Social Anxiety Disorder: Signs, Symptoms, & Treatment

By Chesney Fowler, MD
Medically reviewed
March 1, 2020

Have you ever experienced nervousness, such as before giving a presentation to your boss and colleagues? The feeling of butterflies in your stomach, or sweaty palms is a common response for many. However, for those with social anxiety disorder, the fear of both unfamiliar and everyday social interactions is more intense. The resulting stress is high enough that it pushes sufferers to avoid these situations altogether, altering their lives.

Social anxiety disorder, or social phobia, is an overwhelming fear of social situations. It is a common mental health condition with a variety of treatments available, from self-help to behavioral therapy.

What Is Social Anxiety Disorder (Social Phobia)?

Social anxiety disorder, also referred to as social phobia, extends beyond shyness or discomfort in certain social situations. It is a long-lasting fear, and people who experience it face significant embarrassment, self-consciousness, and anxiety in everyday social interactions in large part because they dread being judged by others.

For example, let’s say you have to give a presentation in front of a lot of people. Pre-presentation jitters would be perfectly expected in this scenario, whereas someone with social anxiety would react more severely, fretting weeks ahead of time or even making an excuse to avoid the threat of the situation entirely. The stress of it would become too much to tolerate.

Severe social anxiety can feel like it’s taking control of your life, affecting daily routines. Even seemingly commonplace interactions can be stressors, like making eye contact or small talk with another person.

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Social Anxiety Causes

What causes social anxiety varies from person to person. Though many people struggle with it, their phobias often manifest in a variety of ways, whether it’s chatting with strangers or public speaking. Here are some common social anxiety causes:

  • Meeting new people
  • Taking exams
  • Going to parties
  • Using public restrooms
  • Eating or drinking in front of others
  • Dating
  • Making phone calls
  • Being the center of attention
  • Performing on stage

Family history can play a role in having social anxiety disorder. While no one is born with social anxiety, there’s an increased likelihood of developing the condition if your biological parents or siblings have it. In addition, childhood trauma—teasing, bullying, or rejection, for example—may leave people more susceptible to social phobia, along with negative life events like abuse or family conflict.

As an adult, new social or work demands may induce symptoms of social anxiety for the first time. A physical condition that draws people’s attention, such as a large birthmark or a stutter, might also trigger social anxiety disorder in some.

Symptoms of Social Anxiety Disorder

The symptoms of social anxiety disorder can be physical, emotional, and behavioral. Symptoms usually begin to appear when you’re a teenager. Many who deal with social anxiety disorder also face adjacent mental health issues like sleep anxiety or depression.

Physical symptoms

If you suffer from social anxiety disorder you may experience physical symptoms such as:

Emotional symptoms

Those with social anxiety experience emotional symptoms such as:

  • Dreading everyday activities
  • Intense self-consciousness
  • Low self-esteem
  • Constant fear of embarrassment
  • Persistent worry in anticipation of a social event

Behavioral symptoms

Behavioral symptoms of social anxiety disorder include:

  • Avoiding eye contact
  • Staying quiet or hiding in the background
  • Shying away from scenarios that might make you the center of attention
  • Avoiding activities altogether due to fear of embarrassment
  • Expecting dire consequences after an awkward social interaction

How Is Social Anxiety Disorder Diagnosed?

If you suspect you exhibit signs of social anxiety disorder, seeking help early can make a difference in regaining control. Your health care professional’s evaluation may include a physical exam, blood tests, plus a discussion of your symptoms and triggers for these symptoms. He or she might also reference the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, which includes the following criteria for social anxiety disorder:

  • Constant, extreme fear or anxiety about specific social situations because you worry you may be judged, embarrassed, or humiliated
  • Avoidance of anxiety-producing social situations or enduring them with intense fear
  • Anxiety that’s out of proportion to the situation
  • Anxiety or distress that interferes with your everyday life

How to Overcome Social Phobia

People facing social anxiety disorder have a robust array of treatment options, ranging from cognitive behavioral therapy (CBT) to guided self-help techniques and antidepressant medication.

CBT has been proven highly effective and one of the best treatments for social anxiety. It’s a form of therapy that helps patients identify and change negative thoughts, which in turn helps them gradually build confidence in the social situations they fear most. It can be equally successful conducted in one-in-one and group settings.

Several medications are available for combating social anxiety, but selective serotonin reuptake inhibitors (SSRIs) are often the first option. If diagnosed, your doctor might prescribe sertraline (Zoloft) or paroxetine (Paxil).

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Remedies for Social Anxiety Disorder

Self-help can go a long way to assuage the stressors that impact victims of social anxiety disorder. Here’s how to overcome social anxiety through five steps:

  • Identify and challenge your negative thoughts: A technique also employed via CBT, taking time to analyze the thoughts that heighten your social phobia is a vital step in understanding and lessening their impact.
  • Flip your focus from internal to external: Concentrating on what’s happening around you can draw your attention away from self-conscious thoughts.
  • Control your breathing: Inhale slowly through your nose, hold your breath for a couple of seconds, and exhale slowly through your mouth. Breathing exercises can help you stay calm.
  • Face your fears: Build slowly towards tackling situations that induce social anxiety, and use the techniques listed above to cope more effectively.
  • Take care of your body: Limiting caffeine and alcohol plus getting more sleep and exercise will leave you less vulnerable to bouts of social anxiety. Research suggests how you treat your body can have a significant impact on your mind.

Forgoing social anxiety treatment can lead to physical and psychological challenges that impact your life, including:

  • Poor social skills
  • Negative thoughts
  • Heightened sensitivity to criticism
  • Underachieving in academic or professional settings

Depression often occurs with social anxiety disorder, and the condition can leave those with it more susceptible to substance abuse as a coping mechanism.

When to Seek Help

If you’re an adult and you think you are suffering from social anxiety disorder, you should see a health care professional—particularly if your symptoms are having a large impact on your day-to-day life. If you have severe symptoms or are experiencing suicidal thoughts, call this help line: 800-273-TALK, go to the nearest emergency department, or call 911 for help.

Social anxiety can also affect children. While shyness in children is common and considered a temperament rather than a social phobia, parents who notice the following symptoms may consider speaking to a doctor:

  • Increased crying and tantrums when confronted with new people
  • Avoiding interaction with children or adults
  • Fear of going to school or participating in classroom activities

How K Health Can Help

Anxiety and depression are among the most under-reported and under-treated diseases in America. Nearly 20% of adults in the US suffer from mental health illness and fewer than half receive treatment. Our mission is to increase access to treatment for those suffering in silence.

You can start controlling your anxiety and depression and get access to the treatment you need with K Health. Starting at $12/month get prescriptions for mental health medications plus unlimited doctor visits through the K Health app. Start your free assessment to see if you’re eligible.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Chesney Fowler, MD

Dr. Fowler is an emergency medicine physician and received her MD from George Washington University. She completed her residency in emergency medicine at Christiana Care Health System. In addition to her work at K Health, Dr. Fowler is a practicing emergency medicine physician in Washington, DC.