Social anxiety disorder: An informative guide to social phobia

What Is Social Anxiety Disorder?

Social anxiety disorder, also called social phobia, is a type of anxiety disorder characterized by an intense fear of social interactions. This disorder usually starts in early adolescence. People experience fear and anxiety in all or some social interactions (like nobody’s favorite pastime: public speaking).

At the heart of social anxiety resides the terror of being perceived in a bad light. You fear others will think you’re stupid, boring, less-than, awkward, or weak (or insert some other awful adjective here). Or you fear you’ll do something to offend someone or humiliate yourself. Or worse, you’ll get rejected. In front of everyone. 

Like other anxiety disorders, social anxiety can kick-start a vicious cycle: You fear a situation. So, you avoid it. And your anxiety about that situation becomes more and more entrenched. Because even though avoidance is temporarily effective, in the long run, it amplifies our fear, becoming the big monster under our beds. 

Social anxiety disorder can be a painful, paralyzing condition. However, it’s also been extensively studied and effective treatments are available.

What Are the Symptoms of Social Anxiety Disorder?

What does social anxiety feel like? Besides an intense fear of social interactions, rejection, and potential humiliation, social anxiety disorder can have both psychological and physical symptoms. Common social anxiety disorder symptoms include:

Psychological social anxiety symptoms

• Assuming others have exceptional social and performance skills
• Assuming you’ll say or do the wrong thing
• Believing you need alcohol or other substances to deal with a social situation
• Fearing your body will freak out with an embarrassing reaction, such as shaking in your voice or hands and sweating nonstop
• Having worst-case-scenario, negative thoughts: What if I bomb the presentation and everyone thinks I don’t deserve the position? What if it’s super obvious I’m a nervous wreck? What if I can’t stop stuttering?
• Picking apart a past performance or interaction and inevitably finding a slew of flaws

Physical social anxiety symptoms

• Accelerated heartbeat
• Blushing
• Dizziness
• Feeling like your mind is going blank
• Headaches
• Muscle tension
• Shaking
• Sick-to-your-stomach feeling
• Sweating
• Having full-blown panic attacks

How Is Social Anxiety Disorder Diagnosed?

How can you tell if someone has social anxiety disorder? Social anxiety disorder requires diagnosis from a medical professional. If you see a primary care physician first, they’ll likely perform a physical exam and order blood work to rule out any underlying conditions. For example, an underactive thyroid (hypothyroidism) causes anxiety and depression, as well as brain fog.

To diagnose social anxiety disorder, therapists will ask you a series of questions or have you complete a questionnaire based on criteria in the DSM-5—basically the bible of mental health conditions. 

The DSM criteria includes:

• Being anxious or afraid about one or more social interactions where you’ll be evaluated
• Fearing that you’ll embarrass yourself or show visible signs of anxiety
• Almost always feeling fearful or anxious during the same social situation
• Avoiding social situations or enduring them with a lot of anxiety
• Experiencing significant distress or impairment in important areas of your life
• Having these issues for 6 months or more

Is Social Anxiety Disorder Common?

Having any kind of mental health condition can lead you to feel alone. Even though intellectually you know it’s a condition and not some profound defect, you still berate yourself. 

Social anxiety disorder can feel especially isolating because you struggle with the very thing that can help you heal and realize you’re not alone: connection.

But social anxiety disorder is actually quite common, affecting 15 million Americans (6.8%). It’s the second most common anxiety disorder, after specific phobias.

What Causes Social Anxiety Disorder?

We don’t know exactly what causes social anxiety disorder (or most disorders for that matter).  But it’s likely a combination of contributing factors, including genetic and environmental factors, such as: 

• Close family members with social anxiety, who either give a genetic risk or inadvertently model anxious social behavior
• A history of stressful events, such as bullying, teasing, family conflict, or trauma
• An overactive amygdala—the emotional center of our brains involved in fight or flight—which sharpens anxiety in social interactions
• Controlling or overprotective parenting

What Triggers Social Anxiety?

Social anxiety can be triggered by any social situation, or any situation in which you and at least one other person are present. The two main categories of social situations are performance (where you feel as if you’re being observed by others) and interpersonal (where you directly interact with others).

Performance situations include giving a presentation, walking into a room full of people, and talking or asking a question in a meeting/class. Interpersonal interactions include meeting new people, talking to friends, going to a party, and ordering at a restaurant.  

