Social Anxiety Disorder involves experiencing intense fear or anxiety when in social situations. This fear usually centres around worries that one will be judged by others, and can manifest as early as 13 years old. 

While it is common to be nervous and anxious when being in new and unfamiliar situations, those who experience this disorder face this nervousness on a more intense level, and may continue to feel discomfort and uneasiness even in familiar situations or with people they are close to (e.g. family and friends). In such cases, the symptoms are often very distressing and the consequences can be dysfunctional (e.g. avoiding social events, absence from school). 

Unlike Generalised Anxiety Disorder (GAD), where worries can include a wide range of topics, individuals with Social Anxiety Disorder experience fear and anxiety focused around social events. 

Causes of Social Anxiety Disorder

Social Anxiety Disorder can have a genetic basis, as having a family history of the disorder increases the likelihood that one will experience the same. An individual's environment also plays a part, and exposure to abuse, neglect, or bullying increases the risk of developing Social Anxiety Disorder as well.

Signs and Symptoms of Social Anxiety Disorder

• Fear and anxiety about social situations (e.g. having a conversation, being observed when drinking/eating, giving a speech)
• Fear humiliation from others (e.g. anxiousness is showing)
• Avoidance of social events 
• Overthinking of own behaviour in public 
• Nauseousness, dizziness or chest palpitations (even at the thought of the event) 

The Endless Cycle of Social Anxiety Disorder

When individuals first notice such symptoms, they become cautious and afraid to do or try anything in order to avoid negative evaluations from others. Some might also believe that it will get better over time or they may “outgrow” these symptoms.

Most individuals use avoidance as a coping mechanism (e.g. avoiding conversations, not meeting friends). However, these methods can be more harmful than helpful. By avoiding their fears, they are unable to disconfirm their negative beliefs and are continuously reinforced that being alone is a safer option. 

For instance, one might think: “The last time I talked to someone, I felt so nauseous I thought I was going to die. But when I am at home, I don’t get dizzy or chest palpitations. I will only be fine if I am by myself.”

This fails to expose the individual to situations like talking to others, and to allow the body to adapt to the initial nervousness or fear. Individuals also do not get the chance to realise that they are not being judged as badly as they thought. This forms an endless cycle as their fears will not be overcome and they cannot overcome their fear as they are afraid to try. 

Treatment for Social Anxiety Disorder 

✽ Psychotherapy

Psychotherapy such as Cognitive Behavioural Therapy (CBT) can help to change an individual's thinking, beliefs and behaviour about social situations. 

✽ Medication

Certain classes of medication can help to relieve the symptoms of anxiety

• Antidepressants: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Regulate serotonin, dopamine, and norepinephrine
• Benzodiazepine: Used to calm a person by altering levels of the neurotransmitter GABA in the brain
• B-Blockers: Reduces the physical symptoms of performance anxiety