Social Anxiety Disorder: Signs, Symptoms, & Treatment

By Chesney Fowler, MD
Medically reviewed
July 30, 2021

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.

Social Anxiety in Women vs. Men

Research has shown that women have consistently higher prevalence rates of anxiety disorders than men.

In fact, according to a 2016 research review of 48 studies, women are almost twice as likely to suffer from anxiety and people living in North America and Europe are disproportionately affected.

While there is no exact science when it comes to why more women are affected, researchers believe brain chemistry, hormone fluctuations, and biological mechanisms (how we react to life events) all play a factor.

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

Social Anxiety Disorder in children

Social anxiety disorder in children looks different than adults because children have different experiences in everyday life.

A child with social anxiety disorder might find small interactions like eating with classmates in the cafeteria or being called on by a teacher extremely scary.

Shyness in young children could be a possible sign of social anxiety, but the two are not always connected. Social anxiety disorder can manifest differently with some children hiding their fear while others come off angry or aggressive.

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

Is There a Social Anxiety Disorder Test?

If you or someone you know might be struggling with social anxiety disorder, there are assessments like our Mental Health Assessment that you can take online to evaluate your symptoms.

The assessment will ask you how you react to everyday situations including events that could lead to anxiety and stress. Answer truthfully, review your responses, and share them with a healthcare professional. 

How to Treat Social Anxiety Disorder

If social anxiety affects you, it does not have to control your life.

There are several treatment options available to help manage this disorder.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy that helps people find ways to change their behavior by changing their thought patterns.

This type of therapy is short-term and uses a problem-specific, goal-oriented approach that requires active participation.

In a CBT session, your provider will ask about the factors that trigger your social anxiety, and can offer strategies for challenging these thoughts to create new thought patterns.

Exposure Therapy

Exposure therapy centers around people facing and confronting their fears to help break patterns of avoidance resulting in long-term recovery. There are several types of exposure therapy, including:

  • Imaginal exposure
  • Virtual reality exposure
  • In vivo exposure
  • Interoceptive exposure

Support Groups

Group therapy brings people with social anxiety disorder together in a safe space to discuss their everyday challenges and learn from each other.

The goal is for participants to gain strength from talking about their experiences and hearing from other people they can relate to. 

Medication

A combination of therapy and medication are often prescribed for someone with social anxiety disorder. Your doctor may prescribe antidepressant drugs known as SSRIs (selective serotonin reuptake inhibitors), such as:

Your doctor may also suggest antidepressants called SNRIs (selective serotonin and norepinephrine reuptake inhibitors). Some examples include:

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.

Social Anxiety Disorder Statistics

The prevalence of social anxiety has been the subject of many studies in recent years. Here are some statistics on the disorder. 

  • An estimated 12.1% of U.S. adults experience social anxiety disorder at some time in their lives.
  • Of adults with social anxiety disorder in the past year, an estimated 29.9% had serious impairment, 38.8% had moderate impairment, and 31.3% had mild impairment.
  • An estimated 9.1% of adolescents had social anxiety disorder, and an estimated 1.3% had severe impairment.
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.

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