Social anxiety


Are you afraid to speak in public or do you feel weird when you walk into a room full of people? Find out if you are experiencing social anxiety or if you are just shy.

Medically reviewed article by Dr. Adriana-Valentina Șeicăreanu – resident psychiatrist


Table of contents

1. What is social anxiety?
2. Causes of social anxiety
3. Symptoms of social anxiety
4. Complications of social phobia
5. Test to find out if you suffer from social anxiety
6. Diagnosis and treatment of social anxiety
6.1 Psychotherapy
6.2 Drug treatment
6.3 Natural treatment
6.4 Exercises for social anxiety
7. Social anxiety in children
8. Recommended books for social anxiety
9. Tips for preventing and treating social anxiety


1. What is social anxiety?

Social anxiety (social phobia) is an anxiety disorder that manifests itself through fear or intense anxiety when someone is exposed to other people, and can be observed or criticized. Talking or eating in public, meeting new people, using public toilets, attending a party or event are situations that will create intense discomfort for those who face this disorder.


2. Causes of social anxiety

The causes of social anxiety are not fully known. It seems that there are several factors that can lead to its development:
– Biological: excessive release of hormones or increased activity of parts of the brain
– Genetics: it seems that half of the patients have a relative affected by the same pathology
– Environmental: traumatic experiences in childhood, imitation of the behavior of a family member, development of a condition that draws attention to physical appearance or voice


3. Symptoms of social anxiety

Social anxiety can manifest differently depending on the person and the situations you are subjected to.

Physical symptoms

– Fast heartbeat
– Sweating
– Tremor, spasm
– Difficulty breathing or rapid breathing
– Back pain, headache
– Cold hands or sweaty palms
– Muscle tension
– Fatigue
– Redness or pallor
– Urinate frequently
– Diarrhea
– Dry mouth
– Numbness
– Difficulty swallowing

Psychological symptoms

– Feeling scared
– Feeling of “knot in the throat” or “butterflies in the stomach”
– Difficulty concentrating
– Alert status
– Insomnia
– Low sexual appetite

Emotional and behavioral symptoms

– Fear of situations in which you may be judged negatively
– Intense fear of interacting or talking to strangers
– Fear that others will notice the signs of anxiety
– Fear when anticipating an activity or event
– Avoid situations where you could be the center of attention
– Analyze your performance and identify defects in your interactions after a social situation
– Expecting the worst possible consequences from a negative experience during a social interaction
– Low tolerance for criticism
– Low self-esteem

Among the most common situations in which social anxiety occurs:

– Public speaking or eating
– Romantic dates
– Dialogue with strangers or higher status
– Going to school or work
– Parties or other events involving many new people
– Use of public toilets

4. Complications of social phobia

Social anxiety disorder is treatable, however, in the absence of an optimal diagnosis and therapeutic approach, it can have serious repercussions on the quality of life. Social phobia can significantly disrupt daily activities, work or school outcomes, and interactions with others.
Social anxiety can be associated with other mental health problems, such as depression and substance abuse.
People who suffer from social phobia may have thoughts of death, suicide, and in worst cases, even suicide attempts.


5. Test to find out if you suffer from social anxiety

There is no standard test to find out if you suffer from social anxiety, but your doctor or psychologist may ask you some questions to guide your diagnosis. What questions should you expect:

– Did you feel intense fear of social situations in which people would judge you?
– Did you feel afraid that you might be humiliated by the actions you took?
– Were you afraid that other people would notice that you blushed, sweated, shivered, or had other symptoms of anxiety?
– Is it difficult for you to realize that the fear felt is exaggerated and irrational?
– Do certain situations scare you every time?
– Do the situations you are afraid of make you make certain sacrifices to avoid them?
– Do those fears and symptoms interfere with everyday life?
– What symptoms do you feel when you expose yourself to the situations you are afraid of?


6. Diagnosis and treatment of social anxiety

For the diagnosis of social anxiety, certain criteria mentioned in the Manual of Diagnosis and Statistical Classification of Mental Disorders (DSM) must be met:

– Marked fear or anxiety about one or more social situations in which you may be exposed to evaluation by others
– Fear that others might negatively assess your anxiety symptoms or your mode of action
– Social situations almost always cause you anxiety or fear
– Avoid or support social situations with intense fear or anxiety
– Fear or anxiety is more intense than the danger you are actually subjected to
– The minimum duration of symptoms is 6 months
– Symptoms cause discomfort or interfere with social, professional or other important areas of functioning
– Fear, anxiety or avoidance are not triggered by substance use or a medical condition

Depending on the conclusions reached by the doctor after discussions with you, the diagnosis will be made and treatment options will be discussed.

