Social anxiety disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 23, 2016
StartDiseasesSocial anxiety disorder

When people suffer from social anxiety disorder, they have an exaggerated fear of social situations. They become self-conscious, anxious, and fearful of being judged and criticized by other people. It is very unnerving for those with social anxiety disorder to be in social situations, and therefore they often avoid them. Social anxiety disorder is also known as social phobia.


Definition & Facts

A person who suffers from social anxiety disorder has a fear of making mistakes, looking foolish, and being embarrassed in front of other people. Those with social anxiety disorder do not know how to react in social situations and have a fear that something will happen to create tension which will cause a panic.

Full panic attacks may occur due to this intense anxiety. People who suffer from social anxiety disorder often avoid social situations altogether. Avoiding situations is used by people who suffer from social anxiety disorder to avoid anticipatory anxiety, which is nervousness leading up to social situations.

Oftentimes, the person knows their fear of social situations or of speaking to other people is unreasonable, but they are still unable to overcome it. About 7% of people suffer from social anxiety disorder at any given time, and about 13% of people experience at least once in their lifetime.

In the United States, social anxiety disorder is the most common kind of anxiety disorder, only behind specific phobias. The disorder can happen at any time, but it most often comes about in adolescence or in early adulthood. Women are more likely to suffer from this than men.

Symptoms & Complaints

People who suffer from social anxiety typically experience distress and anxiety when being introduced to new people, when they need to talk to strangers, when they are the center of attention, when they are being criticized, when they are being observed, during public speaking, or when meeting people they consider important.

They feel insecure and do not know how to react in these situations. They often want to run away when their fight-or-flight response kicks in. They are easily embarrassed and often avoid eye contact.

Sufferers may feel high levels of fear, negativity, nervousness, rapid heart beat, blushing, sweating, dry mouth, muscle twitches, and trembling. They may also look for ways to divert attention from themselves or look busy by writing, making a phone call, or attending to their smartphones.

Fear is the most common symptom, but in very extreme cases, people can develop body dysmorphia, where they see their faces or their bodies in an irrational way, fearing other people are doing the same.


Research suggests that many factors may play into the role of having social anxiety disorder, but there is not a simple and clear answer as to what causes it. Biological, environmental, family history, and psychological factors are likely to play a role in the development of social anxiety disorder.

People who suffer from this may also develop their behaviors by witnessing other people fail in social situations. They may see someone get very embarrassed in public and fear it may happen to them. Children who are not put in social situations early in life may not have a normal social development. They may not develop the skills that are necessary in childhood to function in an adult social society.

Painful or traumatic experiences may contribute to social anxiety. If someone endures a traumatic or embarrassing social situation, the person may fear that something similar will happen again.

Diagnosis & Tests

A physical exam as well as a medical history overview will be conducted to diagnose social anxiety disorder. While there is not a basic lab test to diagnose this issue, other lab tests may be performed to make sure the anxiety is not a symptom of another root issue.

If no additional illness is uncovered, sufferers may be referred to psychiatrists, psychologists, or other trained individuals who help those who suffer from anxiety. After someone is evaluated, and the intensity of the diagnosis is determined, a doctor can work with the patient to help work through their reactions to social situations.

Treatment & Therapy

Cognitive behavioral therapy or CBT is the most commonly used and most effective treatment for social anxiety disorder. The goal of CBT is to help people think critically about their own thoughts and experiences so they can stop avoiding social situations. It teaches sufferers how to react to social situations that trigger anxiety.

In addition to CBT, other forms of psychotherapy may include exposure therapy, or desensitization to tough situations. This is most often done in a safe place such as a therapist's office. The patient can slowly begin to experience real life exposure with the support of their mental health professional. Psychotherapy can also help improve social skills and self-esteem and to teach relaxation techniques.

There are also several types of medication that are used to treat this disorder. They can be used to help treat the symptoms that occur during social interactions. These include selective serotonin reuptake inhibitor antidepressants, also known as SSRIs, such as Zoloft® or Prozac®; and benzodiazepines, which are anti-anxiety medications, such as Ativan® or Xanax®.

Prevention & Prophylaxis

Social anxiety disorder cannot be prevented but is best treated if diagnosed and addressed early on. The outlook of people who suffer from this disorder is very positive with the help of therapy and medication.