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Social Anxiety Disorder: Symptoms, Causes, Risk Factors, Complications, Diagnosis And Treatment

Feeling nervous or anxious in a social situation is normal. Most of us are no strangers to shivery knees or cracky voice while giving a presentation and that feeling of butterflies in your stomach when meeting someone (no, it's not love - it's just nervousness).

While these are normal, when your normal day-to-day actions cause you jitteriness or when you avoid social interactions due to the fear of embarrassment and self-consciousness, it is no longer mere shyness but you may be suffering from a social anxiety disorder, also called social phobia [1] .

So, What Is Social Anxiety Disorder?

Social anxiety disorder or social anxiety is a type of anxiety disorder which cause fear and worry in social settings. An individual with the disorder finds it extremely difficult to talk to people because they fear of getting scrutinized or judged by others, which in turn, disrupt one's life and affect the daily routine, work, school or other activities.

A chronic mental health condition, individuals with a social anxiety disorder may understand that their fears are irrational or unreasonable, but feel powerless to overcome them. Social anxiety often occurs early in childhood as a normal part of social development and may go unnoticed until the person is older [2] . It normally begins at the age of 13.

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What Are The Symptoms Of Social Anxiety Disorder?

The condition causes fear, anxiety and avoidance that interfere with one's daily routine. The symptoms vary and are classified as being emotional, behavioural and physical [3] .

The emotional and behavioural symptoms are as follows:

  • Fear that others will notice that you being anxious
  • Fear of situations in which you may be judged
  • Worrying about embarrassing or humiliating yourself
  • Worrying intensely about social situations
  • Worrying for days or weeks before an event
  • Avoiding doing things or speaking to people out of fear of embarrassment
  • Avoiding situations where you might be the centre of attention
  • Enduring a social situation with intense fear or anxiety
  • Expecting the worst possible consequences from a negative experience during a social situation
  • Missing school or work because of anxiety

In the case of children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations [4] .

The physical symptoms of social anxiety are as follows [5] :

  • Upset stomach or nausea
  • Feeling that your mind has gone blank
  • Fast heartbeat
  • Trembling
  • Sweating
  • Blushing
  • Trouble catching your breath
  • Dizziness or light-headedness
  • Muscle tension

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Individuals suffering from social anxiety live in a constant state of fear and the symptoms may not occur in all situations, that is, you can have limited or selective anxiety. And they tend to avoid common social situations like the following:

  • Using a public restroom
  • Attending parties or social gatherings
  • Starting conversations
  • Returning items to a store
  • Interacting with unfamiliar people or strangers
  • Making eye contact
  • Dating
  • Entering a room in which people are already seated
  • Going to work or school
  • Eating in front of others

Social anxiety disorder symptoms can change over time. It can aggravate in the event of stressful situations [6] .

What Causes Social Anxiety Disorder?

The mental health condition arises from the complex interaction of environmental and genetic factors. The possible causes of social anxiety disorder are as follows, as the exact cause is unknown [7] :

Brain structure: Amygdala, a structure in the brain may play a role in controlling the fear response. Hence, individuals with an overactive amygdala can have increased anxiety in social situations.

Environment: Social anxiety is termed as being a learned behaviour, that is, one is not born with it but develops it with age. So, some people may develop the condition after an unpleasant or embarrassing social situation [8] .

Genetics: Anxiety disorders tend to run in families. However, it isn't entirely clear how much of this may be due to genetics.

What Are The Risk Factors Of Social Anxiety Disorder?

  • Family history
  • Negative experiences such as teasing, bullying, rejection, ridicule or humiliation
  • New social or work demands [8]
  • Having an appearance or condition that draws attention such as facial disfigurement, stuttering or tremors
  • Temperament

What Are Complications Of Social Anxiety Disorder?

If not provided with proper and timely medical care, the mental health condition can affect your life on a large scale. The complications about the condition are as follows [9] :

  • Hypersensitivity to criticism
  • Suicide or suicide attempts
  • Low self-esteem
  • Poor social skills
  • Trouble being assertive
  • Negative self-talk
  • Substance abuse
  • Low academic and employment achievement
  • Isolation and difficult social relationships

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How Is Social Anxiety Disorder Diagnosed?

Consequently, there is no medical test to check for social anxiety disorder. The doctor will examine if any underlying conditions are causing anxiety disorder or if there are any other physical or mental health disorder [10] .