6.1 Psychotherapy

Supportive psychotherapy – this addresses the promotion of the development of positive defense mechanisms and discourages negative defense mechanisms. The therapist assists and can give advice on behavior.
Awareness-oriented psychotherapy – the goal is to increase awareness of psychological conflicts that could lead to the development of anxiety symptoms.
Behavioral therapy – aims to produce a change in behavior, it tries to replace negative thoughts with positive ones.
Exposure therapy – the patient will be gradually exposed to social situations that generate symptoms.
Group therapy – the exercise of social skills through interactions with people suffering from the same pathology.

6.2 Drug treatment

To treat social phobia there are several classes of drugs that work, the doctor will prescribe what he considers best for your situation.

– Antidepressants are indicated as the first intention to treat this condition
– Oral beta-blockers before an event that causes anxiety helps to relieve some of the symptoms, such as rapid heartbeat, tremor or the feeling of “butterflies in the stomach”
– Benzodiazepines alleviate the symptoms of social anxiety by slowing down the central nervous system
– Anxiolytics can be used for short periods to treat social anxiety

It should be noted that all medicines can have side effects, so it is very important that they are administered according to the medical prescription, and the discontinuation of treatment will be done gradually, under the supervision of a doctor.

6.3 Natural treatment

In case of mild forms or in combination with other treatments, certain herbal food supplements can be tried out. Valerian, rhubarb, rhodiola, pollen seem to be helpful in treating anxiety.
Aromatherapy, yoga, massage are alternatives if you face social phobia.


6.4 Exercises for social anxiety

The possibility of using exercise as a treatment option for social anxiety disorder has been studied. In addition to the general health benefits of sport, it has been reported that it helps with fatigue, depression, tension, muscle aches, irritability, lack of concentration and feelings of fear and anxiety. According to the American Association for Anxiety and Depression, regular participation in aerobic exercise (running, jogging, swimming, cycling, walking) increases mood, lowers tension, improves sleep and self-esteem.

It has been found that relaxation exercises and activities can have a positive impact on people with social phobia, making them perceive their environment in a less threatening way.
Yoga – involves stretching, movement, breathing, relaxation and meditation
Pilates – a system of exercises designed to improve physical strength, flexibility and posture
Progressive muscle relaxation – encourages relaxation of muscle groups in turn


7. Social anxiety in children

The average age of onset is 13 years, it occurs more frequently in adolescents, but can affect any child. Social anxiety can be limited to specific situations, and children tend to avoid it. They are afraid of strangers and it is difficult to make friends.
Intense crying, seizures or blockages, physical symptoms, elements of depression, suicidal thoughts, behavior problems, dropping out of school, substance abuse can be manifestations of social phobia in children.


8. Recommended books for social anxiety

If reading is a means of relaxation for you, why not combine the useful with the pleasant ?! There are many books that have as a topic of discussion your condition and you can find useful information, some recommendations would be:

– Anxiety – Scott Stossel
– How to control your anxiety. Take the best of worries, stress and fears – Bert A. Moore
– The courage to be vulnerable – Brene Brown
– The subtle art of indifference – Mark Manson
– Looking for Audrey – Sophie Kinsella
– 12 Rules of life. An antidote to the chaos around us – Jordan B. Peterson
– How to be yourself. Calm Your Inner Critic and Overcome Social Anxiety – Ellen Hendriksen
– How to speak in public – Dale Carnegie
– Taming Anxiety – Judson Brewer
– The courage to be happy – Ichiro Kishimi, Fumitake Koga
– Improve your self-esteem! – Laurie Hawkes


9. Tips for preventing and treating social anxiety

Social anxiety can be a disorder that interferes quite a bit with your social life, but you can learn to control and treat it. Here are some tips that might help you:
– Try to do more sports, have a proper diet and get enough sleep
– Avoid caffeinated beverages as they may increase your anxiety symptoms
– Practice your social skills, try to have small dialogues with others and maintain eye contact
– Participate in events, do not refuse the invitations of others to activities and try to prepare in advance for them (role-playing games or practicing mirror dialogues could help you)
– Join an association or volunteer club, you will meet new people, you will get used to speaking in public and you will overcome social anxiety
– Try to think positively and not make the worst scenarios in your head
– Be gentler with yourself, to make mistakes is human
– Find pleasant activities and learn to relax
– Talk to someone close about the problems you face
– Read and find out about your condition
– If you feel overwhelmed, ask for help
– If you have been prescribed a treatment, do not deviate from it, take your medication and go to psychotherapy sessions

social anxiety

Leave a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.