What Is Social Anxiety Disorder?

Social anxiety disorder, previously known as social phobia, is characterized by an intense fear of being humiliated, negatively judged, or embarrassed in social situations. Individuals with this disorder experience significant anxiety that interferes with their daily functioning, including work, relationships, and other aspects of life.

In the United States, approximately 7% of adults are diagnosed with social anxiety disorder in a given year, making it one of the most commonly diagnosed anxiety disorders after specific phobia. The exact cause of social anxiety disorder is not fully understood, but there are identified risk factors that can contribute to its development. These include having a family history of social anxiety disorder and experiencing traumatic social experiences.

People with social anxiety disorder often experience significant distress and anticipation of certain social situations. They may spend extended periods dreading upcoming events or activities, and even the thought of speaking in front of others can trigger physical symptoms like nausea or a rapid heartbeat.

The good news is that effective treatment options are available for social anxiety disorder. Healthcare providers typically recommend therapy as the initial approach, with medication being considered if symptoms persist or are particularly severe.

Types of Social Anxiety Disorder

In the context of social anxiety disorder, researchers and healthcare providers often distinguish between two main subtypes based on the specific social situations that individuals fear or find challenging. These subtypes are:

1. Specific Social Anxiety Disorder

It is also known as non-generalized social anxiety disorder, is characterized by a fear of a limited range of social situations. Individuals with this subtype primarily experience anxiety and distress in specific situations that involve public speaking or performing, such as giving a presentation, delivering a speech, or acting in a play.

2. Generalized Social Anxiety Disorder

It is the more prevalent type of social anxiety disorder. Individuals with this subtype experience intense fear and anxiety in almost all social situations. Unlike specific social anxiety disorder, generalized social anxiety disorder encompasses a broader range of social interactions and can significantly impact various aspects of a person’s life. It often begins earlier in life and tends to be more persistent and disruptive.

Social Anxiety Disorder Symptoms

People with social anxiety disorder experience severe anxiety when faced with unfamiliar people or situations where they perceive themselves to be under scrutiny. This anxiety is more intense than typical shyness or introversion and often develops during childhood or adolescence, though it can also emerge later in life.

Individuals with social anxiety disorder may go to great lengths to avoid certain places or events, and they may experience prolonged worry and anticipation leading up to social situations, despite recognizing that their fears may be irrational. Some common triggers for anxiety in social situations include meeting new people, being the center of attention, attending social events with strangers, going to parties, eating in public, and using public restrooms.

Many individuals with social anxiety disorder tend to avoid social events altogether, but in some cases, it may be necessary or unavoidable to attend. When faced with anxiety-inducing situations or unexpected embarrassment, individuals with social anxiety disorder may experience various physical symptoms such as blushing, sweating, trembling, a rapid heart rate, rigid body posture, nausea, soft spokenness, and avoidance of eye contact.

In children, social anxiety disorder can manifest as crying, tantrums, refusal to participate in classroom or peer activities, and avoidance of social interactions like sports or birthday parties. Recognizing these symptoms is important for early intervention and support.

What Causes Social Anxiety Disorder?

Social anxiety disorder is characterized by extreme anxiety related to interacting with or being observed by others. While the exact cause is unknown, researchers believe that a combination of factors contributes to its development.

One factor is a genetic predisposition, as social anxiety disorder tends to run in families. Studies involving twins have shown that having genetic ties to the disorder increases the likelihood of developing social anxiety disorder.

Personal experiences also play a role in the onset of social anxiety disorder. Growing up with a parent who exhibits anxious behavior in social situations or having an overprotective or abusive parent can contribute to the development of the disorder. Additionally, experiencing stressful social events during childhood, such as being bullied or experiencing performance anxiety, can contribute to the development of social anxiety disorder.

Research has indicated that individuals with social anxiety disorder may have an overactive amygdala, which is the part of the brain responsible for releasing stress hormones. However, it is unclear whether this overactivity causes the disorder or is a result of it.

It is worth noting that women are more likely than men to be diagnosed with social anxiety disorder.

How Is Social Anxiety Disorder Diagnosed?

Social anxiety disorder often goes undiagnosed or is misdiagnosed as depression, as many individuals mistakenly believe their symptoms are just a part of their personality rather than a treatable medical condition.

If you suspect that you may have social anxiety disorder, it is important to speak with a healthcare provider. They will likely conduct a thorough assessment, including a detailed history of your symptoms, review of other health conditions, and possibly a physical examination to rule out any underlying physical issues.

A diagnosis of social anxiety disorder is based on meeting the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by the American Psychiatric Association. These criteria include experiencing extreme fear or anxiety in one or more social situations involving possible scrutiny by others, with the anxiety being out of proportion to the actual threat posed by the situation. The individual may actively avoid these social situations or endure them with intense fear or anxiety, leading to significant distress or impairment in functioning. These symptoms must persist for at least six months and are not attributed to substance abuse, another medical condition, or another mental disorder.

