A social anxiety disorder (sometimes referred to as social phobia) is a type of anxiety that affects the way a person interacts with others. More often than not, the condition leads to a generalized anxiety, self-consciousness, and embarrassment that’s perpetuated by others.
Those who struggle with social anxiety tend to avoid social situations. In turn, this can disrupt various aspects of their life (such as school, work, relationships, and daily routine) and cause extreme stress.
While there is no cure for social anxiety, there are a number of ways to curb symptoms. Throughout this article, we’re going to give you an overview of social anxiety. From there, we’ll look into treatment options and other ways you can cope. At the end, we invite you to ask further questions.
At one time or another, we’ve all felt shy and uncomfortable in a social situation and these shouldn’t be recognized as symptoms of social anxiety. Furthermore, how we feel around others very much varies from life experience and other personal traits. Due to this, it can be difficult to initially come to a conclusion about social anxiety.
However, if you’ve felt generalized anxiety and have avoided social situations for more than six months, you may be struggling with social anxiety. Most people first experience the condition in their early to mid-teens and carry it with them 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’re having a very difficult time with a handful. In such cases, it’s important to talk to a medical professional to receive a diagnosis.
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 judgement (and situations where you may be judged)
- Fear of physical symptoms (i.e. blushing, sweating, trembling, etc.)
- Feelings of anxiety prior to 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’re struggling with a social anxiety disorder. Children and adults may reveal these symptoms differently, but the general emotion and behavior remains 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 and this is referred to as a performance type of social anxiety.
Some people may also feel a set of social symptoms alongside their emotions and behaviors. These include: ⁵
- Difficulty catching your breath
- Feeling like your mind has gone blank
- Muscle tension
- Rapid heartbeat ⁶
- Upset stomach (sometime includes nausea)
A social anxiety disorder usually reveals itself when you’re in social situations. Do you feel an anxiety during the following everyday experiences? ⁷
- Eating around or in front of other people
- Going to parties or social gatherings
- Going to work or school
- 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
If so, you may be experiencing social anxiety. It’s important to keep in mind that symptoms can change throughout time and will 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.
Scientists still aren’t 100% sure what causes social phobia. However, they have a few ideas behind potential causes:
- Brain Structure – While there are a number of 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, as a child, 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.
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 in this manner around strangers or 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
Unfortunately, social anxiety can take control over one’s life. Most notably, it can interfere with their relationships, work, school, and overall enjoyment. In turn, this can lead to:
- Difficulty with assertion
- Lack of social skills
- Low self-esteem
- Poor academic and employment fulfillment
- Poor social skills
- Sensitivity to criticism
- Substance abuse disorder
- Suicidal ideation
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 National Suicide Prevention Lifeline at 1 (800) 273-8255.
Can Social Phobia Be Prevented?
Unfortunately, there is no way to prevent social anxiety. Furthermore, it’s quite 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
In order 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)
In accordance with 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 that 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’s 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 is inhibiting 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.
Psychotherapies are a form of therapy where you learn to recognize negative thoughts and, from there, 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 on your coping abilities. ²⁰
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, from there, gradually increase your dose. 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 your doctor may prescribe includes:
- Anti-Anxiety Medications – Benzodiazepines are commonly prescribed as they produce almost immediate results. However, such medication can be addictive and, with that, 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 several other antidepressants. The goal is to figure out which medication is not only most effective but produces the least amount of side effects.
Natural Remedies for Social Anxiety
With the potential side effects of traditional medication, many have looked towards natural remedies as a cure for social anxiety. While these herbs and supplements can have a positive effect on your phobias, it’s important to note that they currently 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 a number of anxiety disorders, including obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). ²⁵
- Chamomile – A 2016 clinical study found that chamomile was effective in treating 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 mental health professional to learn more.
Social anxiety disorder can be extremely damaging to your physical, mental, and spiritual wellbeing. 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 in order to be treated.
When it comes to treatment options, everyone’s different. With that said, you may need to experiment around with various medications, therapies, and natural remedies before finding the right option for you. We highly suggest you do all of this under the guidance of a medical professional.
Still have questions concerning a social anxiety disorder?
We invite you to ask them in the comment section below. If you have any further knowledge to share – whether personal or professional – we’d also love to hear from you.
¹ National Institute of Mental Health (NIMH): Social Anxiety Disorder: More Than Just Shyness
² Biological Psychiatry: Neural Mechanisms of Cognitive Reappraisal of Negative Self-Beliefs in Social Anxiety Disorder
³ Journal of Psychiatry 4 Neuroscience: Amygdala and insula response to emotional images in patients with generalized social anxiety disorder
⁴ Biology of Mood & Anxiety Disorders: Emotion regulation in social anxiety disorder: behavioral and neural responses to three socio-emotional tasks
⁵ Anxiety & Depression Association of America: Social Anxiety Disorder: Symptoms
⁷ Journal of Anxiety Disorders: The role of social isolation in social anxiety disorders: A systematic review and meta-analysis
⁸ HHS Public Access: Amygdala Activity, Fear, and Anxiety: Modulation by Stress
⁹ Neuropsychiatric Disease and Treatment (Dovepress): Social Anxiety Disorder: A review of environmental risk factors
¹⁰ Dialogues in clinical neuroscience: Genetics of generalized anxiety disorder and related traits
¹¹ Trauma-Informed Care in Behavioral Health Services: Chapter 3: Understanding the Impact of Trauma
¹² Child Mind Institute: Social Anxiety Disorder Basics
¹³ HHS Public Access: Stressful Life Events, Anxiety Sensitivity, and Internalizing Symptoms in Adolescents
¹⁵ HHS Public Access: Anxiety and Substance Abuse Disorders: A Review
¹⁷ JMIR Mental Health (JMIR Publications): Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms: A Preliminary Randomized Controlled Trial
¹⁹ Dialogues in clinical neuroscience: Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence
²⁰ ClinicalTrials.gov: Virtual Reality Exposure Therapy for the Treatment of Social Phobia (FOPSII)
²¹ Neuropsychiatric Disease and Treatment (Dovepress): Optimal treatment of social phobia: systematic review and meta-analysis
²² National Library of Medicine (PubMed): Benzodiazepines and anticonvulsants for social phobia (social anxiety disorder)
²³ Journal of Psychopharmacology (SAGE): Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis
²⁴ National Library of Medicine (PubMed): Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients
²⁵ Neurotherapeutics (Springer): Cannabidiol as a Potential Treatment for Anxiety Disorders
²⁶ National Library of Medicine (PubMed): Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial
²⁷ Journal of Clinical Psychopharmacology: Kava in the Treatment of Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled Study
²⁸ National Center for Complementary and Integrative Health: Valerian