Social Anxiety Disorder (Social Phobia)

Social anxiety disorder (social phobia) can present with physical, behavioral, and emotional symptoms. While some symptoms may be more easily noticeable, others are internal experiences that may not be immediately evident to others. It can be crucial to recognize that SAD goes beyond shyness and can be significantly distressing for the affected individual, impacting many aspects of daily life. 

Physical symptoms

Physical symptoms of social anxiety disorder are often the result of the body's "fight or flight" response to perceived danger, even though there is no actual physical threat in social situations. These symptoms can include:

• Trembling or shaking
• Sweating excessively
• Getting nauseous or experiencing stomach discomfort
• Rapid heart rate or palpitations
• Shortness of breath or tightness in the chest
• Dizziness or lightheadedness
• Dry mouth
• Muscle tension

Behavioral symptoms

Behavioral symptoms of social anxiety disorder are often a result of attempts to avoid or escape from social situations. These can include:

• Avoiding or refusing to attend social events
• Avoiding eye contact with others
• Speaking softly, mumbling, or avoiding speaking altogether
• Using electronic devices or other objects as distractions
• Standing or sitting at a distance from others
• Leaving social situations abruptly
• Forgetting what to say in social situations or experiencing a “brain block” 
• Asking for repeated reassurance that one has not made a social error or that others still like them 

Emotional symptoms

Emotional symptoms of social anxiety disorder may include the following: 

• Intense fear of being judged, embarrassed, or humiliated
• Fear of being “awkward” or disliked
• Having repeated thoughts about how one is perceived by others 
• Attempting to act or dress in ways to appease others
• Worrying excessively about upcoming social events
• Experiencing self-consciousness or thoughts of being inferior in social situations
• Struggling with low self-esteem or self-confidence
• Experiencing panic attacks in social settings or after socializing 

Social anxiety in children 

In children, SAD can manifest differently than in adults. For instance, children may:

• Cry or throw tantrums when confronted with social situations
• Cling to familiar adults or refuse to leave their side
• Refuse to speak to unfamiliar people or in specific settings (selective mutism)²
• Struggle to make friends or participate in group activities

According to the Diagnostic and Statistical Manual of Mental Disorders, an individual’s fear or anxiety usually must persist for six months before a mental health professional can provide a diagnosis of social phobia. While some individuals may experience only a few of these symptoms, others may experience many or all of them. The intensity of the symptoms can also vary from one person to another. However, regardless of the severity, SAD can be treated, and people can learn strategies to manage their anxiety and navigate social situations more comfortably.

The causes of social anxiety disorder are diverse, involving a combination of biological, psychological, and environmental factors. These factors interact in complex ways to produce the symptoms of SAD, and understanding them can be crucial for managing the condition.

Biological factors

Biology may play a part in the development of social anxiety, including the following factors: 

• Genetics: Family studies have shown that SAD is more common in people who have an immediate family member (parent, sibling, or child) with the condition.
• Neurobiology: SAD may be related to abnormal functioning of specific brain structures involved in fear and anxiety, such as the amygdala.
• Temperament: Individuals with certain personality traits may be more prone to developing social anxiety disorder. Social phobia is thought to occur more frequently in people with inhibited or introverted temperaments.

Psychological factors

Psychological factors potentially contributing to SAD could include the following: 

• Negative beliefs about oneself: People with SAD often have low self-esteem and negative beliefs about their social competence. They may think that they are unattractive, dull, or inferior to others.
• Perfectionism: Some individuals with SAD set unrealistic social performance standards for themselves and fear being criticized for any perceived imperfections.
• Social learning: People with SAD may have learned to fear social situations from observing the behavior of others, especially parents or siblings with similar anxieties.
• Other mental health conditions: There may be a connection between social anxiety disorder and conditions like obsessive-compulsive disorder (OCD), autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), depression, and other anxiety disorders. 

Environmental factors

Below are some of the environmental factors that may impact the development of social anxiety disorder: 

• Childhood experiences: Traumatic or negative social experiences during childhood, such as bullying, ridicule, or rejection, can increase the risk of developing SAD later in life.
• Cultural influences: Some cultures emphasize individualism and assertiveness, while others prioritize group harmony and conformity. People from cultures that stress the latter may be more likely to experience social anxiety.

These factors can interact with and reinforce one another, so there is often no single cause of SAD. Individuals may have different risk factors contributing to their social anxiety. Identifying and addressing these factors can be crucial in effectively treating SAD.

Treating social anxiety disorder may involve a combination of therapy, medication, and self-help strategies to manage symptoms and improve one's ability to interact socially. Often, the primary goal of treatment is to reduce social anxiety, build social skills, and enhance overall quality of life.

