Social anxiety disorder: symptoms, causes, & treatments

By

Walter Alejos

|

April 2, 2021

group of young people recovering from social anxiety disorder having picnic on grass
For people with social anxiety disorder, social situations can produce significant anxiety.

Social anxiety disorder isn’t the same as shyness or self-consciousness. Shyness describes a common personality trait involving mild introversion, and self-consciousness may create some nervousness or anxious thinking.

But social anxiety disorder is different. If you have this condition, fear of social situations and interactions makes it difficult to function in key areas of life.

For people with anxiety and depression, purposefully engaging in pleasurable activities can improve mental health.
For people with social anxiety disorder, social situations can produce significant anxiety.

Social anxiety disorder isn’t the same as shyness or self-consciousness. Shyness describes a common personality trait involving mild introversion, and self-consciousness may create some nervousness or anxious thinking.

But social anxiety disorder is different. If you have this condition, fear of social situations and interactions makes it difficult to function in key areas of life.

What is social anxiety disorder?

Social anxiety disorder, formerly called social phobia, is an ongoing anxiety disorder characterized by an intense fear of social situations.

If you have this condition, any form of social interaction can provoke extreme anxiety from public speaking to having a conversation. Some people with this kind of anxiety fear specific situations, while others experience generalized distress around any type of social engagement.

Statistics

How common is this condition? According to the National Institute of Mental Health:

  • 7.1% of adults in the U.S. showed social anxiety symptoms in the past year.
  • 8% of women had social anxiety disorder in 2020 compared with 6.1% of men.
  • 12.1% of adults and 9.1% of adolescents in the U.S. have experienced this anxiety disorder at some point in their lives.

Symptoms

The symptoms of this disorder vary depending on the age of the patient. Most people with social anxiety disorder first experience symptoms in their teenage years, but the disorder may also present for the first time in children and adults.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists the following symptoms as unique to children:

  • Crying
  • Tantrums
  • Freezing
  • Clinging
  • Shrinking
  • Failing to speak in social situations

The above symptoms are also characteristic of separation anxiety disorder, which is most common in children.

For adults and teens, some of the physical symptoms of social anxiety disorder may include:

  • Blushing
  • Sweating
  • Trembling
  • Rapid heart rate
  • Mind going blank
  • Nausea
  • Rigid body posture
  • Trouble making eye contact
  • Speaking with a soft voice

Some symptoms of this disorder apply to both adults and children. In order to be diagnosed with social anxiety disorder, you must have:

  • Anxiety about one or more social situations, including:
    • Having a conversation
    • Meeting unfamiliar people
    • Being observed eating or drinking
    • Performing in front of others
  • Fear out of proportion to the social situation, taking socio-cultural context into account
  • The tendency to avoid those situations or endure them with intense fear or anxiety
  • Fear, anxiety, or avoidance that cause clinically significant distress or impairment at work, home, school, and other essential areas of your life

For a professional to diagnose social anxiety disorder, the situation you fear must consistently provoke an immediate and serious response. Also, your social anxiety symptoms must persist for at least 6 months in order to receive a clinical diagnosis.

Even if you don’t fit the full diagnostic criteria but experience some of the symptoms, it’s worthwhile to seek professional support early.

Causes

Researchers haven’t been able to pinpoint precise social anxiety causes. As with other mental health conditions, scientists believe that many factors contribute to developing this disorder. There’s growing consensus in the medical field that this disorder develops in response to a complex mix of hormonal, genetic, neurobiological, environmental, and social factors.

The typical age of onset is between the ages of 10 and 19, though it can also develop earlier or later.

Hormones

Hormone levels may play a role. Studies suggest that hormones like oxytocin and testosterone play an essential role in the development of the social brain in humans and the social behavior of other species.

Genes

In some cases, social anxiety runs in families. Scientists hope to learn more about how genetics predispose certain people to be more vulnerable to social anxiety.

Neurobiology

Studies have shown that people with social anxiety disorder demonstrate unique activity in the amygdala when exposed to social triggers. The amygdala is the part of the brain that processes fear and is responsible for activating the fight or flight response.

Compared to people without social anxiety, those with this condition display greater blood flow to the amygdala during brain scans.

Environmental factors

Environmental factors may also be involved— in particular underdeveloped social skills. Some researchers theorize that people with social anxiety disorder may be unable to read other people’s behavior and facial cues accurately.

Social development

Adolescents with social anxiety disorder may avoid parties and other situations that trigger their phobia. This means they may also miss out on critical social development opportunities—and functional and developmental impairment can get worse without appropriate treatment.

Risk factors

Risk factors that can make someone more likely to develop this disorder include:

Family history

This disorder sometimes runs in families. You’re more likely to develop this disorder if your parents or siblings have it.

Personality type

Some people are more prone to anxiety and shyness. If you’re already nervous in social situations, temporary stressors may cause your anxiety to worsen.

Trauma

Family conflict, abuse, teasing, bullying, and other forms of trauma can put you at greater risk for developing social anxiety disorder.

Stress

An increase in responsibilities at work or a big presentation at school can trigger the first onset of this disorder.

Physical Impairment

Any disease, disfigurement, or disability that draws unwanted attention may cause you to feel self-conscious in social situations. This heightens the risk of developing social anxiety.

Diagnosis

When diagnosing anxiety disorders, a mental health professional will generally ask you to complete an evaluation involving a questionnaire and a structured interview. You may be asked to describe the social encounters that trigger your anxiety.

