Social anxiety disorder: Signs and symptoms

From attending a networking event or making friends in a new city, there are a number of situations where you can expect to feel a certain amount of anxiety in front of other people.  

But in the case of social anxiety disorder, it’s more than just feeling shy or even nervous. When you have this type of anxiety disorder, it can manifest in your everyday activities, like simply eating lunch in front of or with someone else. If you suspect you or a loved one may be living with social anxiety disorder, read on to learn more about symptoms of the condition and how it can be treated.  

What is social anxiety disorder?

Social anxiety disorder—sometimes called social phobia—is a type of anxiety disorder in which social interactions cause irrational levels of anxiety. When it’s untreated, it can cause you to avoid triggering situations, including any that involve other people. As a result, you might end up avoiding social interactions and isolating yourself, which can impact your relationships, work and routines.

For each individual person, the situations that trigger symptoms of social anxiety may be a little bit different. Some people experience social anxiety in almost any social situation involving other people, but others may only be triggered by specific situations. For example, they may get nervous when speaking with strangers or mingling at parties, but not performing in front of an audience.  

While social anxiety is sometimes used in everyday language to mean shyness, it’s actually quite different. There are certain similarities, but it’s important to remember that while social anxiety is a mental health condition, shyness is a personality trait. Distinguishing shyness from social anxiety disorder depends on how disruptive the symptoms are to your daily life, the intensity of the fear, and the level of avoidance. Here’s a brief look at the differences:

What does social anxiety disorder feel like?

When you experience symptoms of social anxiety or social phobia, you may have the following physical, emotional, and behavioral reactions.  

Physical symptoms

• Blushing
• Trembling
• Sweating
• A rapid heartbeat
• Chest pain
• Nausea
• Dizziness
• Shortness of breath

Emotional symptoms

• Intense worry before, during, and after a social situation
• Self-consciousness and fear of doing something embarrassing
• Concerns that others will notice they are stressed or nervous
• Feeling a need to consume alcohol to help face a social situation
• Feeling very self-conscious
• Believing that other people are judging or rejecting them

Behavioral symptoms

• Difficulty talking
• Avoiding social situations or trying to blend into the background if they must attend
• Missing school or work because of anxiety
• Speaking in a very quiet voice
• Avoiding eye contact
• Having stiff or rigid posture

What are some situations that might trigger social anxiety?

In order to avoid experiencing these symptoms entirely, people with social phobia tend to avoid all social situations. Some examples of particularly triggering situations include:  

• Asking a question in front of others  
• Going on job interviews
• Shopping
• Using public restrooms
• Talking on the phone, especially in front of other people
• Eating in public or in front of strangers

Some people may experience symptoms in all social contexts, while others experience anxiety more selectively. In any case, when anxiety impacts your day-to-day life, it usually means it’s time to get help from a professional. To learn more, check out: When to see a psychiatrist

What causes social anxiety disorder and social phobia?  

Social anxiety disorder, like a lot of other mental health conditions, most likely arises from a mix of biological and environmental factors. Some possible causes include:  

• Genes and inherited traits: The chances for someone to have social phobia may run in families, but no one knows for sure why some family members have it while others don’t. It also isn't entirely clear how much of inherited anxiety in general could be due to genetics and how much could be due to learned behavior.
• Brain structure: The amygdala, a structure in the brain that plays a role in controlling the fear response, may be overactive in people with social anxiety disorder. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations. ‍
• Environment: Some people may develop significant anxiety after an traumatically unpleasant or embarrassing social situation.

Risk factors for social anxiety disorder include:  

• Negative experiences: People who experienced teasing, bullying, rejection, ridicule or humiliation as children may be more prone to having this disorder. In addition, other negative events in life, such as family conflict, trauma or abuse, may be associated with it.
• Temperament: If you are already shy, timid, or withdrawn when it comes to facing new situations or people, you may be at greater risk of developing social anxiety.  
• New social or work demands: Meeting new people, giving a speech in public or making an important work presentation may trigger symptoms for the first time as an adult.  
• Having an appearance or condition that draws attention: Facial disfigurement, stuttering, or tremors due to Parkinson's disease, for example, can increase feelings of self-consciousness and may trigger social anxiety in some people.  

Other types of anxiety disorders also increase your risk of developing social anxiety disorder. For instance, it’s common for this condition to coexist alongside depression. In fact, social anxiety is reported to be the most commonly occurring anxiety disorder among patients with major depressive disorder. Social phobia almost always starts first, often many years prior to the onset of depression.