The diagnosis will be carried out through the following means [11] :

  • Examining your symptoms and how often they occur and in what situations
  • Filling out a self-report questionnaire about symptoms of social anxiety
  • Reviewing a list of situations to see if they make you anxious
  • A physical exam to help assess whether any medical condition or medication may trigger symptoms of anxiety
  • Also, carry out an examination based on the Diagnostic and Statistical Manual of Mental
  • Disorders (DSM-5), published by the American Psychiatric Association

How Is Social Anxiety Disorder Treated?

The medical care provided for the mental health condition depends on how it affects your ability to function in daily life. The two most common types of treatment for social anxiety disorder are psychotherapy or medications. And in some cases, both are advised [12] .

Antidepressants, anti-anxiety medications and beta-blockers are some of the medications that are prescribed for social anxiety disorder. The therapies include cognitive behavioural therapy, exposure therapy and group therapy.

The doctors also advise avoiding caffeine (coffee, chocolate and soda) and getting plenty of sleep.

FAQs On Social Anxiety Disorder

Q. Is Social Anxiety a mental illness?

A. Social anxiety disorder (also called social phobia) is a mental health condition.

Q. Can social anxiety be cured?

A. No, but the symptoms can be managed.

Q. How does social anxiety affect teenagers?

A. It can cripple their social life and often result in them being branded as outcasts and be on the receiving end of bullying.

View Article References
  1. [1] Hofmann, S. G., & Otto, M. W. (2017). Cognitive-behavioural therapy for social anxiety disorder: Evidence-based and disorder specific treatment techniques. Routledge.
  2. [2] Whitfield-Gabrieli, S., Ghosh, S. S., Nieto-Castanon, A., Saygin, Z., Doehrmann, O., Chai, X. J., ... & Gabrieli, J. D. E. (2016). Brain connectomics predict response to treatment in social anxiety disorder. Molecular psychiatry, 21(5), 680.
  3. [3] Spence, S. H., & Rapee, R. M. (2016). The etiology of social anxiety disorder: An evidence-based model. Behaviour Research and Therapy, 86, 50-67.
  4. [4] Goldin, P. R., Morrison, A., Jazaieri, H., Brozovich, F., Heimberg, R., & Gross, J. J. (2016). Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 84(5), 427.
  5. [5] Taylor, J. H., Landeros-Weisenberger, A., Coughlin, C., Mulqueen, J., Johnson, J. A., Gabriel, D., ... & Bloch, M. H. (2018). Ketamine for social anxiety disorder: A randomized, placebo-controlled crossover trial. Neuropsychopharmacology, 43(2), 325.
  6. [6] Wong, Q. J., Certoma, S. P., McLellan, L. F., Halldorsson, B., Reyes, N., Boulton, K., ... & Rapee, R. M. (2018). Development and validation of a measure of maladaptive social-evaluative beliefs characteristic of social anxiety disorder in youth: The Report of Youth Social Cognitions (RYSC). Psychological assessment, 30(7), 904.
  7. [7] Stein, M. B., & Stein, D. J. (2008). Social anxiety disorder. The lancet, 371(9618), 1115-1125.
  8. [8] Schmidt, N. B., Richey, J. A., Buckner, J. D., & Timpano, K. R. (2009). Attention training for generalized social anxiety disorder. Journal of abnormal psychology, 118(1), 5.
  9. [9] Beidel, D. C., Turner, S. M., & American Psychological Association. (2007). Shy children, phobic adults: Nature and treatment of social anxiety disorder. Washington, DC: American Psychological Association.
  10. [10] Ballenger, J. C., Davidson, J. R., Lecrubier, Y., Nutt, D. J., Bobes, J., Beidel, D. C., ... & Westenberg, H. G. (1998). Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety. The Journal of clinical psychiatry.
  11. [11] Morrison, A. S., Mateen, M. A., Brozovich, F. A., Zaki, J., Goldin, P. R., Heimberg, R. G., & Gross, J. J. (2019). Changes in Empathy Mediate the Effects of Cognitive Behavioral Group Therapy but not Mindfulness-Based Stress Reduction for Social Anxiety Disorder. Behavior Therapy.
  12. [12] Langer, J. K., Tonge, N. A., Piccirillo, M., Rodebaugh, T. L., Thompson, R. J., & Gotlib, I. H. (2019). Symptoms of social anxiety disorder and major depressive disorder: A network perspective. Journal of affective disorders, 243, 531-538.

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