What Is Social Anxiety (Social Phobia)?

Social anxiety, sometimes called social phobia, is an exaggerated fear of being in social situations, with concerns over negative judgments and criticism based on your ability to communicate or perform. The most severe version, called social anxiety disorder, can lead to crippling levels of personal invisibility, with problems arising at school, work, and in relationships, as you avoid necessary contact with others. Social anxiety is not the same as shyness, which is usually mild and transitory as the reserved individual grows comfortable with his or her surroundings. Social anxiety, which is more common in women than in men, typically first becomes evident in the early teenage years. 

If you or a loved one is battling with a fear of social interaction, the psychiatric specialists at Baptist Health may be able to help.

Symptoms

Social anxiety is marked by physical and psychological symptoms. Psychological symptoms include:

• Grave concerns over how you will be perceived in public
• Fear of interacting with others, especially strangers
• Worry over being found out, based on visible signs of anxiety
• Avoidance of all or nearly all social activities
• Feeling extreme discomfort for the entire span of a social event
• Self-criticism over mistakes you feel you made while socializing
• Assuming the worst possible outcome of any interaction that didn’t go as you wished.

Physical symptoms of social anxiety are:

• Sweating
• Trembling
• Blushing
• Rapid heartbeat
• Nausea
• Labored breathing
• Dizziness
• Muscle spasms
• Inability to make eye contact.

Severe cases of social anxiety can complicate daily living. Relatively simple tasks such as eating in a restaurant or using a public restroom become challenges. Significant life events, including job interviews, work presentations, and dating, are even more difficult, always accompanied by feelings of dread.

Causes

The cause or causes of social anxiety remain unclear but scientists think that both genetics and environment likely play a role. Negative experiences early in life may have an impact. Some individuals diagnosed with social anxiety disorder report having been bullied or sexually abused. There is also the possibility that serotonin imbalances are involved. Serotonin is a mood-regulating chemical that may influence the degree of anxiety felt by people confronted with stressful social events.  

Risk factors for social anxiety include a family history of psychological disorders, being naturally introverted, and the prospect of facing novel demands in life that tax one’s limited coping skills.

Diagnosis

There are no universally agreed-upon protocols for diagnosing social anxiety. Here are some steps that your physician or mental-health provider are likely to take:

• Symptoms documentation: Your physician or mental-health provider will want a complete list of symptoms, which can be obtained during a detailed question-and-answer session.
• Family medical history: Because of the prevalence of mental-health conditions in some families, your physician will want to know your medical history.
• Physical exam: A physical exam is important as a means of ruling out an underlying physical or medical cause of your condition.
• Psychological evaluation: You might be asked to fill out a questionnaire with the purpose of documenting medical and behavioral evidence for social anxiety. Your physician can use this information, in conjunction with the criteria published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to make his or her diagnosis.

The DSM-5 criteria include an outsized fear of social interaction, avoidance of social situations, interference with activities of daily living, and the inadequacy of any other medical or psychological disorder to explain the documented symptoms.

Treatment

There are three primary forms of treatment for social anxiety: psychotherapy, medications, and support groups.

Psychotherapy for Social Anxiety

Types of psychotherapy employed to treat social anxiety include:

• Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy is a pragmatic approach to psychotherapy that identifies certain issues in daily living associated with your condition, and provides you with the tools to confront them. It does this by altering the way you think about them, which leads to changes in your emotional responses and behaviors. 
• Exposure therapy: Exposure therapy inoculates a patient with social anxiety against the fears he or she has by gradually exposing him or her to different forms of social interaction in controlled settings and demonstrating the lack of a cause for worry.

Psychotherapy is most effective when supported by a good case-management program.

Medications for Social Anxiety

Medications are sometimes prescribed for people with social anxiety:

• Anti-anxiety medications, such as benzodiazepine.
• Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), such as paroxetine and sertraline. A related drug is venlafaxine, a serotonin and norepinephrine reuptake inhibitor.
• Beta-blockers, which reduce the impact of adrenalin released by the body in fight-or-flight scenarios, limiting the physical manifestations of anxiety, such as rapid heart rate, spiking blood pressure, nervous voice, and fidgety limbs.

Several of these drugs have adverse side effects or can be habit-forming, so prescription usage has to be carefully monitored by a physician.

Support Groups for Social Anxiety

Joining a support group comprised of other people with social anxiety is often helpful. These are people dealing with similar issues and feelings, that will have an understanding of and empathy for your condition. They can be a great resource for developing new coping skills and strategies for social interaction.

Complications

Social anxiety takes a toll. If left untreated, long-term effects can include:

• Decreased self-esteem
• Excessive timidity
• Inability to handle criticism
• Faulty social skills
• A track record of underachievement
• Excessive drinking and substance abuse
• Suicidal thoughts and behaviors.

Fortunately, social anxiety responds to treatment. Some combination of therapy, medication, and support-group activity is often effective in helping an individual overcome an excessive fear of social interaction and group behavior.

Prevention

Social anxiety disorder may not be strictly preventable, but there are positive means of limiting its symptoms and impact on your life:

Learn More About Social Anxiety at Baptist Health

Helping a loved one with social anxiety can be a challenge. Just remember: the caring providers at Baptist Health are on your side. If you’re looking for treatment options or more information about social anxiety, please contact a behavioral health provider with Baptist Health today.