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Social Anxiety Disorder: Symptoms, Causes, Treatment, Coping Strategies

Social Anxiety Disorder (Social Phobia)

What Is Social Anxiety Disorder

Social Anxiety Disorder (SAD), which is also referred to as Social Phobia, is a disorder that causes a person to feel intense fear in social situations that involve interaction with other people, or in public performances, such as public speaking.

People with social anxiety often fear that they are being watched, judged, and evaluated by other people. It is often confused with shyness or low self-esteem. According to the Social Anxiety Association, Social Anxiety Disorder is the third largest psychological problem in the world today (about 7% of people suffer from this condition).
Social Anxiety Disorder: Social Phobia: Definition, Symptoms, Causes, Treatment: Psychotherapy (psychological counselling) and medication, Help, Overcome and Coping

DSM-IV and DSM 5 Social Anxiety Disorder/ Social Phobia Comparison

The fear that people with social anxiety experience is brought on by many different types of social situations, including speaking in public, speaking to strangers or meeting new people, using public restrooms, speaking on the telephone, eating, drinking, or writing in public, attending parties or large gatherings, talking to authority figures, talking to co-workers, shopping, community or job related meetings, crowded places, and entertaining. As you can see, social anxiety can affect the quality of a person’s life quite deeply.

Social anxiety is a mental health disorder that is difficult to understand because it is amongst the last anxiety conditions discovered by doctors, and hence, not widely read by doctors, though psychiatrists are the most familiar. Even though the medical community is finally starting to recognize and treat the symptoms of social anxiety, people who suffer from the disorder are still misdiagnosed many a time.

The fear often causes a multitude of physical symptoms, such as heart palpitations, tremors, sweating, diarrhea, confusion, blushing, nausea, difficulty talking, muscle tension, dry mouth, muscle twitches, dizziness, shortness of breath, chest pain, difficulty swallowing, and paleness. This disorder also brings on other problems, such as feelings of being overwhelmed, feelings of embarrassment, self-consciousness, distorted thoughts, an overwhelming feeling of needing to escape, and feelings of inadequacy. Even the anticipation of being in a social situation can cause a socially anxious person to feel fearful.

Because people with SAD often have panic attacks, some researchers believe that social anxiety disorder has a biological, or biochemical cause. Other researchers do not believe that this is so. However, studies are currently being done to see if there is a possibility of social anxiety disorder being inherited through blood lines. Often, people become socially anxious due to having a bad social experience. Another possibility is learned behavior. If a parent had social anxiety, or demonstrated negative social behaviors, a child can easily learn those behaviors, and develop social anxiety.

Many famous people suffer from social anxiety disorder, including Jerry Seinfeld, Kim Basinger, Donny Osmond, Barbara Streisand, Sir Laurence Olivier, Susie O’Neill, Rebecca Gibney, Gary MacDonald, and Simon Palomares. As performers, many of these stars have learned to deal effectively with their social anxiety disorder. Their bravery in dealing with their social anxiety has been a great encouragement to other sufferers of SAD everywhere.

Symptoms of Social Anxiety Disorder: Signs of Social Phobia

Social Anxiety Disorder (or Social phobia) is distinguished by feelings of apprehensive around others and nervousness. There is also a deep feeling of humiliation or embarrassment when a person with social anxiety is faced with group or single social situations, so much so that they fear being watched or unpleasantly evaluated by others. Other symptoms include:
  • Feeling of self-consciousness around others
  • Feeling that others are judging or staring at you
  • Feeling that others see your nervousness
  • The inability to relax around others
  • A fear of being seen as stupid
  • Avoidance of or escaping from most social interactions or the need to endure a lot of distress if socializing
  • Sweating
  • Racing heart
  • Trembling
  • Abdominal discomfort
  • Breathing problems
  • Dry mouth
  • Physical tingling
  • Lack of concentration
  • Weakness of the legs
  • Urge to urinate frequently
  • Blushing
  • Twitching of muscles
These are the most common symptoms experienced by the people who have social anxiety. You may experience other symptoms, or these symptoms in different degrees. If you are having symptoms that are new or severe, you should seek medical help.

Causes of Social Anxiety Disorder: Social Phobia Risk Factors

The causes of social anxiety disorder are many. The risk of developing social phobia for relatives of people with social phobia is about 3 times higher than that of an unencumbered family. Studies impressively show that genetic factors are of crucial importance for the development of the disease.

In addition to a biologically based susceptibility to the development of social phobia, learning processes such as avoidance learning also play an important role. The theory of avoidance learning states that first an anxiety reaction to certain stimuli is learned. For example, one student stutters when answering a question from the teacher and the other students laugh. In this way, social situations in which the student feels valued can be linked to fear and shame. In the next step, the student will try to avoid such situations by, for example, skipping school and otherwise avoiding contact with classmates because he feels less fear and shame. Reducing fear works internally as a reward for avoiding social situations.

