Social Anxiety Disorder Overview

Reviewed by: HU Medical Review Board | Last reviewed: January 2012 | Last updated: May 2020

Social Anxiety Disorder, formerly called Social Phobia, is a condition ruled by the fear of situations where you come under the scrutiny of others. You anticipate that others’ judgment of and behavior toward you will be negative and cause intense anxiety, embarrassment and feelings of humiliation. An integral part of this is the fear that your own behavior and anxiety will be the culprit. For a formal diagnosis to be made, the symptoms must have continued for at least 6 months and cause you significant distress and/or seriously impairment daily functioning.

It goes way beyond shyness or nervousness. A shy person may feel awkward and uncomfortable, for example, in a situation where she must meet new people or doesn’t know many people; a person in the same situation who has social anxiety disorder, on the other hand, may break out in a sweat, be too self-conscious to speak, tremble severely, even become nauseated.

It is estimated that there is a genetic component in 30 to 40% of people who have social anxiety disorder. Negative social experiences also play a big part and may even trigger the onset of symptoms.

Some people feel social anxiety only in specific situations, one of the most common being public speaking. It becomes much more serious for people who suffer from the disorder in most or all social situations, be it a get-together, a meeting, being in a crowd, shopping, even just walking down the street. In addition, such a person will agonize beforehand about an upcoming social situation.

Examples of Social Anxiety Disorder

A woman finds herself shaking when she has to call a customer service line, imagining that the representative will think she is foolish, sneer at her, make her feel embarrassed and inadequate. After the call, she may go over what was said again and again, feeling humiliated by the representative’s words or tone of voice.

Someone with social anxiety disorder may avoid meetings (“I just know I’ll make a fool of myself”); feel sick standing in lines (“Someone may be laughing to himself about my clothing”); turn down invitations from acquaintances (“They’ll interrupt me, be contemptuous of me, ignore me”); or even spend time with people they’ve known for years (“They’re going to judge me, and I’ll be so nervous I’ll start sounding like an idiot”).

Being teased may cause a socially anxious person intense distress. There is such self-consciousness, such fear of being judged negatively, that any humor in the teasing simply can’t be recognized. Authority figures like supervisors can be particularly difficult to deal with, as these are people who are supposed to judge their employees’ performance.

Other Symptoms of Social Anxiety Disorder

In addition to sweating, trembling and nausea, physical symptoms can include racing or pounding heart, blushing, dry throat and mouth, “throat closing” causing an inability to speak, and others, even up to panic attacks. People with this disorder are likely to have difficulty making and keeping friends and may even become reclusive, refusing to go anywhere because even strangers passing by will judge them.

Co-Occurring Conditions

While some of the symptoms and behaviors of social anxiety disorder are the same as those of agoraphobia, the causal factors are different. A person with agoraphobia fears being trapped and helpless, while the socially anxious person fears the judgment of others. However, the two conditions often co-occur, especially in women.

Panic disorder symptoms can also occur in social anxiety disorder. For example, a socially anxious man may become so upset at a party that he begins feeling suffocated, dizzy, overwhelmingly certain that staying there one more minute will lead to disaster. A panic attack ensues and he flees the gathering. Afterward, his social phobia is reinforced and exacerbated by a sense of humiliation as he relives the feelings again and again, thinking about how negatively the others must have evaluated his behavior.

Treatment of Social Anxiety Disorder

Cognitive behavioral therapy has been shown to be effective in treating this illness. Psychologist Thomas A. Richards, Ph.D., points out that traditional talk therapy can be counterproductive, as it encourages the socially anxious patient to think more about the condition, which is already made worse by rumination. Prescribed medications include antidepressants and anti-anxiety drugs.

Social Anxiety Disorder and Migraine

Few studies have been done regarding social anxiety disorder and migraine, but one such study among young adults found a high correlation between the two. Anecdotal evidence from support forums for the socially anxious supports this data.

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