Social Anxiety Disorder Causes, Symptoms, Treatment, and More

Social anxiety disorder (SAD) is a common but under-diagnosed mental health condition experienced across different age groups and cultures. If you or someone you know has been diagnosed with SAD or you think you may be experiencing symptoms of the disorder, learning more about what to expect can help.

What Is Social Anxiety Disorder?

People with social anxiety disorder have an irrational fear of being watched, judged, or of embarrassing or humiliating themselves. The anxiety and discomfort become so extreme that it interferes with daily functioning. While it can be a debilitating disorder, appropriate treatment recovery is possible.

What Causes Social Anxiety?

Social anxiety disorder usually begins in the teenage years although it may start in childhood. While the exact cause of SAD is unknown, it is believed to result from a combination of both genetic and environmental factors. 

Imbalances in brain chemistry have been linked to SAD. For example, an imbalance in the neurotransmitter serotonin, a brain chemical that regulates mood and emotions, may play a role in the development of social anxiety disorder. 

Over-activity of a structure in the brain called the amygdala has also been linked to social anxiety. People with SAD may be predisposed to an exaggerated fear response and, in turn, increased anxiety.

Several environmental factors may also increase your risk of developing SAD. These include but are not limited to:

• Having an overly critical, controlling, or protective parent
• Being bullied or teased as a child
• Family conflict or sexual abuse
• A shy, timid, or withdrawn temperament as a child

Symptoms of Social Anxiety

People with social anxiety disorder know that their fear is out of proportion to the actual situation, but they are still unable to control their anxiety. The anxiety may be specific to one type of social or performance situation, or it may occur in all situations. 

Some of the situations that are common triggers include interacting with strangers, making eye contact, and initiating conversations. People with social anxiety disorder may experience cognitive, physical, and behavioral symptoms before, during, and after these social and performance situations.

Examples of cognitive symptoms:

• Fearing situations where you don't know other people
• Worrying that you will be judged by others
• Fear of becoming embarrassed or being humiliated
• Thinking that others will notice your anxiety
• Dreading upcoming events weeks in advance

Examples of physical symptoms:

• Blushing
• Profuse sweating
• Trembling hands
• Muscle tension
• Racing heart

Examples of behavioral symptoms:

• Avoiding social/performance activities
• Leaving/escaping situations
• Using safety behaviors

Diagnosing Clinical Social Anxiety

Social anxiety disorder is recognized as a diagnosable mental illness in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). It is also classified as an illness within the International Statistical Classification of Diseases and Related Health Problems (ICD-10), which is published by the World Health Organization (WHO).

SAD is generally diagnosed through a clinical interview with a mental health professional in which one is asked a number of questions related to their symptoms.

In order to receive a diagnosis, a person must meet a number of specific diagnostic criteria. Fear must also be so severe that it significantly impedes daily life, schoolwork, jobs, relationships, or one experiences serious distress about their symptoms.

Depending on whether symptoms are experienced in only a few situations or in most areas of life, one may be diagnosed with either generalized or specific SAD. The best first step if you have symptoms associated with SAD is to make an appointment with a therapist or mental health professional via a phone call or email.

Sharing any thoughts and feelings about your symptoms even with your primary care physician is a great first step. No need to worry about where to start—as long as you're honestly expressing some of what you're feeling, you will be on your way to better understanding your needs. You can start by taking some notes on your symptoms to share so you can reference those during your appointment.

Social Anxiety Disorder Discussion Guide

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Treating Social Anxiety

The most commonly used evidence-based treatments for social anxiety disorder are medication and cognitive-behavioral therapy (CBT). Often these two forms of treatment are used together for best results. In addition to CBT, there are a number of other types of therapy that may be used, either in an individual or group format 

Medications used to treat SAD:

• Benzodiazepines
• Beta-blockers
• Monoamine oxidase inhibitors (MAOIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Selective serotonin-norepinephrine reuptake inhibitors (SNRIs)

Talk therapies used in the treatment of SAD:

• Cognitive-behavioral therapy (CBT)
• Psychodynamic therapy
• Interpersonal therapy (IPT)
• Rational emotive behavior therapy (REBT)
• Acceptance and commitment therapy (ACT)

In addition to medication and therapy, technology-assisted interventions for SAD include Internet delivered CBT, virtual reality exposure therapy, and cognitive bias modifications. Some people also use alternative treatments such as dietary supplements or hypnotherapy. In general, research evidence does not yet exist to support the use of alternative treatments for SAD.

Self-Help Strategies

Self-help strategies for social anxiety disorder can be useful as an add-on to traditional treatment or for relieving mild symptoms. Examples of strategies include the following:

• Relaxation techniques, such as deep breathing, guided imagery, autogenic training, and progressive muscle relaxation
• Monitoring your own negative thoughts and replacing them with more helpful ones
• Exposing yourself gradually to feared situations
• Aromatherapy
• Self-help books
• Joining online forums to connect with others
• Healthy self-care such as eating right, exercising, and getting enough sleep

While self-help strategies are never a replacement for traditional treatment, they may help you to feel more in control of your symptoms.

Work and School

Social anxiety disorder can have an effect on your ability to attend school and work at a job. Starting in a new place, making friends, giving presentations, eating with others—these and other aspects of school and work are all triggers for those with social anxiety.

If you have been diagnosed with SAD, you can apply for accommodations at your workplace or college. If you have a child diagnosed with SAD, communication with teachers and support staff will be important to ensure that your child's needs are being met.

If SAD prevents you from working, you can also apply for social assistance. There are many support options in place to help those with mental health issues. If you aren't sure where to start, asking your mental health professional is a good way to go. 

Social Skills

Improving your social skills is an important component of social anxiety disorder treatment. Various aspects of social skills may be impaired in those with SAD, mostly because you've never had a chance to practice.

In general, you will want to work on improving communication skills—whether that means learning how to make small talk or understanding others' body language better.

If You're Recently Diagnosed With Social Anxiety Disorder

Slow down and take a breath. Although a diagnosis of SAD may feel scary, it is the best first step toward improving your situation. You will probably receive medication, therapy, or a combination of both to treat the disorder. You may also be eligible for more support if you attend school or work.

Living With Social Anxiety Disorder

In addition to receiving professional treatment, you can do a number of things to help cope with SAD. Some of these include practicing relaxation exercises, getting enough sleep, and eating a well-balanced diet.

It is important not to avoid situations that make you anxious. While avoidance may reduce your anxiety in the short-term, it will make things worse long term. If you find yourself feeling anxious, it may help to remind yourself that you can get through the situation, that your anxiety is usually short-lived, and that your worst fears are not likely to come true.

Remember that feeling anxious and nervous is not a sign of weakness or inferiority. SAD is a medical condition that requires attention. If left untreated, it can lead to other health problems such as substance abuse or risk of depression. However, with proper treatment and ongoing care, your quality of life can be much improved.

Although this may feel like a frightening journey you have embarked upon, learning more about social anxiety disorder and finding treatment can be the first step toward lessening the impact that it has on your life. It's okay to feel afraid to take that first step—take a deep breath and know that you are making the right decision.