Exploring Severe Social Anxiety Disorder

Medically reviewed by Melissa Guarnaccia, LCSW and Laura Angers Maddox, NCC, LPC
Updated October 25, 2024by BetterHelp Editorial Team
This disorder is characterized by a persistent fear of social and performance situations with a perception that you are under the intense scrutiny of others. Feeling fear or anxiety may be heightened by an overarching concern that you will act in a way that is embarrassing and/or humiliating.

If you (or someone close to you) is facing symptoms of social anxiety disorder, know the symptoms are treatable and can be improved with appropriate interventions. Once social anxiety disorder is diagnosed, a mental health professional can help provide strategies to overcome social anxiety symptoms. In this article, you will learn strategies on how to manage severe social anxiety symptoms and how to reach out for professional assistance when it is needed. We’ll also explain symptoms of social anxiety disorder (SAD) and resources to help people with social anxiety or social phobia find mental health support.

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What is social anxiety disorder?

Social anxiety disorder, also known as social phobia, belongs to a broad group of anxiety-based disorders and is characterized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by intense fear or anxiety in one or more social situations where the individual is exposed to possible scrutiny by others. Other anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders include generalized anxiety disorder, panic disorder, and phobia-specific disorders.

Social anxiety can interfere with everyday activities, including work and school tasks, especially those that involve interacting or talking with others. An affected individual may experience significant anxiety when experiencing situations that require social interaction like participating in a group, having a job interview, or having to make a presentation in school. 

While some of these situations may cause some sense of nervousness or anxiety for many, those with social anxiety are particularly affected. Still, like other anxiety disorders, its symptoms can often be managed with medication and therapy.

What are the symptoms of social anxiety?

Social anxiety is often mistakenly confused with being shy or reserved. However, it can be a complex mental disorder that involves a debilitating fear response and various physical and psychological symptoms. The intense anxiety toward situations associated with social phobia usually stems from a fear of being judged negatively or humiliated, and those with social anxiety may feel self-conscious or embarrassed in front of others and worry that they might be rejected. 

Many people feel uncomfortable or nervous when meeting new people or when speaking in front of a group of people. However, these feelings can seem unbearable for those with social anxiety due to the many symptoms that it causes, including:
  • Sweating and blushing
  • Avoiding eye contact
  • Rapid heart rate
  • Tremors
  • Muscle tension and stiff posture
  • Dizziness or shortness of breath
  • “Blanking out” mentally.
  • Nausea and stomach pain
Often, those with a social anxiety disorder might find that they fear the symptoms more than the social situations themselves. These symptoms can be so uncomfortable and uncontrollable that many individuals who struggle with this condition will deliberately avoid these settings so that they can dodge the anxiety. Additionally, it is not uncommon for people to experience anxiety weeks in advance before an event where they might have to interact with other people. They may also continue to feel stress about the event, worrying about how they appeared to others after the fact.

Exploring the potential causes and roots

Like the other types of anxiety disorders, social anxiety can have many different causes involving a complex interaction between genetic and environmental risk factors. For example, having family members with a history of mental disorders may be a potential risk factor. A study that looked at genetic risk variants for social anxiety in twins confirmed a heritable basis for social anxiety. However, research scientists in the study were unable to establish a correlation between common traits of social anxiety disorder, such as neuroticism and introversion.

Social anxiety disorder may also be traced to a person’s experiences growing up and their social environment at school or home. Traumatic events in personal relationships, such as bullying, teasing, and abuse at a young age or during a person’s teenage years, may be a factor in developing social anxiety disorder later on. Overly controlling parents may also contribute to the disorder during a person’s early years of social development. 

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

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While shyness is not indicative of social anxiety, it is also thought that the trait of shyness may be involved in its development. This disorder may show up around the age of 13, which is a typical age when adolescents are trying to fit in with their peers. Certain events during a person’s development can also impact their self-esteem and lead to feelings of embarrassment and self-consciousness that persist long after the events occurred. Oftentimes, these feelings of social anxiety continue for fear that they will live through them again.

Another cause of social anxiety disorder can be related to the neurological system.  There are certain areas of the brain that can make people more susceptible to anxiety, and this, combined with all the potential social and environmental factors, can lead to social anxiety. For example, the hypothalamic-pituitary-adrenal (HPA) axis is a significant component of the nervous system that controls the stress response. 

People with social anxiety disorder have been shown to have higher levels of the stress hormone cortisol in their saliva and a more active HPA axis as compared to those who do not experience social phobia. Their reactions to a perceived threat lead to higher amounts of stress hormones and a heightened stress response to any threat. This may explain why they experience a number of symptoms when anxious related to the flight-or-fight response. 

