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Social anxiety

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This article is about an emotion, for the disorder, see Social anxiety disorder.

Social anxiety is a specific form of anxiety. It is an emotion characterized by a discomfort or a fear when a person is in a social interaction that involves a concern of being judged or evaluated by others.[1] It is typically characterised by an intense fear of what others are thinking about them (specifically fear of embarrassment or humiliation, criticism, or rejection), which results in the individual feeling insecure and not good enough for other people, and/or the assumption that peers will automatically reject them.[2] Developmental social anxiety occurs early in childhood as a normal part of the development of social functioning and is a stage that most children grow out of, but it may persist or resurface and grow into chronic social anxiety during their teenage years or possibly in adulthood.[3] People vary in how often they experience social anxiety, and in which kinds of situations they experience it.

Chronic social anxiety that causes considerable distress and impaired ability to function in at least some parts of daily life is an anxiety disorder called social anxiety disorder (SAD).[4]:15 It is the most common anxiety disorder and one of the most common psychiatric disorders, with 12% of American adults having experienced it.[5]


Child development[edit]

Social anxiety first occurs in infancy and is said to be a normal and necessary emotion for effective social functioning and developmental growth. Cognitive advances and increased pressures in late childhood and early adolescence result in repeated social anxiety. Adolescents have identified their most common anxieties as focused on relationships with peers to whom they are attracted, peer rejection, public speaking, blushing, self-consciousness, and past behavior. Most adolescents progress through their fears and meet the developmental demands placed on them.[3] More and more children are being diagnosed with social anxiety and this can lead to problems with education if not closely monitored. Part of social anxiety is fear of being criticized by others, and in children social anxiety causes extreme distress over everyday activities such as playing with other kids, reading in class, or speaking to adults. On the other hand some children with social anxiety will act out because of their fear. The problem with identifying social anxiety disorder in children is that it can be difficult to determine the difference between social anxiety and basic shyness.[6]


It can be easier to identify social anxiety within adults because they tend to shy away from any social situation and keep to themselves. Common adult forms of social anxiety include performance anxiety, public speaking anxiety, stage fright, and timidness. All of these may also assume clinical forms, i.e., become anxiety disorders (see below).[7]

Criteria that distinguish between clinical and nonclinical forms of social anxiety include the intensity and level of behavioral and psychosomatic disruption (discomfort) in addition to the anticipatory nature of the fear.[7] Social anxieties may also be classified according to the broadness of triggering social situations. For example, fear of eating in public has a very narrow situational scope (eating in public), while shyness may have a wide scope (a person may be shy of doing many things in various circumstances).[7] The clinical (disorder) forms are also divided into general social phobia (i.e., social anxiety disorder) and specific social phobia.



Physical symptoms often accompanying social anxiety disorder include excessive blushing, excess sweating, trembling, palpitations and nausea. Stammering may be present, along with rapid speech. Panic attacks can also occur under intense fear and discomfort. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. It is common for sufferers of social phobia to self-medicate in this fashion, especially if they are undiagnosed, untreated, or both; this can lead to alcoholism, eating disorders or other kinds of substance abuse. SAD is sometimes referred to as an 'illness of lost opportunities' where 'individuals make major life choices to accommodate their illness.'[8][9] Standardized rating scales such as the Social Phobia Inventory, the SPAI-B and Liebowitz Social Anxiety Scale can be used to screen for social anxiety disorder and measure the severity of anxiety.

The first line treatment for social anxiety disorder is cognitive behavioral therapy with medications recommended only in those who are not interested in therapy.[10] Cognitive behavioral therapy is effective in treating social phobia, whether delivered individually or in a group setting.[11] The cognitive and behavioral components seek to change thought patterns and physical reactions to anxiety-inducing situations. The attention given to social anxiety disorder has significantly increased since 1999 with the approval and marketing of drugs for its treatment. Prescribed medications include several classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs).[12] Other commonly used medications include beta blockers and benzodiazepines.

See also[edit]


  1. ^ Jacobs, Andrew M. "Social Anxiety Disorder and Social Phobia". Retrieved 14 November 2012. 
  2. ^ Garcia-Lopez, L. J. (2013). "Tratando...trastorno de ansiedad social/ anxiety disorder". Madrid: Piramide. 
  3. ^ a b Albano, A.M. & Detweiler, M.F. (2001) The Developmental and Clinical Impact of Social Anxiety and Social Phobia in Children and Adolescents. In Hofmann, S.G. and DiBartolo, P.M. (eds). From Social Anxiety to Social Phobia: Multiple Perspectives. Allyn & Bacon.
  4. ^ a b National Institute for Health and Clinical Excellence: Guidance. Social Anxiety Disorder: Recognition, Assessment and Treatment. Leicester (UK): British Psychological Society; 2013. PMID 25577940
  5. ^ a b Stein MB, Stein DJ. Social anxiety disorder. Lancet. 2008 Mar 29;371(9618):1115-25. Review. PMID 18374843
  6. ^ Child Development, Vol. 66, No.6 (Dec 1995) "Role of Social Withdrawal, Social Anxiety, and Locus of Control"
  7. ^ a b c Harold Leitenberg (1990) "Handbook of Social and Evaluation Anxiety", ISBN 0-306-43438-5
  8. ^ Stein, MD, Murray B.; Gorman, Jack M., MD (2001). "Unmasking social anxiety disorder" (PDF). Journal of Psychiatry & Neuroscience. 3 26: 185–9. Retrieved 17 March 2014. 
  9. ^ Shields, Margot (2004). "Social anxiety disorder— beyond shyness" (PDF). How Healthy are Canadians? Statistics Canada Annual Report 15: 58. Retrieved 17 March 2014. 
  10. ^ Pilling, S; Mayo-Wilson, E; Mavranezouli, I; Kew, K; Taylor, C; Clark, DM; Guideline Development, Group (May 22, 2013). "Recognition, assessment and treatment of social anxiety disorder: summary of NICE guidance.". BMJ (Clinical research ed.) 346: f2541. doi:10.1136/bmj.f2541. PMID 23697669. 
  11. ^ Hofmann, S. G.; Smits, J. A. (2008). "Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials". The Journal of clinical psychiatry 69 (4): 621–632. doi:10.4088/JCP.v69n0415. PMC 2409267. PMID 18363421.  edit
  12. ^ Blanco, C.; Bragdon, L. B.; Schneier, F. R.; Liebowitz, M. R. (2012). "The evidence-based pharmacotherapy of social anxiety disorder". The International Journal of Neuropsychopharmacology 16 (1): 235–249. doi:10.1017/S1461145712000119. PMID 22436306.  edit