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Social Anxiety Disorder: Causes, Symptoms, Diagnosis And Treatment

People with social anxiety disorder (SAD) experience significant and chronic fear of social or performance-related situations. They always feel there is the possibility of becoming embarrassed, rejected, or scrutinized.

In other words, social anxiety disorder or social anxiety is excessive emotional discomfort, fear, or worry about social situations. The individual is worried about being scrutinized by other people, and there is a heightened fear of interactions with others.

A phobia is an irrational fear of certain situations, objects, or environments, and social anxiety disorder is sometimes referred to as social phobia.

It is estimated that 7% of adults in the United States have experienced social anxiety over the last year. It is also thought of that 12% of the same population will do so at some point in their lives.

In these situations, people with SAD almost always know their fear is unreasonable; however, they can’t seem to do anything to stop it.

So, they either avoid these situations altogether or get through them while feeling intense anxiety and distress. In this way, a social anxiety disorder can be extremely impairing.

Causes Of Social Anxiety Disorder

Experts say that social anxiety disorder has both environmental and genetic causes.

Genetic: As the condition has been noticed to run in families, genetic links are being investigated. There is ongoing research that attempts to find out how much of this is genetic and how much is assimilated.

Hormones and Chemicals in the body: Researchers are currently researching which chemicals in the body might promote the development of social anxiety disorder. Some experts are looking at serotonin, a brain chemical, that may play a key role when levels are not right.

Brain configuration: Some researchers believe the amygdala in the brain may play a role in fear response and may result in excessive reactions.

Weather and environmental factors: it has been observed that Mediterranean countries have lower rates of social anxiety disorder compared to Scandinavian countries. This could be due to warmer weather, which may reduce the avoidance of social situations and increase contact with other people, as well as a higher population density. There is still the suggestion that cultural factors may contribute to social anxiety rates.

Symptoms of Social Anxiety Disorder

Symptoms of social anxiety disorder typically fall within three different areas that include Physical symptoms (what you feel), Cognitive symptoms (what you think), and Behavioral symptoms (what you do)

Physical Symptoms of Social Anxiety Disorder (SAD) can be extremely distressing, and you might experience:

  • Sweating
  • Blushing
  • Shaking
  • Muscle tension
  • Chills
  • Chest tightness
  • Chest pain
  • Trembling voice
  • Shortness of breath
  • Lump in the throat
  • Blurred vision
  • Ringing in the ears
  • Headaches
  • Dry mouth
  • Dizziness
  • Paresthesias (tingling)
  • Nausea
  • Diarrhea
  • Heart racing (tachycardia) or Heart pounding (palpitations)
  • Disorientation (depersonalization or de-realization)
  • For some people, the symptoms can escalate into a full-blown panic attack.

If negative thought patterns are allowed to continue without treatment, they may also wear down your self-esteem over time, and you may experience the following:

  • A tendency to discount positive social encounters and magnify the social abilities of others (Negative bias)
  • Automatic negative evaluations about yourself in social or performance-related situations (Negative thoughts).
  • Strongly held beliefs about your inadequacy in social and/or performance-related situations (Negative beliefs).

Behavioral Symptoms of Social Anxiety Disorder may make people with social anxiety disorder to act in certain ways. They may tend to make choices based on fear and avoidance rather than actual preferences, desires, or cravings.

They may drop a class to avoid doing a presentation or turned down a job promotion because it meant increased social and performance demands.

  • People with generalized SAD are particularly at risk of having a poor quality of life.
  • They may have few or no friends,
  • They may have no romantic relationships,
  • They may drop out of school or quit jobs,
  • They may use alcohol to tolerate anxiety.

Other common behavioral symptoms include:

  • Avoiding being in social or performance-related situations.
  • Take actions to control or limit experiences of social or performance-related situations.
  • Leaving or escaping from a feared social or performance situation

Symptoms of SAD in Children and Teens

Social anxiety disorder in children and teens may appear differently than in adults.

  • Young children with the disorder may cling to a parent,
  • They may have a tantrum when forced into a social situation,
  • They may refuse to play with other kids, cry, or complain of an upset stomach or other physical problem.
  • Behavioral inhibition during infancy is often a precursor for later social anxiety.

In contrast, teenagers with SAD may avoid group gatherings altogether and may show little interest in having friends.

Situational Triggers Of Social Anxiety Disorder

Symptoms of social anxiety disorder may be triggered by different situations like:

  • Giving a speech or presentation
  • Having a conversation
  • Eating in public
  • Using a public restroom
  • Making telephone calls


A GP will probably refer the individual to a mental health professional, like a psychiatrist or psychologist.

The mental health practitioner will ask the person with suspected social anxiety to describe symptoms, when they occur, how often, and how long they have been occurring, and they may ask the patient to complete a questionnaire.

In the U.S., symptoms must meet the Diagnostic and Statistical Manual (DSM) conditions for social anxiety before a diagnosis can be given.

Treatment of Social Anxiety Disorder

Social anxiety disorder is a lifelong condition for many people, but treatments can help people control their symptoms and gain confidence.

Psychotherapy and medications are considered to be the most effective treatments for SAD.


Psychotherapy is a psychological treatment that uses a wide variety of techniques to help the person view themselves and their problems in a more realistic manner. This helps them to overcome and cope with them effectively.

Types of psychotherapy, includes cognitive therapy, interpersonal therapy, psychodynamic therapy, and family therapy.

Cognitive behavioral therapy (CBT) has been shown to improve symptoms a great deal.

CBT helps the patient realize that it is their own thoughts, rather than other people, that determine how they react or behave, and the patient learns how to recognize and change negative thoughts about themselves.

Therapy has two main parts; a cognitive element, designed to limit distorted or disproportionate thinking, and a behavioral element, designed to change the way people react to objects or situations that trigger anxiety.

The individual may also receive exposure therapy, in which they gradually work up to facing their fears or situations they fear.

With cognitive delivered exposure (CDE), the patient safely confronts the situations or places that cause anxiety or fear, often in the company of the therapist.


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