How to treat anxiety symptoms

Treatment interventions for social anxiety disorder symptoms vary depending on your unique history and the severity of your symptoms. Treatment typically includes therapy, medications, or a combination of both. Understanding the causes of social anxiety and why you experience the symptoms that you do is crucial when treating social phobia. 

Talk therapy

Social anxiety therapy can help you through the self-discovery process of why you think and react to situations. Psychotherapy is highly recommended for the treatment of social anxiety disorder and may include various types, including cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). 

CBT has been demonstrated to be highly successful in treating this disorder, along with a variety of other mental health conditions. Social anxiety disorder is often rooted in a person’s thoughts and behavior. The techniques learned with CBT work to change how you currently feel about the social situations that create anxiety and how you react to them. CBT also helps you to identify thoughts associated with increased stress and learn how to challenge and balance those thoughts.

Exposure therapy can gradually expose the client to the different situations that create anxiety. Confronting these fears can be incredibly difficult and frightening. Therapy techniques work one step at a time, starting with the things that only make you mildly uncomfortable and working up from there. 

Group therapy

Though social anxiety group therapy may sound overwhelming to someone with social anxiety, it has been shown to help in lessening the symptoms. Group therapy is a safe place to find support from other people struggling with the same condition.

You can participate in cognitive behavioral therapy in one-on-one sessions or in group therapy. Due to the nature of social anxiety, group sessions can be extremely beneficial to overcoming the symptoms, especially surrounded by others who are experiencing a similar state of mind.

Group settings are facilitated by trained mental health professionals and are supportive, non-judgmental environments. As you attend either group or individual CBT therapy, you begin to relearn how to look at situations, how to perceive and interpret information, and how to cope with symptoms of anxiety.

There are also support groups that are specifically tailored to those who have a social anxiety disorder. With assistance from a support group, you can discuss your experiences and work on strategies to overcome it.

Medication

Medications are particularly helpful in managing severe symptoms as well as other conditions you may also be experiencing, such as depression, but will require a consultation from your doctor. There is a range of medications that may be used to help manage anxiety and its symptoms, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). They can make the difference between avoiding the situation entirely or facing it, which can ultimately help practice the exposure techniques learned in therapy.

Nonetheless, even though medication can be beneficial, its effects are contingent on consistent use. Therapy is a helpful addition to medication-based therapy that can support you in reducing medication if you or your doctor decide to use medication temporarily or to transition you to stopping it altogether.

Consult with your healthcare provider before taking any new medications or supplements, as there may be interactions that can affect your health or the efficacy of medications you are already taking. 

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Where can I find a therapist for mental health support?

Many mental health professionals, such as counselors and therapists, specialize in social anxiety disorder psychotherapy treatments. If you are looking for professional support, be sure to look for a therapist who specializes in the treatment of social anxiety disorder. They most likely will offer some sort of talk therapy, especially cognitive behavioral therapy or a similar psychological treatment.  

Cognitive behavioral therapy for social anxiety and talk-therapy, in general, can be provided in-person and face-to-face with a professional, or it can be carried out online. Both are viable methods for treating social anxiety disorder, and it is ultimately your choice which one you prefer.

Online therapy can be a highly available option for people who are living with social anxiety and increased stress. You can attend therapy sessions in a space where you feel most comfortable without having to commute to and from a physical office. 

Online therapy treatment for anxiety disorders

Research also supports online therapy as being equally effective as in-person therapy for people managing social anxiety with the added benefits of convenience and availability. For example, a study published in Cogent Psychology examined the effectiveness of online cognitive behavioral therapy for college students with social anxiety disorder. 

All the study’s participants remained throughout the course of treatment and reported a great reduction in symptoms accompanied by a high satisfaction of the virtual mode of treatment delivery. The study also showed how online delivery of therapy can reach hard-to-reach populations, as many of the participants were international students unable to receive care otherwise. 

Our therapists at BetterHelp are experts in their field and are dedicated to helping people manage symptoms related to social anxiety disorder and improve their mental well-being.  If you or someone you know is experiencing severe anxiety symptoms and needs help, contact us today to speak to a licensed professional. Once you have joined, all you need is an internet connection and either a computer, tablet or a mobile device to connect to therapists who can help you.

Takeaway

Social anxiety disorder and its symptoms can be extremely uncomfortable for individuals and confronting the sources that cause fear and anxiety can seem overwhelming. However, these symptoms are often treatable. The goal of interventions such as cognitive behavioral therapy is to reduce or eliminate thinking patterns and behaviors that lead to anxiety. You will also learn coping skills to calm and prepare you for social situations that might feel problematic, especially in the early stages of your therapy. With the tools available to you, severe social anxiety can be treated and you can start living a life with far less fear and anxiety.
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