What is Social Anxiety Disorder? (Social Phobia)
Social Anxiety Disorder, also known as social phobia, is a type of anxiety disorder characterized by excessive fear, anxiety, discomfort, and self-consciousness in social settings. While it is normal for people to feel anxious in some social settings, individuals with social anxiety disorder (social phobia) have a heightened fear of interaction with others in a variety of social interactions and worry they will be scrutinized by others. This intense anxiety causes impairment in functioning and interferes significantly with the individual’s life and relationships.
People with social anxiety typically know that their anxiety is irrational, is not based on fact, and does not make rational sense. Nevertheless, thoughts and feelings of anxiety persist and are chronic in nature.
Common Triggers
People with social anxiety commonly experience significant worry and distress in the following situations:
Eating in front of other people
Speaking in public
Being the center of attention
Talking to strangers
Going on dates
Meeting new people
Interviewing for a new job
Going to work or school
Meeting other people’s eyes
Making phone calls in public
Using public restrooms
Symptoms
An individual may experience physical, emotional, and behavioral symptoms of social anxiety disorder. These symptoms can significantly affect the individual’s daily life and relationships.
Physical Symptoms
Rapid heat-beat
Dizziness
Muscle tension or twitches
Stomach trouble
Blushing
Trembling
Excessive sweating
Dry throat and mouth
Emotional Symptoms
High levels of anxiety and fear
Nervousness
Panic attacks
Negative emotional cycles
Dysmorphia concerning part of their body (most commonly the face)
Behavioral Symptoms
Avoiding situations where the individual thinks they may be the center of attention
Refraining from certain activities because of a fear of embarrassment
Becoming isolated; the individual may quit their job or drop out of school
Excessive drinking or substance abuse
DSM-5 Diagnostic Criteria¹
Your healthcare provider will diagnose social anxiety disorder from a description of your symptoms and behavioral patterns. During your appointment, you will be asked to explain what symptoms you are having and discuss situations in which these symptoms present themselves. The diagnostic criteria for social anxiety disorder, as outlined in the DSM-5, includes:
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others lasting for 6 months or more.
Fear of acting in a way that will reveal anxiety symptoms that will be negatively evaluated by others. In children, the anxiety must occur when the child is among peers and not just adults.
The social situations almost always cause fear and anxiety.
The social situations are avoided or endured with intense fear.
The fear or anxiety is out of proportion to the actual threat posed by the situation.
Statistics
Social anxiety disorder affects approximately 15 million American adults.²
According to the US National Comorbidity Survey, social anxiety has a 12-month prevalence rate of 6.8%, placing it as the third most common mental disorder in the United States. ³
Statistically, social anxiety disorder is more common in women than in men. ⁴
Despite the availability of effective treatments, fewer than 5% of people of with social anxiety disorder seek treatment in the year following initial onset. ⁵
More than a third of people report symptoms for 10 or more years before seeking help.⁶
One study found that 85% of participants were able to significantly improve or recover using Cognitive Behavioral Therapy alone.⁷
Causes and Risk Factors
The exact cause of social anxiety disorder (social phobia) is unknown. However, current research suggests it may be caused by a combination of environmental factors and genetics. While there is no causal relationship between childhood maltreatment or other early-onset psychological adversity and the development of social anxiety disorder, they can be considered risk factors.
Individuals prone to behavioral inhibition (the tendency to experience distress and withdraw from unfamiliar situations, people, or environments) and fear of judgement are also predisposed to social anxiety disorder. Genetics may also play a role in the development of social anxiety as these behavioral traits are strongly genetically influenced.
What’s more, social anxiety disorder is a heritable condition—first-degree relatives have a two to six times greater chance of having social anxiety disorder.⁸
Treatment Options
Social anxiety disorder is a fully treatable condition that can be overcome with effective therapy, commitment, and patience. We recommend locating a specialist in your area to find a treatment pathway that works best for you. Some treatment options your doctor may suggest include:
Cognitive-Behavioral Therapy (CBT)
A huge body of research has shown cognitive-behavioral therapy (CBT) to be a markedly successful treatment for those suffering with social anxiety disorder (social phobia). The American Psychological Association defines cognitive-behavioral therapy as “a system of treatment involving a focus on thinking and its influence on both behavior and feelings.” CBT emphasizes the role of unhelpful beliefs and their influence on emotional and behavioral outcomes.
Social-anxiety-specific CBT focuses on changing the individual’s thoughts, beliefs, feelings, and behavior as they relate to social situations. “If the individual feels anxious about doing certain things and feels less anxious when they choose not to do them, this becomes a cycle whereby the individual learns that staying out of social situations keeps them emotionally regulated,” says Kelly Freeman, LCSW. “CBT challenges individuals to replace these thoughts.”
The cognitive part of the therapy refers to thinking and is the part of therapy that can be "taught" to the person. The act of practicing new thoughts through repetition when the individual notices unhelpful thoughts allows new patterns of thinking to become automatic. For instance, an individual might work to replace the anxiety-inducing thought of “everyone will stare at me if I go to the party” with “these feelings I am having right now aren’t rational. When the party is over, I’ll be glad that I went” in order to change the cycle.
The behavioral component of CBT involves attending group therapy with others diagnosed with social anxiety disorder. In the behavioral group, everyone participates in activities that are mildly anxiety-inducing to build confidence and a more rational perception in the person’s mind of what happens when they engage in these kinds of social activities. As a result, the anxiety felt in social situations is gradually reduced.⁹
People with social anxiety disorder might also try various relaxation methods to relieve the symptoms of anxiety. Examples of techniques that have been shown to be helpful include: massage, meditation, mindfulness, hypnotherapy, and acupuncture. However, these methods do not help people fully recover from social anxiety. Only CBT can help those struggling make permanent progress against social anxiety by changing irrational thinking into rational thinking, and helping to induce habitual and appropriate behavioral responses.
Medication
Medication is a useful form of treatment for many, but not all, people with social anxiety disorder (social phobia). Research suggests that the use of anti-anxiety medications, such as benzodiazepines, and certain selective serotonin reuptake inhibitors (SSRIs) used in conjunction with CBT have been most beneficial. Only CBT can permanently change the neural pathway associations in the brain and therefore medication alone has no long-term benefits for people with social anxiety.