So, as is the case with most mental disorders, social phobia arises from a complex interaction of the genes and the environment. Probable causes for the condition are:
  • Genetic: social phobia runs in families. On the other hand, it’s not obvious how much may be because of genes and how much because of learned behavior.
  • Structure of the brain: amygdala, present in the brain, may play a part in governing one’s fear response. Those having an overactive amygdala, may have a greater response to fear, thus triggering increased nervousness in social situations.
  • Brain chemistry: natural chemicals present in the body have a pivotal role to play in the development of social phobia. A disproportion in serotonin (a neurotransmitter) may be a contributing factor; it regulates moods and emotions of a person.
  • Negative incidents: children who have experienced bullying, teasing, denial, mockery or humiliation are more liable to social phobia. Family clashes and sexual abuse is also linked to the condition.
Social phobia, more often than not, commences in the early to mid-teens; risk factors associated with the condition are:
  • Gender: women are more likely than males to have social phobia.
  • Family history: is a predisposing factor.
  • Disposition: children who are shy, introverted, timid, or restrained are at greater risk of developing social anxiety disorder.
  • Environment: social phobia may also be a learned behavior. The disorder could also develop when you see the anxious conduct of others. Also, the condition is common in children whose parents who are more authoritarian.
  • Work demands: having to give a speech in public, meeting new people, making work presentations may prompt social phobia symptoms for the first time. These manifestations generally commence during adolescence.
  • A health condition which tends to draw everyone’s notice: stuttering, disfigurement of the face, Parkinson's disease, etc. may increase feelings of shyness and embarrassment, and could cause social phobia in certain people.

Social Anxiety Disorder Treatment

Psychotherapy (psychological counseling) and medication are used to treat social phobia. The therapeutic measures are carried out in close consultation with the patient, and a combination treatment of psychotherapy and medication is often used. Social phobia can be treated both as part of a single therapy and as part of a group therapy.

Psychotherapy/Counseling for Social Anxiety Disorder

Counseling helps ameliorate the symptoms of the disorder in most people. You will be taught how to identify and alter negative thoughts about yourself. Cognitive behavioral therapy or CBT is the commonest type of counseling. CBT is based up on the suggestion that your own thoughts decide how you behave; not other people of situations. An undesirable situation will not change; however, you can alter the way you think and act.

Counseling will also help you work up to facing the situations that you fear the most. It will help you become better skilled at handling fear-inducing situations and helps develop self-confidence to face them. Your counselor will also teach you stress management techniques for relaxation and rejuvenation.

The effectiveness of cognitive behavioral therapy is best proven in which the person concerned speaks about his thoughts and fears and becomes aware of the irrationality of his thoughts. For example, many people with social phobia fear that a disaster will happen when other people realize that they are fearful or insecure, sweat, shiver, and blush. It is discussed with the patient that these fears are unfounded. On this basis, patients are instructed to calm themselves down, that is, to counter calming thoughts with disastrous thoughts. In the further course of the therapy, the patients then expose themselves to the fear-triggering situations in practice and learn to use the strategies that were previously practiced there.

Recent studies have also shown good results in particular fear-related forms of deep psychological or psychodynamic psychotherapy. The concrete fear in social situations is often based on a deeper, unconscious fear, which "feeds" the symptoms like a hidden source from the depths again and again. This can be based on experiences, for example, that caregivers in childhood did not offer sufficient security to build stable self-esteem, or that this was shaken by experiences of humiliation or neglect. Although the person concerned is then aware that he has nothing to fear in social situations today, the "old fear" of not being valuable enough or being rejected is always coming up unconsciously. In therapy, the connection to "old fear" is established and processed in a lasting relationship with the therapist.

Other interventions such as relaxation procedures (autogenic training, progressive muscle relaxation), social skills training and hypnotherapy can also be helpful for social anxiety disorder.

Medications for Social Anxiety Disorder

Various medicines are used to manage social phobia. However the first type of drug tried for unrelenting symptoms of the disorder are selective serotonin re-uptake inhibitors or SSRIs.
The mental health provider may also prescribe:
  • Anti-depressants
  • Anti-anxiety medications
  • Beta blockers, which block the stimulating effect of adrenaline, and decrease blood pressure, heart rate, and shaking of voice and limbs.
Antidepressants are drugs that are often used to treat depression, but also have an effect on anxiety. The so-called selective serotonin reuptake inhibitors, which include active ingredients such as citalopram, sertraline and paroxetine, have proven particularly effective in the treatment of social phobia, but other antidepressants are also effective (e.g. venlafaxine). The drugs cause a change in the concentration of transmitters between nerve cells, so-called neurotransmitters, and have no potential for dependency.

