With a 12-month incidence in the community of roughly 18%, anxiety disorders are the most prevalent class of mental disorders. The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) and the International Classification of Diseases 10 (ICD-10) both classify social anxiety disorder, also known as social phobia, as a phobic (anxiety) disorder, along with agoraphobia and specific phobias (from which it was only recently distinguished).1
Social anxiety disorder may start in infancy or adolescence. Although a minority (21%) reported onset between the ages of 0 and 5 years, the average age of onset is between 10 and 13 years. Patients in the very early onset group claim that they have had the condition for as long as they can remember.2
Types of social anxiety disorder
Social anxiety disorder is characterised by a great deal of fear and worry in social settings. People who suffer from social anxiety disorder frequently worry too much about being judged, embarrassed, or humiliated by others. The exact social settings that cause anxiety can differ amongst the various forms of social anxiety disorder. Here are a few typical examples:
- Performance anxiety: Fear of speaking or performing in front of others is a component of performance anxiety, a sort of social anxiety. Stage fright, a fear of public speaking, or anxiety before performances, interviews, or presentations could be symptoms.
- Interaction anxiety: Anxiety about interactions with others, whether in small groups or one-on-one, is known as "interaction anxiety." It may involve having trouble starting or continuing conversations, a dread of being the centre of attention, or a worry that people will judge you harshly.
- Observation anxiety: Anxiety over being viewed or scrutinised by others is referred to as observation anxiety. It can be upsetting when doing things like dining in public, using the restroom in front of others, or writing.
- Assertiveness Anxiety: People with this form of social anxiety have trouble speaking up in front of others. In order to avoid being rejected or looked down upon, they may find it difficult to express their demands, ideas, or boundaries.
- Generalised Social Anxiety: Some people have a more widespread form of social anxiety disorder, which causes them to suffer anxiety and self-consciousness in a variety of social settings. Parties, gatherings, and even casual talks could be examples of this.
These categories are not mutually exclusive, so a person with a social anxiety disorder may experience a combination of them. Additionally, each person may have different triggers and degrees of severity3.
Causes of social anxiety disorder
The interaction of genetic, developmental, and neurological elements would be a realistic solution. A study discovered a concordance rate of 15.3% in fraternal twins and a rate of 24.4% in identical twins, indicating that social anxiety disorder affects more people in families than in the general population4.
Here are a few typical causes of social anxiety disorder that may be present:
- Genetic Factors: According to research, genetics may contribute to the emergence of social anxiety disorder. Social anxiety is more likely to occur if a close family member has the condition.
- Brain Chemistry: Unbalances in some neurotransmitters, or brain chemicals, such as serotonin, may play a role in the emergence of social anxiety disorder. The modulation of fear and anxiety responses may be impacted by these abnormalities.
- Environment: Traumatic events like bullying, humiliation, or social rejection can have an impact on the emergence of social anxiety disorder. Negative thoughts and anxieties about social situations can be shaped by these experiences.
- Family and Upbringing: Family relationships and upbringing might have an impact on how social anxiety disorder develops. Social anxiety can arise as a result of overprotective parenting, harsh criticism, or lack of social support during childhood.
- Temperament: Some people may have a temperament that is more reserved or anxious, which can increase their risk of having social anxiety disorder. They might be more perceptive to social criticism or fear criticism more intensely.
- Social learning: Social anxiety disorder can develop as a result of observing and mimicking other people's anxious behaviours or uncomfortable social situations. For instance, if a child observes a parent or other adult role model acting nervously in social situations, they can grow to fear similar circumstances(3,4).
Signs and symptoms of social anxiety disorder
Chronic social anxiety disorder usually starts in the first few years of adolescence. Despite the fact that social anxiety disorder affects more people assigned female by birth than those assigned male by birth, nearly equal percentages of both parties seek treatment. People who seek treatment frequently have symptoms that have persisted for ten years or more, and associated psychiatric illnesses are frequent4.
The signs and symptoms of social anxiety disorder may include any of the following:
- Avoiding or worrying a lot about social activities like group chats, eating with people, and everyday activities like meeting strangers, striking up conversations, talking on the phone, working, or shopping.
- Always being concerned about doing something you think will make you look foolish, like blushing, perspiring, or being incompetent.
- Finding it challenging to perform tasks when others are present. You can feel as though you are constantly being observed and evaluated.
- Dreading criticism, having poor self-esteem or avoiding eye contact
- Frequently experiencing symptoms such as nausea, sweating, shaking, or palpitations (fast beating of the heart).
- Experiencing panic episodes, which are brief periods of intense dread and worry.
Management and treatment for social anxiety disorder
Typically, a variety of therapeutic modalities and, in some situations, medicines are used to control and treat social anxiety disorder. The following are some typical methods for assisting people with social anxiety disorder:
- Cognitive-Behavioral Therapy (CBT): CBT is a form of therapy that concentrates on recognising and altering unfavourable thought patterns and behaviours related to social anxiety. Through exposure treatment, it enables people to confront their concerns, create coping mechanisms, and gradually face their anxiety-inducing situations.
- Social skills training: Therapy that focuses on enhancing social skills and boosting self-assurance in social circumstances is referred to as social skills training. It entails studying and putting assertiveness, problem-solving, and effective communication abilities to use.
