• Anxiety

Living with Social Anxiety Disorder: Causes, Symptoms, and Treatment

Medically reviewed and edited by Dr. Anthony Puopolo

Social anxiety is a mental health issue that affects the daily lives of nearly 15 million Americans.

Individuals with this condition frequently experience persistent feelings of fear and being perceived negatively by others.

It can be a debilitating condition to live with, especially if social anxiety is left untreated. However, it is possible to incorporate various coping strategies into your daily routine to help

What is Social Anxiety Disorder?

Social anxiety disorder is a mental health condition characterized by an intense fear of social situations.

Individuals may have an ongoing fear of being watched and negatively judged by others, especially when they are in public.

It’s important to note that social anxiety goes beyond just shyness or feeling nervous about an event, and may manifest in a variety of situations, including public speaking or eating at a restaurant.

People with this condition experience overwhelming feelings of anxiety and self-consciousness in everyday social interactions.

This may lead to significant distress that impacts their daily life.

What causes social anxiety?

While the exact cause of social anxiety isn’t fully understood, most medical professionals agree that many factors can contribute to its development.

These factors may include:

• Genetics and family history of social anxiety

• Chemical imbalances in the brain

• Previous traumatic or embarrassing social experiences

Someone may also develop social anxiety disorder because of learned behavior that people may have picked up by observing or imitating others with this phobia.

What are common social anxiety triggers?

Social anxiety can be triggered by a variety of situations or circumstances and environmental factors, including:

Performance-based situations such as public speaking, delivering presentations, and work reviews or evaluations.

Social interactions like engaging in conversations, meeting new people, attending parties, or interacting with authority figures.

Being the center of attention, such as during introductions, celebrations, or events.

Romantic activities like going on dates, expressing affection, or initiating intimacy.

These situations commonly cause an individual to experience a fear of being negatively judged, rejected, or embarrassed, which can trigger social anxiety.

What are the Symptoms of Social Anxiety?

Symptoms of social anxiety can vary from person to person, and typically involve more than just feeling shy or nervous.

There are several different types of social anxiety symptoms that can manifest, depending on the situation.

Emotional and behavioral symptoms

These are psychological symptoms that individuals with social anxiety commonly experience, such as:

• Worrying about embarrassing or humiliating themselves

• Intense fear of or anxiety about interacting with strangers

• Avoiding doing social activities that involve speaking to people

• Developing anxiety in anticipation of an activity or event

• Self-critical thoughts

• Difficulty initiating or maintaining conversations

Physical symptoms

Some individuals may also experience physical symptoms due to social anxiety. These may include:

• Rapid heartbeat

• Trembling or shaking

• Blushing

• Sweating

• Nausea or stomach upsets

• Shortness of breath

• Dizziness or feeling lightheaded

• Muscle tension

How is Social Anxiety Diagnosed?

A person typically has to experience persistent symptoms of social anxiety disorder for at least six months before they can be diagnosed.

If you suspect that you may have social anxiety, it’s important to speak to a licensed doctor for a professional diagnosis.

They will evaluate you based on the criteria for social anxiety listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Your healthcare provider will determine if your experience matches the criteria in the DSM-5 by asking you questions about your symptoms.

They may also do a physical examination to make sure your symptoms aren’t caused by any other medical conditions.

What can be mistaken for social anxiety?

Social anxiety shares similarities with other mental health conditions, and it can often be mistaken for different disorders.

Common conditions or traits that can be mistaken for social anxiety may include:

• Generalized anxiety disorders (GAD)

• Panic disorder

• Avoidant personality disorder (AvPD)

• Introversion

If you experience any unusual symptoms that may relate to these disorders or to social anxiety, seek professional medical advice.

Your doctor can accurately diagnose your condition and recommend treatment options to help you.

How Do You Treat Social Anxiety Disorder?

There are several methods for treating social anxiety disorder and managing your symptoms. The effectiveness of each treatment will vary between individuals and the severity of their condition.

Your doctor will typically recommend a treatment option or combination approach that is best suited for your situation.

Counseling

Counseling — specifically cognitive behavioral therapy (CBT) — involves speaking to a mental health professional or attending support groups.

In CBT, individuals usually work with a therapist to identify and challenge negative thought patterns or beliefs contributing to their social anxiety.

They learn coping strategies, such as relaxation techniques and gradual exposure to feared situations — this is also called exposure therapy.

CBT helps people to develop new skills and perspectives that improve their confidence to navigate social interactions over time.

Another counseling technique is called acceptance and commitment therapy (ACT). In ACT, people learn how to use mindfulness and behavioral strategies to overcome social anxiety.

With ACT, individuals can learn how to overcome social anxiety by living a more value-based life.

Your healthcare provider may also recommend group therapy to improve your social skills and techniques.

This may help improve your confidence to interact with people and it also helps you learn that social situations don’t always have to be intimidating.

Medication

In some cases, your doctor may prescribe medications to help treat social anxiety symptoms and improve your quality of life.

Common drugs used to treat social anxiety include:

• Selective serotonin reuptake inhibitors (SSRIs)

• Selective norepinephrine reuptake inhibitors (SNRIs)

It’s important to note that social anxiety medication can take several weeks to have a noticeable effect.

Drugs like propranolol can also be used as a short-acting medication that you can take when you need it.

Before using any medication for social anxiety, consult your doctor. They can help you determine which drug and dosage is right for your condition.

Home remedies

Home remedies can be used together with professional medical treatment to help you overcome social anxiety.

These remedies may include:

• Breathing exercises

• Meditation

• Avoiding caffeine and other stimulants

• Getting enough sleep

• Incorporating exercises like yoga into your routine to help manage stress

• Educating yourself about social anxiety

• Finding a trusted person you can talk to when you feel anxious

• Eating a balanced diet

• Getting regular exercise

• Knowing the signs of social anxiety and when to seek help

When Should You See a Doctor About Social Anxiety?

It’s not always easy to determine if you have social anxiety or if stress is contributing to your symptoms.

You should see a doctor if you experience any of the following, as this could indicate social anxiety:

• Persistent and intense feelings of fear and worry

• Purposefully avoiding social situations to minimize anxiety

• Feeling so anxious that it disrupts your ability to enjoy events or it starts affecting other areas of your life

• Experiencing significant emotional distress, such as feelings of sadness or hopelessness

• Difficulties forming and maintaining meaningful relationships because of anxious feelings

• Self-harm or suicidal thoughts

Remember that although it can be difficult to seek help, getting medical advice is a positive step towards improving your well-being.

Your doctor or a mental health professional can help you determine the cause of your symptoms and guide you through the treatment process to overcome social anxiety.

Where Can You Learn More About Social Anxiety and Similar Conditions?

If you’re concerned about your symptoms or suspect that you might have social anxiety, LifeMD is here to help.

LifeMD is a virtual platform that offers online personalized treatments with licensed professionals to help you reduce the impact of anxiety on your life.

A licensed healthcare provider may also prescribe anxiety medications to help you manage your condition.

Take control of your mental health by scheduling an online appointment today.

Dr. Anthony Puopolo

Dr. Puopolo holds a B.A. in Biology from Tufts University, M.A. in Biology from Boston University, and Doctor of Medicine from the Boston University School of Medicine. He also completed a Family Medicine and Psychiatry residency program in the U.S. Army.

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