Social anxiety disorder: symptoms, causes and treatment

Social anxiety can be debilitating, but you don’t have to suffer on your own. Here are the signs, treatment options, and some tips for coping.

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Page medically reviewed by Natalie Smith (BSc, MSc), Counselling Psychologist at Priory Wellbeing Centre Birmingham, in April 2022. 

Social anxiety, also known as ‘social phobia’, is a type of anxiety that affects people in social situations. As such, it can have a hugely negative impact on your life and relationships with others. Here, we explore this condition in more detail, in terms of what causes it and what symptoms to look out for, as well as provide tips on how you can overcome your social anxiety. We’ll also outline the treatment options that are available to help you get back on track.

What is social anxiety?

Social anxiety disorder is characterised by someone feeling significant distress in social settings or in situations where they're interacting with, or being observed by, other people. While we can all get nervous from time-to-time in social situations, for example, if we’re giving a speech or meeting new people, people with social anxiety experience excessive and disproportionate distress in these situations. They often believe they're going to be humiliated in front of other people or judged by others, to the extent that they might avoid social situations entirely. People with this condition may be able to recognise that their fear of social situations is irrational, but they find they can’t ‘switch off’ these feelings as they feel so real to them.

The triggers for social anxiety can vary between different people, but they can include:

  • Meeting new people
  • Speaking in front of a group
  • Talking in front of strangers
  • Eating in front of other people
  • Dating
  • Using a public toilet
  • Entering a room on your own
  • Going to parties
  • Initiating conversations

Social anxiety disorder can be debilitating and can have huge repercussions on a person's ability to:

  • Go to work or school – find out more about social anxiety at school
  • Talk to anyone outside their family
  • Develop relationships and friendships
  • Engage in normal, day-to-day tasks such as food shopping

social anxiety compared to generalised anxiety disorder

What causes social anxiety?

As with other types of anxiety, it’s likely that there isn’t a single cause for social anxiety. It’s thought that the chances of someone developing social anxiety disorder is down to a combination of genetic, environmental and social factors. These include:

  • Having a close family member that struggles with social anxiety
  • Experiencing abuse and/or neglect, especially if this happens during childhood
  • Experiencing stressful situations such as family conflict
  • Being the victim of bullying or rejection

Find out more about the causes of anxiety.

Social anxiety symptoms

The symptoms of social anxiety can differ from person to person, depending on their unique experiences and the severity of their condition. Nonetheless, there are several common symptoms to be aware of that can help in identifying social anxiety.

  • Excessive fear and discomfort when you’re in a social situation
  • Feeling very self-conscious in front of other people
  • Worrying about a social event for weeks beforehand and going over and over it in your head afterwards
  • Having difficulty speaking in front of other people or feeling as though your mind has ‘gone blank’
  • Avoiding social situations wherever possible, which can lead to loneliness and isolation
  • Believing that you’re going to be humiliated or embarrassed in front of other people
  • Believing that other people are looking at you and judging you. People often describe feeling as though there’s a giant spotlight over their head, drawing attention to them
  • Worrying that other people will know you’re distressed and uncomfortable around them
  • Absences from work or school because of your anxiety
  • Feeling as though you need to drink alcohol to be able to face a social event
  • Having low self-esteem and being very sensitive to criticism
  • Racing heart
  • Rapid breathing
  • Sweating
  • Nausea and diarrhoea
  • Blushing
  • Feeling dizzy and lightheaded
  • Trembling and shaking
  • Panic attacks

It’s important to note that someone with social anxiety may not experience these symptoms in all situations. For some, their social anxiety only centres on one type of social interaction such as eating in front of other people, or talking to strangers. However, with severe social anxiety, it’s possible for these symptoms to occur in all social situations.

How to get over social anxiety

Dealing with anxiety can seem daunting, but there are a number of things you can do that can help.

Talk to a trusted friend or family member about how you’re feeling

By opening up to someone about your anxiety in social situations, they’ll be able to recognise when you might be feeling uncomfortable, understand your triggers and be able to support you better.

Take time out for yourself

It’s important that you try to make time each day to do something that you enjoy or find relaxing. This might be going for a walk, taking a hot bath or listening to your favourite music. These kinds of activities can boost your mood and release ‘feel good’ chemicals in the brain, which can make you feel less anxious. Doing one of these mood boosting activities right before a social situation can also help, as it can get you in a more positive frame of mind and make the situation feel less scary.

Practise relaxation and breathing techniques

If you’re feeling anxious, try taking a deep breath in, hold it for a few seconds, and then breathe out slowly. If you repeat this a number of times, it can help to combat the ‘fight or flight’ response and help your body settle down to a more natural resting state. You could also think about learning some relaxation techniques such as mediation or even joining a yoga class. If you’d be anxious doing this in person, there are lots of resources online and some classes may even be available remotely.

Take steps to re-frame your thoughts

Avoiding social situations completely can reduce your anxiety in the short-term, but can make it much worse in the long-term. Try to put yourself in a social situation that you feel anxious about, to see if any of the things you’re worried about (such as being humiliated or embarrassed in front of other people) actually happen. It’s likely that they won’t and this can help to re-frame your thoughts about these situations. You could always ask a friend or family member to accompany you for moral support.

Look after yourself

It’s important that you look after yourself physically in order to feel better mentally. Avoid caffeine and alcohol as these can make your anxiety symptoms worse, get plenty of sleep each night (aim for 7 to 8 hours), eat healthily and drink plenty of water. If you’re feeling good physically, this can help to boost your mood and reduce your anxiety.

Even though the above tips can help you to cope better with your social anxiety, it’s important to understand that in order to get over your social anxiety completely, it might be that you need professional treatment from a mental health expert.

Social anxiety treatment

Asking for help can be daunting, but it’s really important so you can start your journey to recovery. There are two core treatments for anxiety: therapy and medication.

Therapy

There are a few types of therapy used to treat social anxiety, and the most effective of these is cognitive behavioural therapy (CBT). CBT for anxiety works by encouraging you to challenge the negative thoughts and beliefs you hold about social situations and learn to replace them with positive alternatives. This can help to reduce your fears around social interactions and allow you to view social settings in a much more positive and healthy way.

Exposure therapy, including exposure response prevention (ERP), is another effective tool when it comes to treating social anxiety. During this therapy, you'll gradually be exposed to social situations that you fear in carefully graded steps and under the guidance of your therapist. These situations might cause you to feel anxious at first, but with time, your anxiety will subside when you realise that nothing bad is happening and there was nothing to be afraid of.

Another form of treatment for social anxiety is emotional regulation and anxiety management work. These techniques are designed to help you to calm your anxious thoughts before you enter a social situation.

Medication

Prescribed medication is also an effective way to treat social anxiety. The most common type of medication are selective serotonin reuptake inhibitors (SSRIs), which also have antidepressant properties. This can be effective when it's taken alongside therapy as it acts as an additional buffer against your social anxiety symptoms. Beta-blockers and anxiolytics are other examples of medications that might be used to treat social anxiety.

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