It’s normal for people with social anxiety to fear certain social situations but not others. For example, you might feel completely comfortable interacting with friends and family but feel anxious and uncomfortable around strangers. Additionally, just one social scenario might trigger your anxiety, such as public speaking.

Who Is At Risk of Developing Social Anxiety Disorder?

You generally have a higher chance of developing social anxiety disorder if:

• Your parents or siblings have social anxiety
• You’ve experienced negative events (like the above)
• You are naturally more shy and timid (though social anxiety disorder is much more than just shyness)
• You tend toward perfectionism and worry about making mistakes
• You have a condition that makes you feel more self-conscious, such as a speech disorder or psoriasis

When Does Social Anxiety Disorder Typically Manifest?

When social anxiety shows up varies from person to person. Some people may have a tough time in some social interactions but not others.

In general, though, social anxiety may manifest when:

• Attending parties
• Eating, drinking, or exercising in public
• Getting called on in class
• Giving a toast
• Giving a presentation
• Interviewing for a job 
• Making eye contact
• Meeting new people
• Participating in sports competitions
• Performing on stage, such as dancing, singing, or playing an instrument
• Speaking up in a meeting
• Talking to strangers, like ordering takeout or asking a store employee a question  

Significant life events can also trigger social anxiety. “The COVID-19 pandemic has caused a significant increase in social anxiety for many,” says Christine Ridley, Licensed Clinical Social Worker (LCSW) at Thriveworks. “Most of us have been isolated in our homes (sheltering in place) and have regressed in terms of socialization, as we have been social distancing and have had to adhere to safe distances.”

How Can Social Anxiety Disorder Impact Someone’s Life?

Even though social anxiety disorder revolves around social situations, it can affect all areas of your life: work, school, relationships, finances, and more.

Your social anxiety might lead you to avoid building more vulnerable connections with close friends and family or developing new relationships. It might lead you to avoid giving presentations or sharing important insights at work, so you get passed over for promotions or a raise.

While it seems like you’re protecting yourself from potential judgment and rejection, you also might miss out on a lot of joy, which can come from:

• Attending get-togethers
• Meeting interesting people
• Saying yes to new opportunities
• Trying new things

Over time, social anxiety can also lead to depression (more on that below). Thankfully, however, treatment can change all this.

Can Social Anxiety Disorder Lead to Agoraphobia?

People with social anxiety disorder typically don’t develop agoraphobia. But it’s easy to confuse the two since they involve fear and anxiety in certain situations. To clarify, agoraphobia causes intense panic about being in situations you can’t control, escape from, or might feel embarrassed about.

In both conditions, people can experience debilitating panic attacks. So, for example, someone with agoraphobia might fear they’ll have a panic attack on the subway, get super embarrassed, and not be able to leave. This is why many with agoraphobia fear being in crowded or enclosed spaces or using transportation. They fear being trapped.

Can Social Anxiety Cause Depression?

Anxiety and depression are often co-occuring conditions. According to research, major depression is actually the most common mental health condition to co-occur with social anxiety disorder. This makes sense.

Social anxiety disorder can be debilitating, leading you to withdraw from others (because you fear getting rejected) or stay stuck in a job you hate (because you’re terrified of interviews or the public speaking responsibilities of a different position).

Some research has found that people with both conditions may be more likely to have depression with atypical features. In atypical depression, people experience a normal downward slump or sadness they can shake out of (this, versus clinical depression, in which people experience despair and they cannot simply shake). So, your mood brightens after getting good news or catching up with a close friend.  

In atypical depression, you also might: 

• Eat more
• Sleep more, typically over 10 hours a day
• Feel like your arms and legs are being weighed down (clinically called leaden paralysis)

Social anxiety and atypical depression also share a common symptom: interpersonal rejection sensitivity. This big term simply describes how people are extra sensitive to being criticized or rejected.

Social Anxiety Disorder Treatment: How to Overcome Social Anxiety

If you’ve lived with long-term social anxiety, you might mistakenly assume that this is just who and how you are. You’re just a loner. Or, you don’t do public speaking. You’re super quiet or an anxious mess.

But these aren’t core traits. These are social anxiety disorder symptoms and habits that you can change to help you create a more meaningful, fulfilling life.

Treating social anxiety disorder involves therapy and, in some cases, also medication – these treatments can help one better manage their social anxiety, build confidence, and improve their social interactions. Your specific course of treatment will depend on whether you have any additional conditions, such as depression. Often, people will actually seek treatment for depression without addressing their social anxiety (yet, of course, focusing on both is key).

