Social anxiety disorder: causes, symptoms and treatment


Social anxiety disorder: causes, symptoms and treatment

Social anxiety disorder or social anxiety is an excessive emotional discomfort, anxiety, fear or worry about social situations. The individual is exceptionally worried about social situations, being evaluated or scrutinized by other people - there is a heightened fear of interactions with others.

Social anxiety disorder is sometimes referred to as social phobia. A phobia is an irrational fear of certain situations, objects or environments.

Here are some key points about social anxiety. More detail and supporting information is in the main article.

  • People with social anxiety disorder are disproportionately nervous of social situations.
  • Symptoms can include abdominal discomfort and lightheadedness.
  • Sufferers may feel anxious about feeling anxious, creating a negative loop.
  • Panic attacks may occur.
  • Some people with social anxiety disorder are so nervous about how they appear that they trip or fall when walking past peers.
  • Between 3% and 13% of people in Western countries experience social anxiety disorder at some point.
  • It is more common in females than males.
  • Serotonin may play a role in social anxiety disorder.
  • The amygdala may be overactive in sufferers.
  • Treatment can include psychotherapy.

What is social anxiety disorder?

Social anxiety disorder can significantly disrupt the life of someone with the condition.

A person with social anxiety disorder typically is excessively fearful of embarrassment in social situations - this fear can sometimes have a debilitating effect on personal and professional relationships.

An individual with social anxiety disorder may have signs and symptoms of blushing, trembling, accelerated heartbeat, muscle tension, nausea, sweating, abdominal discomfort and lightheadedness.

Social anxiety often occurs early in childhood as a normal part of social development and may go unnoticed until the person is older. The triggers and frequency of social anxiety vary considerably, depending on the individual.

Most of us may feel nervous in certain social situations, such as giving a presentation, going out on a date, or taking part in a competition (such as a quiz). This is normal and in most cases is not social anxiety disorder. Social anxiety disorder is when everyday social interactions cause excessive fear, self-consciousness and embarrassment. Such trivial tasks as filling a form with people around, or eating in public places or with friends may become considerable ordeals for somebody with social anxiety disorder.

Symptoms of social anxiety disorder

Social anxiety disorder is a chronic mental health condition in which the sufferer has an irrational fear or anxiety of situations or activities, believing he/she will be observed and judged by others. There is considerable fear of humiliation or embarrassment. There may be physical, emotional and behavioral signs and symptoms.

Behavioral and emotional signs and symptoms:

  • Anxiety reaches such a point that daily tasks, including school life, work and other activities become affected
  • Avoiding situations where the sufferer feels he/she may be the center of attention
  • Children with possible social anxiety disorder tend to be worried about being embarrassed in front of peers, but not generally in front of adults
  • Considerable fear of being in situations with strangers (people the sufferer does not know)
  • Dread over how they will be presented to others
  • Excessive fear of being teased or criticized
  • Excessive fear that other people may notice that the sufferer looks anxious
  • Excessive worry about being anxious, which makes the anxiety worse
  • Excessive worry about embarrassment and humiliation
  • Fear of meeting people in authority
  • Having severe anxiety or panic attacks when in the feared situation
  • Refraining from doing certain things or talking to people because of a fear of humiliation or embarrassment
  • The individual worries excessively about being in situations where he/she may be judged
  • When in a situation that causes anxiety the sufferer's mind may go blank.
Physical signs and symptoms:
  • A feeling that the heart is either pounding too hard or fluttering (palpitations)
  • Abdominal pain and/or stomach upset
  • Avoiding eye contact
  • Blushing
  • Children with social phobia may weep, have tantrums, cling to parents, or shut themselves out
  • Clammy hands
  • Cold hands
  • Confusion
  • Crying
  • Diarrhea
  • Difficulty talking; this may include a shaky voice
  • Dry mouth
  • Dry throat
  • Excessive sweating
  • Muscle tension
  • Nausea
  • Shaking
  • Trembling
  • Walk disturbance - the individual is so worried about how they walk that they lose balance when passing a group of people.
An individual with social anxiety disorder may also:
  • Be over-sensitive to criticism
  • Have low self-esteem
  • Have poor social skills
  • Not be assertive
  • Talk negatively about himself/herself - thoughts are often self-defeating and inaccurate.
Individuals with social anxiety disorder sometimes underachieve at school or at work in order to avoiding the attention of being promoted or having to participate in group tasks. In severe or chronic (long-term) cases of social anxiety the person may develop other psychological conditions, such as depression.

A person with social anxiety disorder may find the following situations extremely difficult to face:

  • Being introduced to people they don't know
  • Talking to people they don't know
  • Going into a room where the people are already settled
  • Looking at people straight in the eye (eye contact)
  • Ordering a meal in a restaurant
  • Starting a conversation
  • Using a public telephone
  • Using a public toilet
  • Writing in front of other people
  • Doing anything where other people may be looking on.

People with social anxiety disorder usually know that their anxiety is irrational. However, in many cases the anxiety persists and does not get better without appropriate treatment.


On the next page, we look at the risk factors, causes and diagnosis of anxiety disorder.

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