Social anxiety disorder: Causes, symptoms, and treatment
Reviewed by therapist.com team
Written bytherapist.com team
Last updated: 10/24/2023
Social anxiety disorder, also known as social phobia, is characterized by intense fear and worry when socializing with other people. Most people experience nerves when meeting new people, but people with social anxiety disorder experience intense fear of judgment that disrupts their lives.
People with shyness may exhibit similar symptoms to social anxiety disorder, but they are fundamentally different conditions. Shyness is a personality trait characterized by reserve and wariness when meeting new people. After the initial meeting, however, most people with shyness tend to relax and warm up to others. People with social anxiety do not become comfortable with others and continue to worry about how they are being judged or rejected.
Similarly, social awkwardness should not be confused with social anxiety. A person who exhibits social awkwardness finds it difficult to interact with people in social settings. They may struggle to communicate with or relate to others. Although social awkwardness may cause a person some anxiety, it is not as severe as the fear and worry experienced by a person with social anxiety disorder.
The cause of social anxiety disorder is uncertain, but researchers have identified common risk factors:
- Genetics: If someone in your family has an anxiety disorder, you have a greater risk for developing one as well.
- Biochemistry: The lack or suppression of certain chemicals in the brain may contribute to anxiety disorders.
- Learned behaviors: In addition to genetic risk, having a family member with an anxiety disorder may increase your risk for learning social anxiety behaviors. Parenting styles may also have an effect.
- Temperament: If you are naturally shy, you may have a greater risk of developing social phobia.
- Trauma: Traumatic experiences like bullying or abuse may lead to social anxiety disorder.
Various situations may trigger social anxiety symptoms, including:
- Eye contact: In the United States, eye contact is culturally expected when you’re having a conversation. Depending on the cultural norms of your specific city or town, it may even be expected as you encounter strangers when walking down the street.
- Work or school: Work and school are environments for productivity and learning, but they are also social environments. The social expectations of work and school may make it difficult to focus on your job or school assignments.
- Being in public: Simply existing in public spaces can be difficult for people with social phobia. Symptoms may arise when taking public transportation, using a public restroom, or enjoying a public outdoor space, like a park.
- Transactions: Interacting with strangers for transactional purposes can cause social anxiety. Making a purchase, returning items, asking for directions, or interacting with restaurant staff may be difficult.
- Dating: Dating is often a struggle for people with social phobia since it requires meeting new people and typically involves going to a public place.
- Parties: Parties are especially difficult for people with social anxiety disorder. It doesn’t matter if they are large or small, full of strangers or full of friends, or during the day or late in the evening. The stress of interacting with so many people is often too much for people with social phobia.
There are both physical and mental symptoms associated with social anxiety disorder, such as:
- Difficulty breathing
- Rapid heart rate
- Digestive problems
- Muscle tension or pain
- Dissociation (not feeling “in” your body)
- Anxiety or panic
- Practice mindfulness: People with social anxiety disorder often become preoccupied with other people’s potential judgments. Mindfulness can help you learn to stay grounded in the present moment. The practice of mindfulness encourages people with social phobia to observe their thoughts nonjudgmentally instead of reacting to stressors.
- Learn to self-regulate: Self-regulation can help you address the symptoms of social phobia in the moment. By learning to self-regulate, you can learn how to behave in line with your values instead of in response to your fear of being judged.
- Prioritize self-care: Self-care is the foundation of our physical, mental, emotional, and social health. It’s difficult to interact with other people if you are not getting enough sleep, eating regularly, or investing in other aspects of your health. By prioritizing self-care, you’ll have the energy and resources to stay calm in social settings.
- Avoid relying on substances: Some people with social phobia end up relying on alcohol or drugs to dull their symptoms and help them socialize. Relying on substances is dangerous for both your physical and mental health and can lead to addiction.
It’s important to remember that social phobia is a mental health disorder, not just a personality trait. At-home strategies may help you manage your symptoms more effectively, but you will likely need professional treatment to enjoy long-lasting relief. The good news is that there are many options for professional treatment for social anxiety disorder, including:
- Cognitive behavioral therapy (CBT): CBT helps people identify unhelpful or negative thought patterns that affect their emotions and behaviors. A CBT therapist can help people with social phobia challenge the thoughts at the root of their anxiety.
- Intentional mistake practice: A common component of CBT that may be helpful for some people with social anxiety involves intentionally engaging in behaviors that cause them embarrassment. The goal is for individuals to see that they can successfully tolerate their distress—even in the midst of this feared worst case scenario—and that their anticipatory anxiety is often disproportionate to the actual outcome.
- Exposure therapy: People with social phobia often avoid social situations. An exposure therapist can help you safely enter social situations while managing your symptoms.
- Acceptance & commitment therapy (ACT): ACT is a mindfulness-based behavioral therapy that helps people accept what they cannot change and commit to action where change is possible. An ACT therapist can help you accept your anxious feelings (instead of fighting against them), identify what matters to you in life, and take actions that are in line with these values, even in the face of anxiety.
- Medications: Your doctor may prescribe certain antianxiety medications to help you manage your social phobia symptoms. Typically, medication is prescribed alongside talk therapy.
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