A social anxiety disorder (or, social phobia) is a type of anxiety that affects the way you interact with others. The condition leads to generalized anxiety, self-consciousness, and embarrassment that’s perpetuated by other people.

Those who struggle with social anxiety tend to avoid social situations. This can disrupt various aspects of your life (such as school, work, relationships, and daily routine) and cause extreme stress.

While there is no cure for social anxiety, there are several ways to curb symptoms. Throughout this article, we’ll give you an overview of social anxiety. From there, we’ll look into treatment options and other ways you can cope.

Symptoms

At one time or another, we’ve all felt shy and uncomfortable in a social situation. Furthermore, how we feel around others varies from life experience and other personality traits (i.e. introversion). These shouldn’t be recognized as symptoms of social anxiety.

However, if you’ve felt generalized anxiety when socializing and have avoided social situations for more than six months, you may struggle with social anxiety. Most people first experience the condition in their early to mid-teens and carry it throughout adulthood. Still, symptoms can arise in children and adults.

There are three categories of symptoms for social phobia. While it’s unlikely you’ll experience all these symptoms, there’s a chance you’ll have a difficult time with a handful.

Emotional and Behavioral Symptoms

Have you experienced a persistence of any of the following symptoms? ² ³ ⁴

• Avoiding people and activities due to fear of embarrassment
• Expecting the worst from social situations
• Fear of judgment (and situations where you may be judged)
• Fear of physical symptoms (i.e. blushing, sweating, trembling, etc.)
• Feelings of anxiety before activity or event
• Rethinking social situations (analyzing your performance and flaws)
• Severe anxiety when interacting with strangers or in social situations
• Staying away from people, places, or situations

If so, this is strong evidence that you struggle with a social anxiety disorder. Children and adults may reveal these symptoms differently, but the general emotion and behavior remain the same among all age groups.

Some individuals may only develop these fears in certain situations. The most notable is when one has to perform in public (a performance subtype of social anxiety).

Physical Symptoms

Some people may also feel physical symptoms alongside their emotions and behaviors. These include: ⁵

• Blushing
• Difficulty catching your breath
• Dizziness and headaches
• Feeling like your mind has gone blank
• Muscle tension
• Rapid heartbeat ⁶
• Sweating
• Trembling
• Upset stomach (sometimes includes nausea)

Social Symptoms

A social anxiety disorder usually reveals itself when you’re in social situations. Do you feel anxiety during the following everyday experiences? ⁷

• At work or school
• Dating
• Eating around or in front of other people
• Going to parties or social gatherings
• Initiating a conversation
• Interacting with strangers
• Making eye contact
• Returning purchases to a store
• Walking into a room where people are already seated
• Using public restrooms

Remember, symptoms can change and ultimately depend on your life situation. For example, during the COVID-19 pandemic, many people were quarantined in their houses and, therefore, probably not in as many situations that brought about social anxiety.

Causes

Scientists still aren’t 100% sure what causes social phobia. However, they have a few ideas:

• Brain Structure – While there are several mechanisms responsible for anxiety, the amygdala plays a key role. Scientists have observed that those with an anxiety disorder tend to have an overactive amygdala. ⁸

• Environment – Social anxiety may be learned through interactions with your environment. For example, in childhood, you may have observed your parents act anxious in social situations. Or, you may have experienced an embarrassing moment that continues to plague you. ⁹

• Genetics – More often than not, anxiety disorders run in families. While it’s not entirely clear how genetics play a function in these conditions, you’re likely to have social anxiety if a family member has it. ¹⁰

Some also suggest a type of trauma can lead to an anxiety disorder. ¹¹ However, more research is necessary to understand if this leads to social anxiety.

Risk Factors

If you’re concerned about a social anxiety disorder, consider the following risk factors:

• Characteristics – It’s been observed that children with shy, timid, and withdrawn characteristics are prone to anxiety. This is especially true when children act this way around strangers or in new situations. ¹²

• Family History – As mentioned above, you’re more likely to experience social anxiety if a family member has also struggled with the condition.

• Negative Life Experiences – If you have been through a negative experience, you may be vulnerable to social anxiety. This can include an embarrassing moment in your teenage or adult years. Or, it may include experiences from your childhood, such as teasing, bullying, humiliation, or rejection. ¹³

• Social Demand – You may notice you experience anxiety only in specific social demands. For example, giving a speech or going to important meetings may put you at risk of anxiety.

• Your Appearance – If there’s anything unique about your appearance (i.e. noticeable birthmarks, disfigurements, stuttering, etc.), social interactions may trigger anxiety. ¹⁴

Complications

Unfortunately, social anxiety can take control over one’s life. Most notably, it interferes with your relationships, work, school, and enjoyment. In turn, this can lead to:

• Difficulty with assertion
• Lack of social skills
• Low self-esteem
• Poor social skills
• Self-isolation
• Sensitivity to criticism
• Substance use disorder
• Suicidal ideation
• Trouble with academic and employment fulfillment

Furthermore, complications with social anxiety can lead to the development of other mental illnesses, such as depression.

If you or someone you love has discussed suicidal thoughts, it’s important to seek help immediately. Are you in a life-threatening situation? Call 911 or go to your nearest emergency room. If you have no one to talk to, you can contact the 988 Suicide & Crisis Lifeline.

Can Social Phobia Be Prevented?

