Social Anxiety Disorder: Information, Symptoms, Treatment and More

Social Anxiety Disorder (also known as Social Phobia) is an Anxiety-based condition which features a long-standing, intense and overwhelming fear of social situations.

While anxiety itself is a natural feeling, sometimes a person’s worries become very distressing, and impact their day-to-day life significantly.

Social anxiety disorder is limited to social situations, and far exceeds typical ‘shyness’. The person may fear being scrutinised by others, believe that others will intentionally stare at them, or something else that involves causing distress.

While Social anxiety disorder is usually a long-term condition, with treatment and ongoing support, recovery can be attained.

What are the symptoms of Social Anxiety Disorder?

The symptoms of Social Anxiety Disorder normally appear for the first time during teenage years. The symptoms can sometimes vary slightly from individual to individual. Symptoms are normally psychological.

Psychological symptoms

• Dreading any form of social contact (speaking in public, making eye contact, entering rooms, talking to strangers, going to workplace)
• Fearing others are looking at you
• Low self-esteem
• Feeling that you are being judged by others
• Dread of accidentally offending someone
• After a social situation, believing they embarrassed themselves or acted in an offensive way

Due to the fear of social situations, these psychological symptoms cause physical symptoms.

Physical symptoms

• Excessive sweating
• Fast heartbeat
• Shortness of breath
• Panic attacks
• Blushing
• Nausea
• Panic attacks (in some people)

As a result of these symptoms, the behaviour of an individual will change. Typical behavioural changes include avoiding people and normal activities, not wanting to leave home, and a difficulty in maintaining or forming meaningful relationships.

It is common for an individual with Social Anxiety Disorder to adopt harmful coping mechanisms in an effort to cope with their symptoms. In some cases, Substance abuse and eating disorders are two factors that this behaviour can result in.

What are the causes of Social Anxiety Disorder?

The cause of Social anxiety disorder isn’t entirely known. However, some factors do appear to be involved with the condition developing – it may be a combination of factors involved.

Genetics appears to be a key factor in Social anxiety disorder, with research suggesting that the condition commonly runs in families [1].

As Social anxiety disorder normally appears during teenage years, any negative social situation around this time can lead to the onset of anxiety.

Years of negative social interaction may particularly be a risk factor. Personality traits such as shyness and low self-esteem too act as risk factors. Overprotective parenting has also been posited as a possible cause.

Social Anxiety Disorder often runs comorbidly with other mental health conditions, with one study finding two thirds of people with Social Anxiety Disorder had another mental health condition [2].

For example, Depression often runs concurrently, which is probably down to the feelings of loneliness, which can subsequently cause low mood.

Avoidant Personality Disorder is also common with cases of Social Anxiety Disorder [3]. These conditions cannot cause Social Anxiety Disorder, but are associated with the condition.

Diagnosis of Social Anxiety Disorder

It is important to see a Doctor or mental health professional if an individual believes they may be suffering from Social Anxiety Disorder. While this can be challenging, it is a key step towards getting better.

While Anxiety is a normal emotion, if the level of anxiety is causing distress or affecting the life of an individual, it is important to seek help.

At an appointment, a doctor will have a discussion with their patient. They will ask a range of questions around the symptoms of the condition, their severity, how long they have been around, and possible causes.

For Social Anxiety Disorder to be diagnosed, a Doctor will generally look for the following criteria to be satisfied:  

• The individual has long-standing, persistent feelings of anxiety about social situations
• The individual fears these situations due to believing they will be judged by others or embarrass themselves.
• This fear is seen as being abnormal under the circumstances
• The individual will therefore be considered to be suffering from anxiety
• These feelings interfere with the day-to-day life of an individual
• No other mental health condition would better explain the symptoms

Something called the Social Phobia Inventory can be used to assist in diagnosis, if necessary.

How is Social Anxiety Disorder treated?

Treatment is available for Social Anxiety Disorder. The aim is for full recovery. At the very least, a patient should see a reduction in their symptoms and their intensity.

With the right treatment plan, a full recovery is possible. The level of treatment generally depends on how severe the symptoms are. Possible treatment includes:

Self-help

Some anxiety-based conditions improve with self-help measures. For example, these can include getting more sleep, avoiding alcohol, and engaging in regular exercise. Meditation or mindfulness have also helped some people.

Talking Therapy

Some form of talking therapy is recommended for social anxiety disorder. Therapy can help individuals to understand their thoughts and behaviour more, with Cognitive Behavioural Therapy particularly useful for Social Anxiety Disorder [4]. Therapy can also help individuals learn how to cope better with problems. Potential therapy options include:

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

Schema Therapy: Schema Therapy is a talking therapy that combines aspects of Cognitive-Behavioural Therapy, Gestalt therapy and psychoanalytical thinking into one form. It can be useful in treating personality disorders due to its ability to help people change longstanding patterns of thought and behaviour. The therapy is normally based on the idea that childhood needs were not met, leading to deeply-held obstructive beliefs. The therapist will attempt to change long-standing patterns that have contributed to problems, and can be very useful. Schema therapy is mainly intended for use in the treatment of personality disorders.

There are many other types of talking therapies available. Moreover, therapy can help in many ways, as this article shows. For more information on therapy, take a look at our Therapy section.

Medication

In cases of Social Anxiety Disorder that merit it, medication can be prescribed. Normally, an antidepressant will be used. In cases of severe anxiety, a benzodiazepine may be prescribed, but only as a short-term measure.

Two SSRI antidepressants (Paroxetine and Sertraline), and one SNRI antidepressant (Venlafaxine) are licensed to treat Social Anxiety Disorder.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Benzodiazepines: Benzodiazepines are fast-acting sedatives, which can relax an individual and improve their mood. Any anxiety should fade rapidly upon consumption. The individual should therefore have an improved level of functioning. Benzodiazepines cannot be taken for more than a few weeks, due to acute risk of both physical and psychological dependence.

Summary

Social anxiety disorder is very difficult to live with. Moreover, it can seem like a huge challenge to get help, especially given the inevitable socialising that this entails.

However, it is very important to seek help, this can lead to much better mental wellbeing. If needed, there is plenty of information on our website to assist you.

See Also

• Anxiety Section
• What Is The Prognosis for Anxiety?
• Therapy Homepage
• Medicine Homepage