Do I have social phobia? How is it diagnosed?

Some people who have social anxiety disorder may not actively seek diagnosis or treatment. Sometimes they won’t find out they have it until they’re being evaluated for another condition. As with all mental health conditions, if you believe you have social anxiety disorder, it’s important to confirm an official diagnosis from a mental health professional, like a psychiatrist. They will be able to evaluate your symptoms and let you know if you have social phobia, a different type of mental or physical condition is causing your anxiety, or are simply experiencing an expected response to social situations.  

Your doctor will try to rule out any medications you might be taking that might be worsening your anxiety as a side effect. They’ll also want to know how often your symptoms occur and in what situations. In many cases, your doctor will provide a list of situations and ask you if they make you anxious. Your doctor will use the criteria listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) to provide a definitive diagnosis. This criteria includes:  

• Persistent, intense fear or anxiety about specific social situations because you believe you may be judged negatively, embarrassed or humiliated
• Avoidance of anxiety-producing social situations or enduring them with intense fear or anxiety
• Excessive anxiety that's out of proportion to the situation
• Anxiety or distress that interferes with your daily living
• Fear or anxiety that is not better explained by a medical condition, medication or substance abuse

How do you treat social anxiety disorder?

Once you have a correct diagnosis of social anxiety disorder, your doctor will work with you on treatment options, which can depend on how much it affects your ability to function in daily life. Most people respond well to a treatment that includes talk therapy, medications, or both. There are also plenty of coping skills and strategies to fight social anxiety.

Talk therapy

Talk therapy (or psychotherapy) can help you manage the symptoms of social anxiety disorder. In particular, cognitive behavioral therapy, or CBT, is the most effective type of psychotherapy for anxiety, either when conducted individually or in groups. In a type of CBT called exposure-based CBT, you’ll gradually work up to facing the situations you fear most. This exposure can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations.  

First-choice medications  

SSRIs and SNRIs (selective serotonin reuptake inhibitors) are often the first type of medication that psychiatrists turn to for treating social anxiety disorder because of their effectiveness and  relatively low risk of side effects. SSRIs like Paxil (paroxetine) or Zoloft (sertraline) and SNRIs like Effexor (venlafaxine) are FDA-approved treatments.

To reduce the likelihood of side effects, your doctor may start you out on a low dose of medication and gradually increase your prescription. In many cases, it takes up to several weeks for the medication to noticeably improve your symptoms so be patient.

Related article: Does Lexapro help with social anxiety?

Other medications  

Your health care psychiatrist may also prescribe other medications for symptoms of social anxiety, such as other types of antidepressants. As is always the case with this type of medication, you may have to try several different types to find the one that's most effective for you with the fewest side effects.

Anti-anxiety medications like benzodiazepines may also be prescribed to help reduce anxiety levels. However, they are typically used for short-term relief due because there’s a risk of building a tolerance and dependence.

Beta-blockers, such as Propranolol,  may also be prescribed to control the physical symptoms of social anxiety, such as a rapid heartbeat or shaking limbs. It’s generally recommended for specific situations, such as public speaking, rather than as a general treatment for social anxiety disorder.

If you believe you’re experiencing symptoms of social phobia, it’s important to get an evaluation from a medical professional. If you’re not sure where to start, take Talkiatry’s free online assessment. We’ll match you with a psychiatrist who can help you understand your symptoms and whether or not they’re related to a mental health condition.  

FAQs

Here are more answers to your questions about social anxiety disorder.

How does someone with social anxiety act?

How someone with social anxiety disorder acts can depend a lot on the social situation they’re in. However, if they are in a situation that triggers their anxiety, you may notice a few behavioral symptoms, like difficulty talking, speaking in a quiet voice, and avoiding eye contact.  

What makes social anxiety worse?

Avoiding social situations, which is a common way to cope with social anxiety in the short term, can actually make the condition worse over time. By constantly avoiding social interactions, you  miss out on chances to build your confidence and develop effective coping skills. This can reinforce your fear of social situations, leading to increased anxiety.

Learn about social anxiety and depression.

Can you self-treat social anxiety?

Treatment for social anxiety disorder does require help from an expert like a psychiatrist, but there are a number of stress-reduction techniques that may minimize your symptoms. These include avoiding alcohol and limiting caffeine, and regularly getting a good night’s sleep.

What are other anxiety disorders?

In addition to social anxiety disorder, there are a number of other anxiety disorders, including:  

• Generalized anxiety disorder (GAD)
• Panic disorder, with or without agoraphobia
• Specific phobias  

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.