The medication must be taken regularly because this is the only way to achieve an effective blood level. To cut down the side effects, the physician will begin with a low dose and will gradually increase to a full dose.

When treating social phobia, caution should be exercised with drugs that directly relieve anxiety, such as benzodiazepines offered. With prolonged use there is a risk of developing addiction. Since alcohol also has a short-term anxiolytic effect, it is not uncommon for those affected to drink alcohol regularly to calm themselves down. So here too there is a risk of developing alcohol addiction.

For some, the manifestations of social anxiety disorder may weaken over time, and the medicines may be discontinued; whilst others may need the drugs for several years to prevent recurrences.

Visiting Self-help groups and involvement in initiatives by those affected are an important way to escape the vicious circle of fear and social withdrawal. Not only is mutual support important, but also commitment to more knowledge and acceptance of social fears in society and to better treatment options. 

If outpatient treatment is not sufficient or is not possible due to very severe symptoms, inpatient treatment in a specialist clinic with special psychotherapeutic treatment options for patients with anxiety disorders is advisable.


The prospects of a cure depend not insignificantly on the duration of the illness and the accompanying illnesses. With a long history and an accompanying addiction disease, the prospects of a cure are less favorable than if treatment is started after a short period of illness and there are no comorbidities. Overall, studies show that psychotherapy as well as medication are effective. It is assumed that up to two thirds of the treated patients experience a significant improvement in symptoms.

Coping Social Anxiety Disorder: How to Calm Social Phobia

Some coping methods that may be helpful to ease your social anxiety include:
  • Reach out to people with whom you feel safe and comfortable
  • Join a group which will provide you with opportunities to enhance communication and public speaking skills
  • Do enjoyable activities, like, exercise, dancing, pottery, gardening, etc, when anxious
  • Get adequate sleep
  • Eat a well-balanced, wholesome diet
  • Practice meditation
With time, these methods will help you control your symptoms of the disorder and put off recurrences as well.

  See here for 3 Fear Busting Self Help Strategies for Social Anxiety

See also for Ways to Relieve Anxiety:
1. Techniques to Reduce Stress and Anxiety
2. Meditation Techniques for Anxiety and Stress Relief

Shyness vs Social Anxiety

Most people who have heard of social anxiety, and understand what it is, mistakenly believe that shyness is the same thing as social anxiety. Others who have not heard much about social anxiety; also don’t realize that there is a difference between being shy and suffering from social anxiety. Just because someone is shy does not mean that they have social anxiety, and just because a person has social anxiety does not mean that they are shy.

A person can be a little shy - simply because they are shy. People who are simply shy do not suffer from intense fear like people who have social anxiety do. Shy people are still able to interact socially. They may be a little nervous, and they may blush. They may be quieter than other people typically are - but they do not suffer from social anxiety.

Social anxiety on the other hand causes intense fear that does not allow people to function normally in social interactions or situations. Shy people do not typically avoid social situations, whereas people with social anxiety disorder almost always try to avoid social interactions and situations.

People who have social anxiety are not necessarily shy either. Once social anxiety has been effectively treated, and the person is able to interact socially without fear, they do not blush, they are not typically quieter than other people, and they don’t have any nervousness that anyone else would not experience depending on the social situation - such as public speaking, asking someone out on a date, or interviewing for a job.

The truest test to differentiate between shyness and social anxiety is the level of fear that is experienced. As stated, the level of fear that someone with social anxiety experiences can be absolutely debilitating. A person who is simply shy would not experience this fear, just as they typically do not experience the symptoms of social anxiety which include: rapid heartbeat, tremors, sweating, diarrhea, confusion, nausea, difficulty talking, muscle tension, dry throat, dry mouth, muscle twitches, dizziness, shortness of breath, feelings of smothering, chest pain, difficulty swallowing, and paleness. The only physical symptom that shy people and people with social anxiety share is blushing.

Children with social anxiety often act out by crying or throwing tantrums. Children are often shy - but it doesn’t mean that they have social anxiety. The best thing to do with shy children, to avoid turning their natural shyness into social anxiety is not to pay any heed to the shyness. Don’t point it out to the child, or to other people. Most children outgrow shyness on their own. Social anxiety is not outgrown, and in most cases becomes more severe as time passes.

  Read also: How to Overcome Shyness


Social anxiety disorder or social phobia does not have to be suffered alone and it is treatable with the proper support and medical intervention.


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