Social Anxiety Disorder: Types, Causes & Treatment

1. Generalized Social Anxiety Disorder

This type of social anxiety affects nearly all aspects of a person’s social life, making everyday interactions extremely stressful.

People with generalized social anxiety often struggle with casual conversations, work meetings, public speaking, and even routine activities like ordering food at a restaurant.

The constant fear of being judged or embarrassed can lead to avoidance, making it difficult to build relationships, advance in a career, and enjoy everyday experiences.

2. Specific (Performance-Based) Social Anxiety Disorder

People with this type of social anxiety disorder feel extreme nervousness in specific situations, like giving a speech, performing on stage, or being the center of attention.

They might feel at ease in casual conversations or one-on-one interactions but struggle when faced with a crowd. They fear making mistakes, stumbling over words, or being scrutinized.

Each of these situations can cause them overwhelming stress, sometimes leading to panic attacks. Because of this, they tend to avoid career paths or activities that require public performance, limiting their opportunities.

3. Social Anxiety in Professional Settings

This type specifically affects people in work or academic environments, where social interactions are necessary for success.

Those who struggle with it may feel anxious about speaking up in meetings, giving presentations, or interacting with colleagues. They often worry about saying the wrong thing, looking unqualified, or embarrassing themselves in front of supervisors.

Because of this, they may avoid networking events, turn down promotions that involve leadership, or struggle with job interviews, making it harder to grow in their careers.

4. Social Anxiety in Interpersonal Relationships

Some people find it especially hard to build and maintain relationships due to social anxiety. They may feel nervous about dating, making new friends, or engaging in group activities because they fear rejection, criticism, or awkward moments.

This fear can cause them to overanalyze conversations, avoid initiating interactions, or withdraw from social opportunities.

Over time, this withdrawal can lead to loneliness, making the anxiety even worse. Since close relationships are important for emotional well-being, this type of social anxiety can be especially tough to cope with.

5. Social Anxiety Related to Eating or Drinking in Public

For some people, eating or drinking in front of others can be extremely stressful. They may worry about being watched, judged, or making an embarrassing mistake, like spilling food or chewing too loudly.

This anxiety forces them to avoid social meals, such as office lunches, family gatherings, or dining out with friends.

In extreme cases, they may prefer to eat alone at home rather than risk embarrassment in public settings, which can affect their social life and mental health.

Emotional Symptoms

People with Social Anxiety Disorder experience overwhelming emotional distress in social settings, mainly because they fear being judged.

Some of the most common emotional symptoms include:

• Intense Fear of Being Judged or Humiliated: Even in routine social situations, people with SAD worry excessively about saying or doing something embarrassing.
• Excessive Self-Consciousness: They are hyper-aware of their actions and how others might perceive them, leading to constant overthinking.
• Fear of Rejection or Criticism: A minor mistake or perceived awkwardness can make them believe they are disliked or unworthy.
• Anticipatory Anxiety: They may experience extreme nervousness for days or even weeks before a social event.
• Low Self-Esteem: Social anxiety often leads to feelings of inadequacy, making them doubt their abilities and worth.
• Difficulty Making Eye Contact: They may avoid looking people in the eye, fearing it might expose their anxiety or make them feel more vulnerable.

Physical Symptoms

The emotional distress caused by social anxiety often triggers strong physical reactions. These symptoms can be so intense that they mimic a panic attack.

Common physical symptoms include:

• Sweating Excessively: Even in only mildly stressful situations, people with SAD may experience sweaty palms or excessive perspiration.
• Trembling or Shaking: Anxiety can cause noticeable shaking, especially in the hands or voice when speaking.
• Rapid Heartbeat (Palpitations): The fear of social interaction can cause the heart to race, making it difficult to stay calm.
• Shortness of Breath: Some people struggle to breathe properly and often feel like they’re suffocating in social settings.
• Nausea or Stomach Discomfort: Anxiety often affects digestion, leading to nausea, stomach pain, or even irritable bowel syndrome (IBS).
• Dizziness or Lightheadedness: High stress can make people feel faint or unsteady in social situations.
• Muscle Tension: Constant anxiety can cause physical stiffness, leading to neck, shoulder, or jaw pain.

Genetic and Biological Factors

• Family History of Anxiety Disorders: Research suggests that social anxiety can run in families. If a close family member, like a parent or sibling, has SAD, there’s a higher chance of developing it.
• Inherited Temperament: Some people are naturally more prone to shyness and nervousness in social situations. Children who are extremely shy or fearful in unfamiliar settings may be more likely to experience social anxiety as they grow older.
• Overactive Amygdala: The amygdala, a part of the brain responsible for processing fear, is often more active in people with social anxiety. This heightened activity can lead to exaggerated fear responses in social situations.

Environmental Influences and Life Experiences

• Early Childhood Experiences: Negative experiences in early life, such as bullying, rejection, or overcritical parenting, can contribute to the development of SAD. Children who are frequently embarrassed or ridiculed may become overly fearful of social interactions.
• Parental Influence: Children often mirror their parents’ behavior. If they grow up with overly anxious or socially withdrawn parents, they may develop similar fears about interacting with others.
• Lack of Social Exposure: Limited social interactions due to homeschooling, strict parenting, or isolation can make social situations feel overwhelming, simply because they haven’t had enough practice dealing with them.

