological Association defines cognitive-behavioral therapy as “a system of treatment involving a focus on thinking and its influence on both behavior and feelings.” CBT emphasizes the role of unhelpful beliefs and their influence on emotional and behavioral outcomes.

Social-anxiety-specific CBT focuses on changing the individual’s thoughts, beliefs, feelings, and behavior as they relate to social situations. “If the individual feels anxious about doing certain things and feels less anxious when they choose not to do them, this becomes a cycle whereby the individual learns that staying out of social situations keeps them emotionally regulated,” says Kelly Freeman, LCSW. “CBT challenges individuals to replace these thoughts.”

The cognitive part of the therapy refers to thinking and is the part of therapy that can be “taught” to the person. The act of practicing new thoughts through repetition when the individual notices unhelpful thoughts allows new patterns of thinking to become automatic. For instance, an individual might work to replace the anxiety-inducing thought of “everyone will stare at me if I go to the party” with “these feelings I am having right now aren’t rational. When the party is over, I’ll be glad that I went” in order to change the cycle.

The behavioral component of CBT involves attending group therapy with others diagnosed with social anxiety disorder. In the behavioral group, everyone participates in activities that are mildly anxiety-inducing to build confidence and a more rational perception in the person’s mind of what happens when they engage in these kinds of social activities. As a result, the anxiety felt in social situations is gradually reduced.

People with social anxiety disorder might also try various relaxation methods to relieve the symptoms of anxiety. Examples of techniques that have been shown to be helpful include: massage, meditation, mindfulness, hypnotherapy, and acupuncture. However, these methods do not help people fully recover from social anxiety. Only CBT can help those struggling make permanent progress against social anxiety by changing irrational thinking into rational thinking, and helping to induce habitual and appropriate behavioral responses.


Medication is a useful form of treatment for many, but not all, people with social anxiety disorder (social phobia). Research suggests that the use of anti-anxiety medications, such as benzodiazepines, and certain selective serotonin reuptake inhibitors (SSRIs) used in conjunction with CBT have been most beneficial. Only CBT can permanently change the neural pathway associations in the brain and therefore medication alone has no long-term benefits for people with social anxiety.

Source:  Jessica Truschel, Psycom.