Social Anxiety Disorder by Gillian Friedman M.D.

Also called social phobia, social anxiety disorder involves a fear of being in social situations where one can be judged, criticized or negatively evaluated by others. It is a common but under-recognized problem, affecting about 13 percent of the population at some time during their lives.

Social anxiety can be limited to a single social situation, such as speaking in front of groups (a specific social phobia), or it can be generalized to multiple social situations or environments where individuals feel conspicuous. Common situations that can trigger anxiety include being introduced to others, being watched while doing something (like eating), meeting important people, being asked to say something in front of a group, making small talk at parties, returning items at a store or restaurant, making telephone calls to strangers or having to leave a message on a voicemail.

Symptoms that occur with social anxiety can include nervousness, racing heart, sweating, nausea, dry mouth, trembling, intense fear, embarrassment, humiliation and self-judging, critical thoughts. When social anxiety occurs, people often become even more embarrassed that others will notice their anxiety, and further attention will be drawn to them. Socially anxious individuals can never fully relax in the presence of others. They are continually self-conscious, haunted by the possibilities of what others might think of them.

Anxiety attacks or panic attacks can occur within a number of anxiety disorders besides social anxiety disorder. Social anxiety disorder, however, can be distinguished from other common anxiety disorders, such as generalized anxiety disorder (GAD) and panic disorder, by the situations and thoughts that trigger anxiety symptoms. People with generalized anxiety disorder worry excessively throughout the day about multiple events and situations, but the worry is not specific to social evaluation. Individuals with panic disorder experience anxiety mainly as discrete attacks with some of the same symptoms that are seen in social anxiety (sweating, racing heart, nausea, etc.), but their fear is that there is something medically wrong with them (i.e. they’re having a heart attack or suffocating). In contrast, people with social anxiety disorder generally know that anxiety and fear are causing their symptoms.

Social anxiety can cause significant impairment in employment and social functioning. Socially anxious people may keep jobs far below their skill level because they are fearful of job interviews, social contact in the office or having to supervise others. Their social circles can become limited to only immediate family, or in severe cases to no one at all.

The most effective treatment for social anxiety disorder is a type of therapy called Cognitive-Behavioral Therapy or CBT. Through a series of structured exercises, socially anxious individuals learn to identify the negative thoughts that are accompanying their anxiety. They also learn common ways that thinking becomes distorted in emotionally charged situations, and learn to generate more neutral alternatives. The therapy also teaches skills for distracting from anxiety when it starts to occur (focusing the mind on something else so the anxiety is less noticeable). Individuals then practice more neutral thoughts by using behavioral experiments to gradually attempt some of the activities that were previously anxiety-producing. The experiments help people with social anxiety watch for evidence about others’ reactions instead of just making negative assumptions. Therapy groups specific for social anxiety help them practice fearful activities (looking people directly in the eye or doing foolish things in front of other people) in a safe environment.

Medications can sometimes help social anxiety disorder, but are most effective when used in conjunction with CBT. Antidepressant medications, particularly those that work on the brain chemical serotonin, may decrease the intensity of generalized social anxiety. For people with specific social phobias, like public speaking, medications called beta-blockers can prevent some the physical manifestations of anxiety such as racing heartbeat and sweating, although they do not target thoughts or fears. In some instances, anxiolytic medications (such as Valium or Xanax) are prescribed. However, rebound anxiety can occur when these medications wear off, and their addictive potential can make them problematic.

Anxiety Disorders Association of America

Anxiety Network International

Social Anxiety Institute

Assoc. for the Advancement of
Behavior Therapy

Additional Writings About Social Anxiety Disorder?

Triumph Over Fear: A Book of Help and Hope for People with Anxiety, Panic Attacks, and Phobias, by Jerilyn Ross, Rosalynn Carter

Dying of Embarrassment: Help for Social Anxiety & Phobia, by Cheryl N. Carmin, et al

Painfully Shy: How to Overcome Social Anxiety and Reclaim Your Life, by Barbara Markway, et al