Many people experience nervousness and anxiety from time to time or feel shy in certain social situations. For these people, however, the anxiety is short lived and doesn’t interfere with life or fuel their avoidance of social situations. On the other hand, for people with social anxiety disorder, their fear of social situations can be debilitating. Those with social anxiety disorder struggle with persistent, long lasting fear, which goes on for six months or more. Often, people with social anxiety disorder know that their intense fear of situations is slightly irrational, but still can’t shake the anxiety. The fear can get in the way of someone’s social life, professional life, academic life, and love life.

What is Social Anxiety Disorder?

Social anxiety disorder, also called social phobia, is a type of anxiety disorder characterized by an intense, persistent fear of social situations. Someone with social anxiety disorder will be extremely worried about people judging them or being embarrassed in front of others. People with this disorder fear various types of situations, including social interactions, being observed, or performing. They may also be afraid of others noticing that they are anxious. The fear is inappropriate compared to the actual threat of the situation, often leading to avoidance of social situations, which just fuels the intense fear. The level of avoidance and anxiety for the situation interferes with an individual’s functioning and quality of life.

Social anxiety disorder can be generalized or non-generalized. The disorder is considered to be generalized if most social situations are feared, and it’s considered non-generalized if the fear is limited to only a few specific situations. For some people, their social anxiety is limited to being performance related, such as situations like giving a speech or performing.

Typically, the onset of the disorder is in childhood or adolescence. Most people develop it before their twenties. However, it’s common for people with the disorder to wait until adulthood to seek treatment. Some people can pinpoint when their social anxiety began or what triggered it, such as being bullied in school, while others just recall being shy and social anxiety getting worse over time.

Social anxiety disorder is estimated to have affected about 7% of adults over the age of 18 in 2001 – 2003. Among these people, 29.9% experienced serious impairment due to the disorder, 38.8% experienced moderate impairment, and 31.3% experienced mild impairment.

Social Anxiety Disorder Symptoms & Behaviors

There are many symptoms of social anxiety disorder, both physical and mental. Symptoms can vary from person to person, but symptoms are typically intense and cause great distress.

Physical symptoms include:

• Racing heartbeat
• Blushing
• Sweating
• Feeling short of breath
• Nausea or upset stomach
• Lightheadedness or dizziness
• Trembling

Mental symptoms include:

• Feeling self-conscious or embarrassed in front of others
• Having difficulty being with and talking to new people
• Having an intense fear of being judged by others
• Having trouble with eye contact
• Avoiding social situations that would trigger anxiety

Some examples of situations that may be trigger these symptoms include:

• Meeting new people
• Talking to strangers
• Speaking up in group settings such as meetings
• Going to school or work
• Using public toilets
• Being watched while eating or drinking
• Public speaking

Social Anxiety Disorder Causes & Risk Factors

There isn’t one definitive cause for social anxiety disorder. Usually, people with the disorder have a combination of various possible causes and risk factors that predispose them to it.

Some examples of social anxiety disorder causes and risk factors are:

Brain structure: The amygdala is a part of the brain that is responsible for regulating anxiety and the fear response. Research has shown that the amygdala is overactive in people with social anxiety disorder, and this may play a role in the disorder.

Childhood: The way parents raise a child may affect whether or not they develop social anxiety disorder. For example, if someone’s parents were very controlling or overprotective, or if they demonstrated anxious behavior socially, this could result in a higher risk of the child developing social anxiety disorder.

Experiencing stressful or traumatic incidents: If someone has experienced abuse, whether it be physical, sexual, or emotional, they could be at higher risk for developing mental health conditions, including social anxiety disorder. Additionally, other stressful negative incidents such as being bullied or being embarrassed publicly can also contribute to later developing the disorder.

Genetics: If close relatives experience social anxiety disorder, someone in that family is more likely to develop the disorder themselves.

Treatment Options for Social Anxiety Disorder

Luckily, treatment options are available for social anxiety disorder. Treatment plans are individualized and tailored to someone’s specific needs, depending on the severity of the disorder and its impact on quality of life. Types of treatment include:

Therapy

Therapy has been shown to be very effective for helping people with social anxiety disorder. There are a few types of therapy that are commonly used:

Cognitive behavioral therapy (CBT): CBT is the most popular type of therapy for social anxiety disorder. This type of therapy helps people to identify and understand their unhealthy, negative thought patterns and behaviors and create new healthy thoughts and behaviors. CBT teaches people how to look at stressful situations more objectively and clearly, weaving in  coping skills and relaxation methods such as breathing techniques. Studies analyzing the efficacy of CBT for social anxiety disorder have found that this type of therapy can be highly effective in treating the disorder and changing peoples’ negative thought patterns and self-beliefs.

Exposure therapy: Exposure therapy involves someone with social anxiety disorder purposefully exposing themselves to their triggers. The goal is to feel the fear and attempt to do it anyway. With the help of a therapist, a hierarchy list of feared situations is created before the person with social anxiety goes out to actually face these fears. The theory is that with time, after completing multiple exposures, the triggers will become less intense, anxiety will be lower, and social situations will become a bit easier.

Group therapy: Group therapy can seem like a type of exposure therapy in and of itself due to the nature of the disorder since it’s a social situation with strangers and the risk of facing judgement. However, group therapy is a safe space for someone with social anxiety disorder to be able to interact with people who can relate to them on a deeper level, learn new skills, and practice interacting with others in a safe space. Research has found individual CBT and group CBT to be equally effective.

Medications

In cases where social anxiety is severe, medication may be used in addition to therapy in order to get the best results. There are a few different categories of medications that may be used to treat social anxiety disorder. They include:

Antidepressants: Antidepressants aren’t only used to treat depression, but they can also help with anxiety. Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants for social anxiety disorder. These drugs are often taken daily on a long-term basis.

Beta blockers: Beta blockers are a class of medications that lower blood pressure by blocking the effects of adrenaline. Though they are often used to treat physical health conditions, they are also prescribed to people with social anxiety disorder to take on an as-needed basis before stressful events that trigger social anxiety. Propranolol (Inderal) is an example of a beta blocker that is commonly prescribed for social anxiety disorder. This type of medication helps to reduce the physical symptoms of anxiety, including a racing heart and feeling short of breath.

Antianxiety medications: The most common type of antianxiety medication for social anxiety is a drug class called benzodiazepines. They reduce anxiety and have a sedating effect. Like beta blockers, benzodiazepines are fast acting and only taken on an as-needed basis before triggering events. However, this type of medication is more commonly prescribed after other therapy methods and medications have been tried since patients are likely to become physically dependent on them.