Social Anxiety Disorder: Causes, Symptoms and Treatment

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Being uneasy in situations like a first date or a job interview is quite normal and happens to everyone. But when that nervousness escalates into a feeling of extreme discomfort, dread or apprehension about normal social interactions, it can result in a diagnosis of social anxiety disorder.

Social anxiety, also known as social phobia, is so debilitating that it interferes with a person’s ability to perform everyday functions, attend social gatherings or even work.

The fear or social phobia can be very specific — such as an intense dread of public speaking or eating in restaurants — or general in that the sufferer gets anxious even at the thought of being in any social setting. When it involves an overall fear of social interactions, it is termed generalized social anxiety disorder.


Those who experience social anxiety disorder are highly apprehensive in social settings, more so than the occasional case of nerves some may experience in everyday encounters.

Generally, people with social anxiety disorder are concerned about being harshly judged by other people, even if it is not the case. There is a feeling that when they walk into a room everyone is watching them. They are typically afraid of coming off as foolish and have an intense fear of embarrassing themselves.

The symptoms can be physical, such as sweating, shaking, confusion or an accelerated heart rate. Blushing or having a red face is another physical manifestation of the disorder. Sufferers can feel faint or have a highly upset stomach.

Some of the symptoms can come on weeks or months before an event and be brought on by simply thinking about an upcoming social situation.

Social phobias severely inhibit a person’s ability to make and maintain friendships. To cope, many will completely avoid situations or severely limit their activities. If they do attend a social gathering, they will fade to the background. They will rarely attend events alone and need to bring someone they know along for security.


Like many mental health issues, social anxiety disorder sometimes runs in families. People with social anxiety disorder can also exhibit depression or other mental health conditions. Of the 15 million American adults who have the disorder, most begin exhibiting signs in childhood or early adolescence.

While there may be a genetic component, some experts believe that social anxiety is at least partly caused by environmental factors. Children who witness a parent of other significant adult who is uncomfortable in social situations may believe that is typical behavior.

The triggers for social anxiety disorder typically involve situations where the person perceives that he or she may be judged or do something potentially embarrassing. The person does not like being the center of attention, so occasions such as birthdays, graduations or other life events produce a high level of stress.

Eating or drinking — even water — in front of others can make sufferers anxious. Using public restrooms is another cause for nervousness and some will not travel far from home due to this issue.

Activities such as talking on the phone or speaking in a group are also avoided as much as possible by many sufferers. Attending parties, going on dates and other activities where they will have to mingle with others are usually out of the question. [Related: How Wearable Tech Could Improve Your Mental Health]

Connection to drug and alcohol abuse

About 20 percent of those with social anxiety disorder also abuse drugs and/or alcohol. Since many sufferers have difficulty in group settings, some end up consuming alcohol or abusing drugs alone. On the flip side, some may consume alcohol or use drugs as a way to fit in.

While many will self-medicate in order to feel more at ease in social situations, it typically heightens their fear of doing something embarrassing or being judged harshly.

Due to their fear of social interactions, many suffers have difficulty benefiting from peer support meetings or other support groups.

Treatment options

Psychotherapy, medication, or a combination, are often effective treatments for social phobias and social anxiety.

Cognitive behavior therapy, which focuses on changing how person thinks about, behaves and reacts to situations, can reduce fear and anxiety. Role playing and practicing social interactions can also reduce the stress of meeting people or performing some of the anxiety-producing behaviors in public.

Motivational enhancement therapy, which provides patients with self-motivational strategies to change their behavior, has been particularly successful with social anxiety suffers who are also experience alcohol addition.

Anti-anxiety medications and antidepressants are also commonly prescribed to help ease nervousness and tension.

Monoamine oxidase inhibitors, a class of antidepressant, have been particularly successful in treating social phobia. They are not usually the first prescription tried, however, as they can have strong interactions with some foods and other medications.

Beta-blockers are sometimes used to help controls some of the physical symptoms, such as shaking, sweating or elevated heart rate. They typically work best for very specific fears, such as a fear of public speaking, and are used on a limited basis.

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