Therapy

Cognitive behavioral therapy (CBT) is the first-line treatment for social anxiety. In CBT, you:

• Identify unhelpful beliefs and negative thoughts that spark your anxiety
• Challenge and reframe those thought patterns  
• Gradually, step by step, face your social fear and anxiety (e.g., imagining yourself giving a speech; practicing a quick speech with a close friend; sharing something during a work meeting)

CBT may also include virtual reality exposure therapy (VRET), which studies suggest has promising results. VRET allows you to face your feared situations in a virtual world—a great option for working your way to facing them in real life. In addition, your cognitive behavioral therapist may give you homework assignments to go out into the real world and practice social experiments. 

Short-term psychodynamic psychotherapy may also be helpful in reducing social anxiety, as some studies show. While therapists may use different techniques, in general, psychodynamic psychotherapy may involve: 

• Identifying the core relationship theme that underlies and perpetuates your social anxiety symptoms
• Addressing shame and unrealistic expectations
• Slowly facing anxiety-provoking situations

Emotion-focused therapy (EFT) is another treatment with some evidence. EFT sees shame as the heart of social anxiety. EFT helps you to: 

• Discover the shame-based emotional memories at the root of social anxiety
• Process a range of emotions, including anger and grief
• Develop compassion for yourself 

Medication 

Typically, therapy is your best bet because it addresses your social anxiety symptoms head-on. But in some cases, medication may be necessary (and that’s OK, too).

Your doctor might prescribe these first-line medications for social anxiety (which also effectively treat depression): 

• Selective serotonin reuptake inhibitor (SSRI), such as fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft)
• Serotonin norepinephrine reuptake inhibitor (SNRI), such as venlafaxine (Effexor)

Can Social Anxiety Disorder Be Cured?

There’s no cure for social anxiety disorder, just as there’s no way to eliminate anxiety. You might always worry a bit about what others think or get the jitters before meeting someone new. 

But that’s not necessarily a bad thing. It’s simply inherent: As human beings, we yearn to belong and be accepted by our pack. Anything to jeopardize that can naturally make us nervous and upset.

However, with treatment, your social anxiety takes a backseat and becomes background noise as you pursue interesting professional opportunities and develop other meaningful areas of your life.

How Can I Prevent Social Anxiety Disorder?

We can’t prevent social anxiety disorder. But we can keep symptoms from progressing and consuming our lives. We can do this by using a range of strategies. 

It’s helpful to remember that since everyone is different and social anxiety severity varies, what works best will be individual too.

But, overall, these are some helpful techniques, tools, and approaches:  

• See a therapist earlier than later. Look for a clinician who specializes in social anxiety. Therapy is highly effective for reducing social anxiety. Remember that you can move as slowly as you need. Your therapist will support you in pursuing challenging situations—but only after you’ve learned helpful skills (from comping skills to social skills), practiced, and feel more comfortable. 
• Sharpen your skills. Reflect on the situations that are toughest for you. Then look for books or e-courses on that topic. For example, you might want to learn more about general communication strategies, interview best practices, or effective presentation strategies. No one is born knowing these things. These are skills you can learn and over time, practice and master.  
• Take small steps to practice anxiety-provoking social situations, because the more you practice, the quieter your anxiety becomes. Think of the least nerve-racking action you can take, and start there. 
• Learn relaxation strategies that you can turn to during uncomfortable situations. This can include exercises to deepen your breathing and calm your body. 
• Take good care of yourself. This can include getting restful sleep, limiting caffeine, and engaging in exercise you actually enjoy.
• Limit or stop drinking, or using other substances. Alcohol and drugs only increase your anxiety and reduce your inhibitions, which can lead you to act in ways that aren’t indicative of who you really are. 
• Acknowledge that your experiences and fears are universal. Remember that you are in good company. You are among millions of people—literally—who also have social anxiety. So many people can relate to what you’re going through, and there’s absolutely nothing inherently wrong with you. 
• Use kinder, gentler self-talk. For some people, affirmations, such as “I am confident” or “I’ve got this” are helpful. But it’s OK if those don’t resonate with you. By all means, be realistic—while still focusing on encouraging and empowering yourself. You could tell yourself the same things you’d say to someone you love. You could acknowledge how hard something is for you, and that you’ll do your best, versus berating yourself about it being easy and you’re a loser if you mess up. 
• Listen to self-compassion-focused guided meditations. These practices provide extra support for learning to be gentle with yourself. To get started, try this 20-minute loving-kindness meditation from renowned researcher Kristin Neff.