Unfortunately, there is no way to prevent social anxiety. Furthermore, it’s difficult to tell if someone will develop social phobia. However, there are a few steps you can take to ensure symptoms aren’t severe:

• Avoid Drugs and Alcohol – Substance abuse can not only worsen anxiety but also cause further problems outside the condition. Even lesser drugs (such as caffeine and nicotine) have been found to encourage anxiety. If you’re addicted to drugs or alcohol, it’s worth finding a treatment program to help you quit. ¹⁵

• Early Treatment – The sooner you identify and treat a social anxiety disorder, the better chance you have at developing the right coping mechanisms. The longer you wait, the more difficult it becomes to treat. ¹⁶

• Journal Your Experiences – It can help both you and a mental health professional to journal your social anxiety. This will document the experiences associated with stress and, potentially, coping techniques that make you feel better. ¹⁷

• Make a Schedule – It’s been found that people with social anxiety tend to do better when they carefully schedule their time and energy. Whether it’s for things you need to get done (i.e. school, work) or for things you enjoy, managing your time can help you feel less anxious.

Social Anxiety Disorder Diagnosis

For a doctor to diagnose you with social anxiety, they must first rule out the potential of other mental illnesses and physical conditions. To do this, your doctor will:

• Discuss your symptoms (their frequency and when they occur)
• Follow the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
• Perform a physical exam (to rule out other medical conditions)
• Perform a questionnaire (to see if your symptoms relate to social anxiety)

DSM-5 Criteria

Following the DSM-5, people with a social anxiety disorder must meet the following criteria: ¹⁸

• A consistently extreme fear or anxiety that arises during social situations. Usually out of belief you’ll be judged, humiliated, or embarrassed.

• Avoiding certain social situations as you believe they will produce anxiety.

• Experiencing excessive anxiety out of proportion with social situations.

• Having an anxiety that can’t be explained by a medical condition, medication, or substance abuse.

• Having enough anxiety to interfere with your day-to-day life.

Social Anxiety Disorder Treatment

There is no one-size-fits-all treatment option. Therefore, your treatment route will be determined by how much social anxiety inhibits your ability to function in daily life. Most people undergo two types of treatment: psychotherapy and medication. However, many also find benefits from natural and holistic remedies.

Psychotherapy

Psychotherapies are a form of therapy where you learn to recognize negative thoughts and develop coping mechanisms to change them. Most people have success in improving social anxiety disorder symptoms and garnering confidence in social situations through psychotherapies.

The most common type of psychotherapy is cognitive-behavioral therapy (CBT). This is a type of talk therapy where you and a therapist will discuss what’s causing your anxiety. From there, you’ll develop strategies to overcome symptoms. CBT can be done in both a group or individual setting. ¹⁹

People with social anxiety have also found benefits from exposure-based CBT. Through this, you’ll face simulated situations that you’re most afraid of. By putting yourself through these experiences, it’s hoped you’ll improve your coping abilities. ²⁰

Standard Medication

Different medications have been found beneficial for social anxiety. However, the most common are selective serotonin reuptake inhibitors (SSRIs). Such medication may include prescriptions like paroxetine (Paxil) or sertraline (Zoloft). ²¹

The purpose of SSRIs is to reduce overall anxiety symptoms and allow you to better develop coping mechanisms. Your doctor will likely start you on a low dose and gradually increase it over time. The length of medication depends on the severity of your social anxiety and can range anywhere from a few weeks to several months.

Other Medication

Other medications your doctor may prescribe include:

• Anti-Anxiety Medications – Benzodiazepines are commonly prescribed as they produce almost immediate results. However, such medications can be addictive and are only prescribed for short-term use. ²²

• Beta-Blockers – While beta-blockers aren’t typically used for the treatment of social anxiety, they can be effective in anxiety-inducing situations, such as giving a speech. This medication works by inhibiting the stimulating effects of epinephrine (adrenaline). In turn, they reduce heart rate, blood pressure, and the shaking of your voice and limbs. ²³

• Other Antidepressants – If your doctor finds SSRIs aren’t effective, they may try other antidepressants. The goal is to figure out which medication is most effective and produces the least side effects.

Natural Remedies for Social Anxiety

With the potential side effects of traditional medication, many have looked towards natural remedies as a relief of social anxiety. While these herbs and supplements may ease symptoms, it’s important to note that they aren’t approved by the Food and Drug Administration (FDA). With that, these alternatives are taken at the user’s own risk.

• Cannabidiol (CBD) – A 2011 study found that CBD was able to reduce social anxiety in individuals who performed a simulated public speech. ²⁴ A 2015 study discovered that CBD had therapeutic effects for several anxiety disorders, including obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). ²⁵

• Chamomile – A 2016 clinical study found that chamomile effectively treated generalized anxiety disorder (GAD). However, treatment was only found effective through consecutive use. ²⁶

• Kava Kava – Can act as an anxiety suppressant thanks to its calming effects on users. Kava should be taken with caution as it’s known to cause liver toxicity. ²⁷

• Valerian – While studies have yet to indicate the effectiveness of valerian, many self-report it helps ease anxiety. Not to mention, some have found it can greatly improve sleep. ²⁸

Incorporating Natural Remedies

It’s important to understand that simply taking natural remedies isn’t going to completely get rid of social anxiety. Rather, you’ll want to incorporate these alternatives alongside other lifestyle changes.

The two most important are diet and exercise. Research has found that specific diets along with the right amount of physical activity can greatly decrease feelings of anxiety. ²⁹

This combination of lifestyle changes and natural remedies may be best when incorporated with traditional treatment options. We highly suggest consulting your healthcare provider to learn more.

Final Word

Social anxiety disorder can be extremely damaging to your physical, mental, and spiritual well-being. However, there are ways to effectively cope with symptoms and go on to manage a fulfilling life. We hope our review of the condition has given you more insight into how social anxiety works and what you need to do to be treated.

When it comes to treatment options, everyone’s different. You may need to experiment with various medications, therapies, and natural remedies before finding what’s right for you. We highly suggest you do all of this under the guidance of a medical professional.

References

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