Treatments for Social Anxiety Disorder

The goal of treatment for Social Anxiety Disorder is to alleviate symptoms and improve overall functioning, particularly in social situations. Healthcare providers may recommend different treatment approaches based on the specific symptoms and their severity. Generally, there are two potential categories of treatment that may be discussed:

Psychological Therapies

Psychological therapies, particularly for children, are often the initial approach used by healthcare providers. Cognitive behavioral therapy (CBT) and social skills training are two common types of therapy used for treating social anxiety disorder.

• Cognitive Behavioral Therapy (CBT): This therapy involves working with a mental health professional to develop new ways of thinking about and responding to anxiety-provoking situations. CBT may include techniques such as systematic desensitization or exposure therapy, where patients learn relaxation techniques and gradually face their fears in real-life situations.
• Social Skills Training: This therapy focuses on practicing social interactions through role-playing exercises, often in a group setting. It helps individuals develop and improve their social skills, such as initiating conversations, maintaining eye contact, and managing social anxiety.

Medication

In some cases, healthcare providers may recommend medication in addition to therapy for the treatment of social anxiety disorder. The following medications are commonly prescribed:

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used antidepressants for social anxiety disorder. These medications may take a few weeks to show effectiveness and can have minor side effects such as headaches and nausea.
• Beta-Blockers: Beta-blockers are prescribed to control physical symptoms of anxiety, such as rapid heartbeat and sweating. They are often preferred for individuals who experience anxiety specifically in performance or public speaking situations.
• Benzodiazepines: Benzodiazepines are potent sedatives that provide immediate relief from anxiety symptoms. However, they can be habit-forming, so healthcare providers typically recommend short-term use to minimize dependence.

How To Prevent Social Anxiety Disorder

While there is no guaranteed way to prevent the development of social anxiety disorder, there are strategies that can reduce the likelihood of experiencing anxiety symptoms if you already have the disorder.

Treatment plans incorporating therapies and medications can be effective in managing anxiety by helping individuals identify and change negative thought patterns and address physical reactions to social situations.

In addition to professional interventions, certain lifestyle habits can contribute to anxiety reduction. Research suggests that regular exercise can improve mood and reduce anxiety levels. Other lifestyle changes that may help in preventing anxiety include:

• Maintaining Regular Eating Patterns: Eating balanced meals throughout the day can help stabilize blood sugar levels and provide the body with necessary nutrients, which can positively impact mood and overall well-being.
  
• Prioritizing Adequate Sleep: Sufficient sleep is essential for emotional and mental well-being. Establishing a regular sleep schedule and practicing good sleep hygiene can promote better rest and help manage anxiety symptoms.
  
• Limiting or Avoiding Stimulants: Caffeine and alcohol can exacerbate anxiety symptoms in some individuals. It may be beneficial to reduce or eliminate consumption of these substances, as they can interfere with sleep, increase heart rate, and contribute to feelings of restlessness.

Related Conditions

Research indicates that individuals with social anxiety disorder often have comorbidities with other anxiety disorders, such as generalized anxiety disorder or panic disorder. The development of these disorders can occur before or after the onset of social anxiety disorder, and in some cases, children may also experience selective mutism, which involves the inability to speak in specific situations.

In addition to anxiety disorders, individuals with social anxiety disorder may also experience co-occurring mental health conditions like depression. Furthermore, there is a higher likelihood of individuals with social anxiety disorder also having avoidant personality disorder, characterized by feelings of deep inferiority and avoidance of social situations.

It is not uncommon for individuals with social anxiety disorder, particularly those with the generalized form, to rely on drugs and alcohol as coping mechanisms or to make social interactions more tolerable. However, it is important to note that substance use can exacerbate anxiety symptoms and lead to additional challenges in managing the disorder.

Living With Social Anxiety Disorder

Living with social anxiety disorder can lead to feelings of loneliness and social isolation. The impact of social anxiety disorder extends to various aspects of life, including friendships, romantic relationships, educational achievement, earning potential, and the ability to engage in day-to-day activities such as shopping or grooming.

While some symptoms of social anxiety disorder may fluctuate over time, the disorder is unlikely to resolve without treatment. The good news is that effective treatments are available and can significantly reduce symptoms and enhance quality of life.

Individuals with social anxiety disorder can take an active role in managing their condition. This can involve educating themselves about the disorder, seeking support from friends and family by discussing their feelings and experiences, and engaging in anxiety-reducing activities such as meditation or exercise. Additionally, professional treatment options, such as therapy and medication, can provide valuable support and strategies for managing symptoms.

By combining self-help strategies with appropriate treatment, individuals with social anxiety disorder can improve their ability to cope with social situations, enhance their overall well-being, and regain a sense of control in their lives.