Medication

Below are some medication options that may be offered to individuals with social anxiety disorder: 

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat SAD, as they may reduce anxiety by regulating serotonin levels in the brain. Clinical trials show that selective serotonin reuptake inhibitors can effectively reduce the symptoms of social anxiety disorder.
• Anti-anxiety medications: Anti-anxiety medications, such as benzodiazepines, can be effective in the short term for reducing anxiety, but it may be helpful to use them with caution due to the risk of dependence.
• Beta-blockers: These medications are often prescribed to manage the physical symptoms of anxiety, such as a rapid heartbeat.
• Tiagabine and gabapentin: These medications have been found effective in treating social anxiety disorder and were associated with complete symptom remission in two people in a study. However, more studies are needed to prove their effectiveness. 
• Olanzapine: Classified as an antitypical antipsychotic and used frequently as a mood stabilizer, olanzapine also has anxiolytic effects. Clinical trials have confirmed its benefit over placebo in treating social anxiety disorder.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

Other treatment options

Below are other treatment options that may be used for social anxiety disorder: 

• Biofeedback and relaxation techniques: These techniques may reduce the physical symptoms of anxiety by teaching clients to notice and control their physiological responses to stress.
• Self-help books: Reading books about social anxiety disorder or related topics (e.g., personal growth) may provide valuable insight and strategies for managing anxiety. A workbook or guided journal may also be helpful. 
• Supplements or alternative treatments: Supplements or alternative treatments like acupuncture, yoga, or meditation may be helpful for some individuals.

Self-care

Self-care for social anxiety may include the following techniques: 

• Regular exercise: Exercise may reduce stress and anxiety by releasing endorphins, which are natural mood enhancers.
• Healthy eating: A balanced diet may regulate mood and energy levels, making it easier to manage social anxiety.
• Sleep: Sleeping can be crucial for managing anxiety and maintaining well-being.
• Stress management: Learning to manage stress through techniques like deep breathing or progressive muscle relaxation may reduce one’s overall level of anxiety.
• Social practice: Engaging in regular social activities, even when uncomfortable, may help individuals with SAD gradually build their confidence and overcome their fears.

No matter which treatment approach is chosen, the key to managing social anxiety disorder may be recognizing the symptoms and seeking professional help. Depending on the specific symptoms and severity of the disorder, treatment may involve a comprehensive strategy incorporating multiple treatment methods. 

For some individuals experiencing social anxiety disorder, therapy is a cornerstone of treatment. Traditional in-person therapy can be beneficial, but online therapy offers flexibility and convenience. 

With online therapy, individuals can connect with licensed therapists from the comfort of their homes without the added stress of traveling to an office. Online platforms like BetterHelp have qualified therapists who can provide personalized support for SAD. 

In addition to online therapy, there are numerous resources available to support individuals with SAD, including but not limited to the following: 

• The National Institute of Mental Health (NIMH) provides valuable information and resources on SAD and other anxiety disorders. 
• Anxiety and Depression Association of America (ADAA) offers free publications, support groups, and other resources for individuals living with anxiety disorders, including SAD. 
• Social Anxiety Support, an online community, is a place to connect with others who understand the experience of social anxiety and may offer peer support and advice. 

Living with social anxiety disorder can be difficult, but with the right treatment and support, it can be possible to overcome the fear and isolation often associated with SAD. Utilizing these resources can help individuals with SAD better understand their condition and find support and tools to improve symptoms and enhance their quality of life. 

Please see our Get Help Now page for more immediate resources.

Significant advances in the understanding of social anxiety disorder and its treatment have been made in recent years, although there is more to be learned. Clinical research studies are ongoing to better identify the causes and effects of SAD and develop new therapies and treatments. 

A recent study explored the use of internet-based cognitive behavioral therapy (iCBT)³ for SAD. The study found that iCBT was as effective as in-person CBT in reducing SAD symptoms, with positive response rates as high as 75%. The results highlight the potential of internet-based interventions to provide a more cost-effective option for evidence-based psychological treatment.

Another study investigated the role of genetics in SAD. Researchers found that specific genetic variants may contribute to the development of SAD and may influence how individuals respond to treatment. Phenotypic correlations between social anxiety, extraversion, and neuroticism were also evident. Understanding the genetic factors involved in SAD could pave the way for more personalized treatment approaches tailored to an individual's genetic makeup.

Overall, these studies underscore the benefit of continued research in identifying effective treatments for SAD and understanding its underlying causes. Further research can be essential to develop targeted interventions and help individuals affected by SAD reduce the severity of their symptoms and enhance their overall quality of life. 

Below are several statistics on social anxiety disorder:

• Social anxiety disorder is a common condition, affecting approximately 17 million American adults, or about 7.1% of the US population, in the past year.
• The occurrence of social anxiety disorder is more common in adult women, at 8.0%, compared to 6.1% in adult men.
• As many as 90% of individuals with social anxiety disorder may also experience other co-occurring disorders.
• Cognitive-behavioral therapy has been found to be effective in treating social anxiety disorder, with 47.8% to 73.5% of participants showing a significant positive improvement.

These statistics highlight the prevalence of SAD and the co-occurrence with other psychiatric conditions. The promising efficacy of CBT as a treatment for SAD underscores the importance of seeking professional help to manage social anxiety disorder effectively.