How Social Anxiety Disorder Is Diagnosed

Diagnosing Social Anxiety Disorder involves a thorough evaluation by a mental health professional, such as a psychologist or psychiatrist. The diagnostic process includes:

• Clinical Interviews: A mental health professional will ask about symptoms, their intensity, and how they impact daily life. They may use standardized questionnaires like the Social Phobia Inventory (SPIN) or the Liebowitz Social Anxiety Scale (LSAS) to measure the severity of social anxiety.
• DSM-5 Criteria: According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), SAD is diagnosed when an individual experiences persistent fear or anxiety in social situations for at least six months, significantly impacting their daily life.
• Rule Out Other Conditions: Social anxiety symptoms may overlap with other disorders, such as, generalized anxiety disorder (GAD), depression, or autism spectrum disorder. A professional will assess whether SAD is the primary condition or part of a broader mental health issue.
• Once diagnosed, treatment is scheduled based on the individual’s needs and lifestyle.

Treatment Options for Social Anxiety Disorder

The good news is, Social Anxiety Disorder responds to a variety of clinical and non-clinical treatments. The following are effective treatment options for SAD.

1. Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is the most effective form of therapy for Social Anxiety Disorder. It helps people recognize and change negative thought patterns that fuel anxiety.

This treatment encourages people to build confidence by eliminating irrational fears and gradually being a part of social gatherings.

Key techniques include:

• Cognitive Restructuring: Replacing irrational fears with more realistic perspectives.
• Exposure Therapy: Gradually confronting feared social situations to reduce anxiety.
• Social Skills Training: Improving conversation skills, eye contact, and overall communication.

2. Acceptance and Commitment Therapy (ACT)

ACT is a mindfulness-based therapy that encourages people to accept their anxious thoughts rather than try to eliminate them.

Instead of avoiding social situations, people learn to focus on their values and take meaningful actions despite their fears.

This therapy helps people develop psychological flexibility and reduce distress.

• Mindfulness Techniques: Replacing irrational fears with more realistic perspectives.
• Values-Based Action: Helps people engage in social interactions that align with their personal goals, even when anxiety is present.
• Defusion Exercises: Teaches people to distance themselves from anxious thoughts rather than being controlled by them.

3. Group Therapy

Commonly known as psychotherapy for anxiety, it is facilitated in a structured environment where people with Social Anxiety Disorder can practice social interactions in a safe and supportive setting.

Group therapies are particularly effective for people with SAD as they get a chance to interact with people in a social environment without feeling overwhelmed.

It helps participants realize they are not alone and allows them to gain confidence through shared experiences. Led by a trained therapist, group therapy fosters gradual social exposure.

• Role-Playing Exercises: Replacing irrational fears with more realistic perspectives.
• Peer Support: Encourages participants to share their challenges and coping strategies.
• Desensitization to Social Situations: Provides repeated exposure to social settings in a controlled manner.

4. Medication for Social Anxiety Disorder

Medication is often used in combination with therapy to manage symptoms of social anxiety. It helps regulate brain chemistry and control excessive fear responses.

Doctors typically prescribe medication based on the severity of symptoms and the individual’s overall health.

• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
• Beta-Blockers
• Benzodiazepines
• However, not everyone wants to take medication as a treatment protocol to manage their anxiety. Therefore, treatments such as therapy, consultations, and lifestyle changes are available to manage anxiety without medication.

1. Practice Gradual Exposure

Instead of avoiding social situations, try gradual exposure to build confidence.

Start with low-pressure interactions, such as greeting a neighbor or making small talk with a cashier, before moving on to more challenging scenarios like group conversations or public speaking.

2. Challenge Negative Thoughts

Social anxiety often stems from irrational fears about how others perceive you.

When you catch yourself thinking, “Everyone will judge me” or “I’ll embarrass myself”, challenge these thoughts with evidence.

Remind yourself that people are usually focused on themselves, not on judging others.

3. Develop Strong Communication Skills

Improving social skills can reduce anxiety. Practice active listening, maintain open body language, and use small talk starters to ease into conversations.

If verbal interactions feel overwhelming, non-verbal communication — such as nodding and smiling — can still help you feel engaged.

4. Establish a Pre-Social Routine

Having a calming pre-event routine can help reduce stress before social situations. Activities like deep breathing, visualization, or listening to soothing music can prepare your mind for interaction.

5. Use Grounding Techniques

In moments of intense anxiety, grounding exercises can bring your focus back to the present. Try the 5-4-3-2-1 technique:

• 5 things you can see
• 4 things you can touch
• 3 things you can hear
• 2 things you can smell
• 1 thing you can taste
• This method helps break the cycle of anxious thoughts and promotes mindfulness.

6. Listen to Music

When dealing with anxiety, listening to music can help you feel calmer. Since music has the power to distract your mind, it’ll help you deal with the thoughts that lead to anxiousness.

Certain sounds like Binaural beats may influence brainwave activity which is often linked to relaxation, focus, and meditation.

You can try the Subliminal Audio track by AnxietyChecklist that incorporates Binaural beats for Anxiety Relief. This soundtrack also includes positive manifestations to help you ground yourself.