Article

How to recognise social anxiety disorder: Causes, symptoms and treatments

07 November 2022

7-minute read

Mental health Feature Social anxiety

Seeking professional help is the first step in overcoming social anxiety disorder. (Credit: Getty Images)

If you're afraid of meeting new people, you might think you're just shy. However, if the feeling doesn't go away for months and it's affecting your daily activities, you may have social anxiety disorder.

According to the World Health Organization, more than 300 million people live with an anxiety disorder. Around four per cent of the global population have experienced its symptoms at some point in their lives. Social anxiety disorder (SAD) – formerly known as social phobia – is a condition that can affect any age or gender.

The good news is that SAD is treatable. Those diagnosed can regain their self-esteem and confidence with the appropriate treatment and emotional support.

Social anxiety vs shyness

Social anxiety and shyness are often mistaken for one another because they share many traits and symptoms.

Both can cause extreme nervousness and physical symptoms such as increased heart rate, sweating, blushing and shaking. They can trigger coping mechanisms and behaviours designed to avoid situations one perceives as too uncomfortable. Both also impact one's personal and professional life to different degrees.

So, how do you tell them apart?

Shyness is short-lived and often situational. It is a personality trait that tends to surface in specific situations, like unfamiliar settings or gatherings with new people. Once the novelty of the situation has worn off, shyness tends to go away.

Social anxiety is a persistent and disruptive uneasiness of the mind. It's characterised by extreme anguish and fear of being judged, accompanied by the urge to avoid social events or interactions. Sufferers often worry about it for days, weeks or months. Intense symptoms can be triggered by the mere thought of the feared situation.

Unlike shyness, the feelings of dread can worsen in someone with social anxiety. It can also lead to other mental health conditions, such as depression or sleep disorders. Consider these three key factors to determine if you are having a "shy moment" or dealing with something more complex.

The intensity of the fear and discomfort you are experiencing
The impact on your day-to-day life
The degree of avoidance

If the fear severely impacts your work and personal life, speak with your physician or mental health professional.

Symptoms of social anxiety disorder

A social anxiety disorder may hinder a person from performing well in public. (Credit: Shutterstock)

While there is no medical test for social anxiety, the condition can be assessed by a mental health professional based on a description of symptoms, including when and how they occur.

People with social anxiety disorder may experience various cognitive, physical and behavioural symptoms – before, during and after the triggering event. Here are some of the most reported ones:

Cognitive symptoms

They fear interactions with strangers or unfamiliar people.
They are afraid they won't know what to say.
They think they will be negatively judged by others, teased or humiliated.
They feel people will notice their anxiety and worry about being visibly embarrassed.
They agonize about an event for weeks or more in advance, especially when they need to speak to a group.

Physical symptoms

They visibly blush and sweat.
Their hands tremble.
Their muscles are tense, and their body posture is rigid.
They experience shortness of breath, nausea or heart palpitations.
They become dizzy or get headaches.
Their mind can "go blank."

Behavioural symptoms

They avoid social activities and places with people even when it is not crowded.
They struggle to make or maintain eye contact or talk to people in social situations, even when they want to engage.

Causes of social anxiety disorder

Socially anxious people tend to do activities alone because they fear interacting with strangers. (Credit: Getty Images)

While the exact causes behind social anxiety are not yet fully understood, it is thought to result from a combination of life experiences and genetic and environmental factors.

Studies suggest that a difficult upbringing, alongside physical and emotional traumas, might increase one's risk of SAD. These might include:

Having an overly critical, controlling or protective parent
Being bullied, teased or rejected as a child
Being emotionally or physically abused
Being exposed to stressful or traumatic events – such as violence, family conflicts, the sudden death of a loved one or a prolonged illness

New research also suggests that imbalances in brain chemistry and genetic make-up – which make one more prone to the condition – might be linked to it. Particularly, an imbalance in the neurotransmitter serotonin, a brain chemical that regulates mood and emotions, is thought to potentially play a role in developing a social anxiety disorder.