- Relaxation techniques: Learning relaxation techniques, such as progressive muscle relaxation, mindfulness meditation, or deep breathing exercises, might help manage anxiety symptoms brought on by social circumstances. When feeling worried, these methods can help relax the body and mind.
- Support Groups: Associating with people who have experienced similar issues in support groups or group therapy sessions can give you a sense of community and understanding. People will be able to discuss their struggles, learn from others, and get assistance in a secure and accepting setting.
- Medication: In certain circumstances, doctors may recommend medication to treat social anxiety disorder symptoms. Benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) are two drugs that are frequently administered. Using medication along with therapy should be discussed with a healthcare practitioner.
- Lifestyle changes: Regular exercise, eating a balanced diet, getting adequate sleep, and cutting back on caffeine consumption can all help control general anxiety levels. These alterations to one's way of life can benefit one's mental health and enhance the efficacy of other therapeutic modalities3.
Working with a skilled mental health practitioner will help you choose the best course of treatment for your unique needs and situation. They can offer direction and support throughout the course of the treatment.
- Initial Evaluation: During the initial consultation, the medical professional will inquire about your symptoms and worries. They'll want to comprehend the type and severity of your social anxiousness. They could inquire as to what particular circumstances make you anxious and how it affects your day-to-day activities.
- Diagnostic Requirements: For you to be given a diagnosis of social anxiety disorder, your symptoms must match those listed in a diagnostic manual, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The requirements include worrying about being embarrassed or judged, having major dread or anxiety in one or more social settings, and avoiding or dealing with these events with great distress.
- Medical Evaluation: The healthcare provider may perform a physical examination or request blood tests to rule out any underlying medical disorders that could be causing your symptoms because some medical conditions can have symptoms that are similar to those of social anxiety disorder.
- Psychological assessment: To learn more about your symptoms, their intensity, and how they affect your everyday functioning, the healthcare provider may utilise a variety of diagnostic instruments, questionnaires, or interviews. This makes it easier to comprehend your condition.
- Duration and Impairment: Social anxiety disorder is identified when symptoms last for at least six months and severely affect everyday functioning in areas such as relationships, employment, or daily life4.
It's crucial to keep in mind that only a certified healthcare provider can identify social anxiety disorder. It is advised that you seek professional assistance for correct assessment and diagnosis if you think you might have social anxiety disorder.
Risk factors and complications
A family history of the disorder, temperament (such as shyness or behavioural inhibition), adverse childhood experiences (such as bullying or social rejection), and chemical abnormalities in the brain are all risk factors for social anxiety disorder.
Untreated social anxiety disorder can lead to complications like trouble establishing and sustaining relationships, issues in school or at work, substance addiction, low self-esteem, and other mental health diseases like depression. Early detection and adequate management of social anxiety disorder can reduce the condition's possible long-term effects on a person's quality of life and well-being5.
How can I prevent social anxiety disorder?
While social anxiety disorder may not be preventable, several methods like building social skills, creating a positive sense of self, resisting pessimistic ideas, and getting early help for anxiety symptoms can all improve mental health and perhaps lower the chance of social anxiety disorder.
How common is social anxiety disorder?
A relatively common mental health problem is social anxiety disorder. In the United Kingdom, it is thought that 7% of people would at some point in their lives suffer from social anxiety disorder. It affects people of all ages, genders, and backgrounds and has a big impact on how they live their lives and how well they function daily.
When should I see a doctor?
If your chronic and severe social anxiety interferes with your everyday life, relationships, career, or general well-being, make an appointment with a doctor. Seeking medical assistance can offer direction, support, and the best treatment options if your anxiety is severely impairing your ability to function or giving you great distress.
A prevalent mental health disease known as social anxiety disorder, often called social phobia, is characterised by extreme dread and anxiety in social situations. Although it can have an impact on many different facets of life, people can manage their symptoms and enhance their quality of life with early detection, accurate diagnosis, and efficient treatment techniques.
- Bell CC. Dsm-iv: diagnostic and statistical manual of mental disorders. JAMA [Internet]. 1994 Sep 14 [cited 2023 Jun 13];272(10):828–9. Available from: https://doi.org/10.1001/jama.1994.03520100096046.
- Schneier FR, Johnson J, Hornig CD, Liebowitz MR, Weissman MM. Social phobia: comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry [Internet]. 1992 Apr 1 [cited 2023 Jun 13];49(4):282–8. Available from: https://pubmed.ncbi.nlm.nih.gov/1558462/
- Schneier F, Goldmark J. Social anxiety disorder. In: Stein DJ, Vythilingum B, editors. Anxiety Disorders and Gender [Internet]. Cham: Springer International Publishing; 2015 [cited 2023 Jun 13]. p. 49–67. Available from: https://doi.org/10.1007/978-3-319-13060-6_3.
- Jefferson JW. Social anxiety disorder: more than just a little shyness. Prim Care Companion J Clin Psychiatry [Internet]. 2001 Feb [cited 2023 Jun 6];3(1):4–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181152/.
- Brook CA, Schmidt LA. Social anxiety disorder: A review of environmental risk factors. Neuropsychiatr Dis Treat [Internet]. 2008 Feb [cited 2023 Jun 13];4(1):123–43. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515922/.