Your medical professional will likely ask you questions to rule out other possible conditions that could be causing anxiety, such as panic disorder, substance abuse issues, or physical illness.

You’ll also be asked questions like when you first experienced symptoms, how extreme the anxiety is, and how long it typically lasts.

Treatments

Therapy and prescription medication are the most effective social anxiety treatments. With the right treatment, many people can reduce or resolve the symptoms.

Therapy

If you’ve been diagnosed with social anxiety disorder, your medical professional may recommend psychotherapy.

Cognitive behavioral therapy (CBT) is one of the most evidence-based treatments for social anxiety.

CBT can help you uncover thought patterns or core beliefs at the root of your mental health issues. It can also help you develop skills and social strategies to manage your symptoms.

CBT can be delivered individually, in group therapy, or both. The latter typically involves working with a group of individuals who also have the disorder. Group members give each other social feedback and help one another overcome thought patterns that contribute to social anxiety.

Exposure-based CBT can also be helpful, especially for people who fear specific social situations. For example, a patient may role-play and practice gradual exposure to public speaking. Over time, exposure to the source of stress in small doses can help you feel ready to perform publicly.

Medication

In some cases, your mental health professional may also recommend prescription medication. The treatment options for social anxiety include anti-anxiety meds, antidepressants, and beta-blockers.

Anti-anxiety medications

These prescription drugs work quickly to reduce your feelings of anxiety, but they’re not recommended for long-term use. Anti-anxiety medicine is usually prescribed on a short-term basis to alleviate acute distress.

Antidepressants

Antidepressants can be effective at treating this disorder. Depending on the medication, some antidepressants can take several weeks to start working.

Since social anxiety is a chronic condition, many doctors prescribe antidepressants for long-term relief. Some brand-name meds include Prozac, Lexapro, and Zoloft.

Beta-blockers

Beta-blockers block the effects of adrenaline and lower your blood pressure, reducing the physical symptoms of anxiety, like trembling, rapid heartbeat, and sweating. These are often prescribed for patients who fear social situations involving public performance.

Prevention

The following behaviors may help you better manage symptoms, lessen the impact social anxiety has on your life, and prevent it from getting worse.

Seek treatment early

Since delayed social development may worsen symptoms, it’s crucial for children and teens to treat this disorder early.

Exercise

Physical activity causes you to release endorphins, hormones that help you manage stress and anxiety.

Keep a journal

Take notes on your social experiences and review your stressors with a therapist.

Reduce stress

Adopting practices such as meditation and deep breathing can help you calm anxiety in stressful situations. Try these relaxing exercises to help alleviate the physical symptoms of anxiety.

Avoid drugs and alcohol

Over time, substance use can worsen feelings of self-consciousness and anxiety. Some people even experience anxiety shortly after drinking. Anxiety disorders often contribute to substance use and are highly correlated with addictive disorders. In fact, 48% of people with a diagnosis of social anxiety also meet the criteria for an alcohol use disorder (AUD.)

Eliminate caffeine and nicotine

Stimulants worsen the physical symptoms of anxiety, so you may notice an immediate improvement without them.

Social anxiety disorder outlook

This anxiety disorder is usually diagnosed in adolescence, but symptoms can also manifest for the first time in childhood and adulthood. Early treatment may help young people with this condition avoid delays in healthy social development.

For adults, prompt mental health care may help you avoid other anxiety disorders or severe symptoms, including panic attacks.

Psychotherapy and medication are first-line treatments for social anxiety disorder. Finding the right meds and appropriate dosage often requires working closely with mental health providers and following medical advice carefully.

Although both CBT and medication take time to work, they usually help reduce—and, in some cases, completely resolve—symptoms of this disorder.

Some patients can stop taking medication once symptoms have been significantly reduced. Others need to continue using medication to prevent symptoms from returning.

If you have a social anxiety disorder diagnosis or are worried you might have this condition, help is available. With the right treatment or combination of treatments, most people can reduce the intensity of symptoms and learn to face social situations with a greater sense of safety.

Visit Lemonaid to talk with a member of our medical team about what treatment options would be best for you.

Takeaway

  • The onset of social anxiety disorder typically occurs during adolescence but can also first appear in children and adults.
  • Both genetic and environmental factors influence the development of this disorder.
  • Some people with this condition fear specific social situations, while others have a more generalized social anxiety.
  • A combination of cognitive behavioral therapy and medication often works well to reduce or resolve symptoms.
  1. Grant et al. (2005). The epidemiology of social anxiety disorder in the United Stateshttps://pubmed.ncbi.nlm.nih.gov/16420070/
  2. Harvard Health Publishing. (2010). Treating social anxiety disorder. https://www.health.harvard.edu/newsletter_article/treating-social-anxiety-disorder
  3. Mayo Clinic. (2017). Social anxiety disorder (social phobia). https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
  4. The National Institute of Mental Health. (2017). Social Anxiety Disorder. https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder.shtml
  5. The National Institute of Mental Health. (2017). Social Anxiety Disorder: More Than Just Shyness. https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml
  6. The Substance Abuse and Mental Health Services Administration. (2016). DSM-IV to DSM-5 Social Phobia/Social Anxiety Disorder Comparison. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t12/
  7. van Honk et al. (2015). Neuroendocrine models of social anxiety disorder. https://doi.org/10.31887/DCNS.2015.17.3/jhonk

By

Walter Alejos

|

April 2, 2021