Additionally, an over-reactive amygdala – the structure in the brain involved in stress response – might be responsible for setting off your "fight or flight response" without apparent reason. This can trigger an episode of SAD.

Treatment for social anxiety

Social anxiety is a highly personal experience. Triggers vary, and so do causes and risk factors. As a result, treatments and strategies that might help one person may be less effective for another. For this reason, it's essential to work with a mental health professional to find the best social anxiety therapy for you.

Medical professionals may treat SAD with a combination of one-to-one or group psychotherapy (sometimes called talk therapy) and drug therapy.

Psychotherapy

Psychotherapy can help you learn healthy coping skills and manage thought patterns. Cognitive-behavioural therapy (CBT) is a well-studied and research-supported type of psychotherapy used to treat social anxiety disorder. With the guidance of a psychologist or mental health professional, CBT teaches you different ways of thinking, behaving and reacting to situations, helping you feel less anxious and fearful.

CBT also helps you practise social skills through a method known as "exposure therapy." This type of therapy gently and gradually brings you to confront your fears and engage in activities you have been avoiding.

Acceptance and commitment therapy (ACT) is a newer type of psychotherapy treatment. It relies on strategies such as mindfulness and goal setting adapted to your specific situation. Although there is not a lot of data and studies available on ACT, you can check with your doctor if it might help ease your anxiety.

Medication

Medications can help ease symptoms, improve your ability to interact with others and help you regain confidence. Drug therapy is not a cure, but it is used alongside therapy and self-help techniques, which address the underlying cause of SAD.

Some prescriptive medications aim to rebalance brain chemistry and optimise one's levels of serotonin (a hormone linked to anxiety and depression when imbalanced). Others address physical symptoms such as rapid heart rate, high blood pressure, sweating and trembling hands or voice to help lower anxiety.

Precaution: the information here is not a substitute for medical advice. Social anxiety disorder needs a clinical diagnosis to receive psychotherapy or medication. Seek the advice of your doctor so they can prescribe treatments based on your complete medical history.

Evidence suggests that modern life's stresses and strains can trigger or worsen anxiety. Alongside standard therapies, even small lifestyle changes can significantly enhance your treatment's progress while boosting your overall health and wellbeing.

Cutting back on stimulants (like coffee, sugar, alcohol and cigarettes), getting enough quality sleep, making time to relax and be mindful and staying active are simple strategies you can start implementing right away if you suspect you are at risk of social anxiety disorder.

If you need help taking small steps that can lead to tremendous changes and help with social anxiety disorder, join the AIA Vitality wellness programme and its supportive community. Here, you'll find the people, tools, inspiration and knowledge — alongside exclusive discounts and rewards — which will help you make a healthy lifestyle more manageable.

References:

ADAA, Anxiety & Depression Association of America. 2021. Social Anxiety Disorder. [online] [Accessed on 3 July 2022]

NIH, National Library of Medicine. 2017. Social Anxiety Disorder. [online] [Accessed on 3 July 2022]

NIH, National Library of Medicine. 2017. Gender differences in social anxiety disorder: A review. [online] [Accessed on 3 July 2022]

NIH, National Library of Medicine. 2019. Therapeutic strategies for social anxiety disorder: where are we now? [online] [Accessed on 3 July 2022]

NIH, National Library of Medicine. 2016. Social anxiety disorder: a critical overview of neurocognitive research. [online] [Accessed on 3 July 2022]

NIH, National Library of Medicine. 2021. Psychotherapies. [online] [Accessed on 3 July 2022]

NIH, National Library of Medicine. 2021. Caring for your Mental Health. [online] [Accessed on 3 July 2022]

World Health Organization. 2022. Mental disorders. [online] [Accessed on 3 July 2022]

Disclaimer:

This is general information only and is not intended as financial, medical, health, nutritional or other advice. You should obtain professional advice from a financial adviser, or medical or health practitioner in relation to your own personal circumstances.