Symptoms And Signs Of Social Anxiety Disorder

Social anxiety disorder involves emotional, behavioral, and physical symptoms that make social situations feel daunting and unmanageable. Living with the disorder can impact confidence and self-esteem, and may cause an individual to miss out on personal or professional opportunities. If you're experiencing challenges from social anxiety disorder, it’s important to understand that you’re not alone and that effective treatments are available.

Here, we’ll explore some common signs and symptoms of social anxiety disorder, plus how this disorder is diagnosed by mental health professionals. You’ll also find a guide to treating this common disorder so you can lessen their impact on your life. 

Understanding social anxiety disorder

Social Anxiety Disorder (SAD), also known as social phobia, is a chronic mental health condition characterized by an intense, persistent fear of social situations. This fear goes beyond occasional nervousness or shyness, affecting a person’s ability to function in work, school, and other daily activities.

According to the Anxiety and Depression Association of America, social anxiety disorder (SAD) affects around 15 million adults in the United States, yet fewer than 5% of people with social anxiety disorder seek treatment in the year following initial onset.

What is the root cause of social anxiety disorder?

While these factors may make it seem like social anxiety disorder is beyond your control, it’s important to understand that this condition is highly treatable.

Symptoms and signs of social anxiety disorder

The following emotional signs and symptoms are common in individuals with social anxiety disorder.

Mental symptoms of social anxiety disorder

• Fear of embarrassment: Social anxiety is marked by an intense fear of embarrassment. Individuals may worry that their actions or words will make them look foolish or incompetent in front of others.
• Worrying ahead of a social situation: People with social anxiety frequently find themselves worrying for days or even weeks before a social event, imagining all the possible ways things could go wrong.
• Excessive self-consciousness: Excessive self-consciousness is a hallmark of social anxiety, where individuals constantly feel that others are watching and judging their every move.
• Ruminating: After a social interaction, those with social anxiety may spend hours or even days ruminating, replaying the event in their minds and focusing on what they perceive as mistakes or awkward moments.
• Expecting the worst: Expecting the worst is common among individuals with social anxiety, leading them to anticipate negative outcomes and believe that any social interaction will end in humiliation or failure.

Physical symptoms and signs of social anxiety disorder

• Fast heart rate: A fast heart rate is a hallmark symptom of the body’s stress response. With social anxiety, the heart starts racing during—or in anticipation of—social interactions.
• Trembling: Trembling or shaking is another symptom of social anxiety, often visible in the hands or voice, reflecting the body's heightened anxiety response.
• Sweating: Sweating excessively, especially in the palms or underarms, is a frequent sign of social anxiety during stressful social situations.
• Nausea: Nausea or an upset stomach can occur as a physical manifestation of anxiety, making social interactions particularly uncomfortable.
• Blushing: Blushing, or turning red in the face, is a common reaction that can increase self-consciousness and anxiety during social encounters.
• Shortness of breath: Shortness of breath can happen when anxiety levels spike, making it difficult to breathe normally and adding to the overall feeling of panic in social situations.
• Dizziness or lightheadedness: Feeling dizzy or lightheaded can occur as the body's response to intense anxiety, sometimes leading to a sense of unsteadiness or faintness.
• Muscle tension: Muscle tension, particularly in the neck, shoulders, and back, is a typical physical symptom, resulting from the body's prolonged state of stress and alertness.

Behavioral symptoms

• Avoidance of social situations: Individuals with social anxiety often go to great lengths to avoid social situations altogether, missing out on important events and opportunities to prevent feelings of discomfort and anxiety.
• Escaping situations: When avoidance isn't possible, they may escape situations abruptly, leaving gatherings or meetings early to relieve their anxiety.
• Alcohol or substance use: Some people with social anxiety may turn to alcohol or other substances as a way to cope with or dull their anxiety in social settings.
• Excessive preparation: Excessive preparation is common, with individuals spending a lot of time rehearsing conversations or planning how to act in social situations to avoid embarrassment.
• Avoiding eye contact: Avoiding eye contact is a frequent behavior, as making eye contact can increase feelings of vulnerability and anxiety.
• Quietness or speaking softly: Quietness or speaking softly is typical in social anxiety, as individuals fear drawing attention to themselves or being judged for what they say.

Diagnosing social anxiety disorder

Conditions such as generalized anxiety disorder, panic disorder, and even autism spectrum disorder can have overlapping symptoms with social anxiety. To render a diagnosis of social anxiety disorder, an individual must meet the criteria outlined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition):

• A marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).
• The individual fears that they will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
• The social situations almost always provoke fear or anxiety.
• The social situations are avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
• The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
• The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
• If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

It’s important to note that symptoms of anxiety are often linked to other mental disorders, such as body dysmorphic disorder, avoidant personality disorder, and major depressive disorder. Therefore, it’s recommended to seek evaluation from a licensed mental health practitioner.

Treatment

Self-help techniques to improve mental health and manage social anxiety symptoms

Like other anxiety disorders, self-help techniques can be transformative in helping you learn how to manage your social anxiety symptoms. Mindfulness and relaxation techniques, for example, can help you calm your mind and body when you become overwhelmed in social situations. 

A healthy lifestyle can also help you remain resilient and mitigate the effect of social anxiety symptoms on daily functioning—try to prioritize regular exercise, a balanced diet, and adequate sleep. It can also be helpful to avoid alcohol and caffeine, which may ultimately worsen symptoms of anxiety.

Psychotherapy for addressing negative thoughts with social anxiety

Talk therapy, particularly Cognitive Behavioral Therapy (CBT), is considered the most effective form of psychotherapy for treating social anxiety disorder. CBT can help you identify and challenge negative thought patterns and beliefs that contribute to your social anxiety disorder symptoms. By focusing on reshaping these negative thoughts, psychotherapy can play an essential role in alleviating the emotional burden of social anxiety. CBT often includes exposure therapy, where you might gradually face feared social situations, helping desensitize you.

Acceptance and Commitment Therapy (ACT), has also been found to be beneficial for treating symptoms of social anxiety disorder. ACT can help you learn to accept your symptoms of social anxiety as a normal part of life and commit to actions aligned with your personal values, despite the presence of anxiety. Through these therapeutic techniques, you can develop healthier ways of thinking and behaving, leading to improved social interactions and a better quality of life.

Support groups

Support groups can play a crucial role in the treatment of social anxiety disorder by providing a sense of community, as well as a low-pressure way to socialize with people who understand. 

Diagnostic role of medication in treating social anxiety

Additionally, beta-blockers can be used to manage physical symptoms of anxiety, particularly in performance situations. Each medication comes with its own set of potential benefits and side effects, so it is important to work closely with your healthcare provider to find the most suitable treatment plan for social anxiety symptoms. 

Learn to manage symptoms in therapy