Social Anxiety Disorder (Social Phobia)

For many people, attending a party, going on a date or meeting new people might stir up a few nervous butterflies, but for others entering a social situation can bring about intense feelings of fear of being judged by others and of being embarrassed. This fear might even occur during simple social interactions like signing a check in front of a cashier at the grocery store or using a public bathroom.[1] When fear of social interactions interferes with a person’s ability to go to school or work or engage in every day activities, social anxiety disorder might be to blame. Read on to find out more.

What is Social Anxiety?

To understand social anxiety, we first need to understand what anxiety is. Anxiety is a type of fear–a powerful emotion characterized by feelings of tension, worried thoughts and physical changes that has a strong effect on the mind and body because it is one of our natural survival responses. It is usually associated with the thought of a threat or something going wrong in the future, rather than something happening right now.[2,3]. In some cases, anxiety can actually be a useful emotion that helps people do things better.[4]

Social anxiety is a discomfort or a fear of being judged, rejected or embarrassed when a person is in social interactions.[5] Developmental social anxiety occurs early in childhood as a normal part of the development of social functioning, and is a stage that most children grow out of, but if it persists or resurfaces, it can turn into social anxiety disorder.[6]

What Does Anxiety do to the Body and Mind?

When you feel frightened or seriously anxious, the body and mind rev up for an emergency. Your body pumps adrenaline (one of the most common causes of anxiety) to your muscles, boosting them to respond powerfully, and your breathing and heart rate increase to pump more blood throughout your body. At the same time, the brain is doing its part by simultaneously activating the sympathetic nervous system, which triggers the nerves and causes the body to become tense and very alert, and the adrenal-cortical system, which releases about 30 different hormones to prepare the body to handle the threat.[4,7] The hormones released into the body can cause the following physical reactions:

  • Increase in heart rate and blood pressure
  • Dilated pupils
  • Constriction of veins in the skin, which causes the chilly sensation often associated with fear
  • Increased blood glucose
  • Tensing of muscles and goose bumps
  • Relaxation of smooth muscles
  • Shutting down of nonessential systems such as digestion and the immune system
  • Difficulty concentrating on small tasks

Someone with anxiety may suffer from mental effects such as verbal worries and nervous thoughts, as well as physical effects like increased heart rate. It’s possible to experience mental effects more than physical, and vice versa. However, researchers have found that mental and physical effects excite different parts of the brain. Those with worried thoughts have shown more left brain activity when nervous and those with physical symptoms experienced more right brain activity.[3,4]

What is Social Anxiety Disorder?

Social anxiety disorder is not just shyness.[8] It is the extreme fear of being scrutinized and judged by others in social or performance situations. The terms “social phobia” and “social anxiety disorder” have long been used interchangeably, but recently the trend has been to discontinue using “social phobia.” “Social phobia” can be misleading because, unlike people with specific phobia, those with social anxiety disorder may fear many different social situations (e.g., job interviews, dating), in relation to many different types of people (e.g., authority figures, romantic figures), and because of various concerns (e.g., blushing, making mistakes).[9]

Although people with the disorder understand that the fear they feel is excessive and unreasonable, they feel like they have no control over their anxiety. People with the disorder may fear specific types of situations and be comfortable in others. For example, some people may have an intense fear of giving a speech, while others may become anxious when initiating a conversation with an authoritative figure.[8]

What are the Symptoms of Social Anxiety Disorder?

Emotional and behavioral social anxiety disorder signs and symptoms include the following:[10]

  • Intense fear of interacting with strangers
  • Fear of situations in which you may be judged
  • Worrying about embarrassing or humiliating yourself
  • Fear that others will notice that you look anxious
  • Anxiety that disrupts your daily routine, work school or other activities
  • Avoiding doing things or speaking to people out of fear of embarrassment
  • Avoiding situations where you might be the center of attention
  • Difficulty making eye contact
  • Difficulty talking

Physical social anxiety disorder signs and symptoms include the following:[10]

  • Blushing
  • Sweating
  • Trembling or shaking
  • Fast heartbeat
  • Upset stomach
  • Nausea
  • Shaky voice
  • Muscle tension
  • Confusion
  • Diarrhea
  • Cold, clammy hands
  • Worrying about having symptoms

What Causes Social Anxiety?

Researchers know that social anxiety disorder sometimes runs in families, but are not sure why some family members have it an others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety. While it’s not known exactly what causes anxiety, some researchers think that it may be caused by experiences through one’s life or because a person may have trouble creating chemicals in the body (called neurotransmitters) that control mood and send messages to the brain about how to feel, think and act.[4,8,11]

How Can Social Anxiety Disorder Affect Me?

Social anxiety disorder can cause the following:[12]

  • Low self-esteem
  • Trouble being assertive
  • Negative self-talk
  • Hypersensitivity to criticism
  • Poor social skills
  • A poor work record
  • Low academic achievement
  • Isolation and difficult social relationships
  • Substance abuse
  • Excessive drinking (particularly in men)
  • Suicide

What are Treatments for Social Anxiety Disorder?

Anxiety disorders are treatable, but some people may respond to treatment after a few weeks or months, while others may need more than a year. Treatment plans for anxiety may include group or individual psychotherapy, medication, and psychoeducation.[7,8,13] Complementary and alternative treatments, such as stress and relaxation techniques, Yoga, acupuncture and Kava tablets can also be used to help a person control their anxiety.[14]


  1. National Institute of Mental Health. What is social phobia? Retrieved May 24, 2013, from
  2. Mental Health Foundation. Fear and Anxiety. Retrieved February 10, 2013, from
  3. American Psychological Association. Anxiety. Retrieved February 10, 2013, from
  4. Calm Clinic. Anxiety and the Brain: An Introduction. Retrieved February 11, 2013, from
  5. Social Anxiety Support. Social Anxiety Disorder and Social Phobia. Retrieved May 26, 2013, from
  6. Albano, A.M. & Detweiler, M.F. (2001) The Developmental and Clinical Impact of Social Anxiety and Social Phobia in Children and Adolescents. In Hofmann, S.G. and DiBartolo, P.M. (eds). From Social Anxiety to Social Phobia: Multiple Perspectives. Allyn & Bacon.
  7. Science Channel. What happens inside your body when you get scared? Retrieved February 12, 2013, from
  8. Anxiety and Depression Association of America. Social Anxiety Disorder. Retrieved May 26, 2013, from
  9. American Psychiatric Association. SOCIAL ANXIETY DISORDER: QUESTIONS AND ANSWERS FOR THE DSM-V. [PDF] Susan M. Bo¨ gels, Lynn Alden, Deborah C. Beidel, Lee Anna Clark, Daniel S. Pine, Murray B. Stein, and Marisol Voncken. Retrieved May 28, 2013, from
  10. Mayo Clinic. Social anxiety disorder (social phobia) symptoms. Retrieved May 26, 2013, from
  11. National Institute of Mental Health. What causes social phobia? Retrieved May 25, 2013, from
  12. Mayo Clinic. Social anxiety disorder (social phobia) complications. Retrieved May 26, 2013, from
  13. Anxiety and Depression Association of America. Social Anxiety Disorder Treatment. Retrieved May 26, 2013, from
  14. Anxiety and Depression Association of America. Complementary & alternative treatment. Retrieved May 26, 2013, from

By C. J. Newton, MA, Editor

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