At one point or another, we’ve all found ourselves in a social situation that plunges us into a state of anxiety and nerves.
To an extent, anxiety or fear around the idea of being judged or scrutinised is a natural response. For example, feeling anxious before a job interview, first date or a presentation at work is generally considered a healthy response to a high-stakes situation.
However, for around 1 in 10 people, the fear of being humiliated, judged or rejected shows up in everyday social situations such as making phone calls, eating in public or speaking to strangers. This fear can limit their ability to function at work, school, or when meeting new people.
When this phobia of social interactions begins to impact day-to-day functioning for six months or longer, a psychologist or doctor may diagnose social anxiety disorder.
What Is Social Anxiety Disorder?
In the DSM 5, a diagnosis for social anxiety disorder is based on specific symptoms that have been persistent for at least 6 months.
- Anxiety around social situations, fearing embarrassment, humiliation, rejection, or otherwise being negatively valued.
- Anxiety when exposed to unfamiliar people or when required to perform due to fearing judgement or scrutiny by others.
- Experiencing anxiety in the weeks or days leading up to a social situation or event
- Avoiding specific social interactions as much as possible, e.g. gatherings and parties where you will be required to meet new people.
- Experiencing physical symptoms of anxiety such as rapid heart rate, sweating, and nausea in social settings. You may also struggle to make eye contact and speak or think clearly. You may even have an anxiety or panic attack.
- Knowing that your fear and anxiety is excessive and irrational, but feeling like you cannot control it.
Although common, social anxiety disorder is frequently misunderstood. In this post, we will break down the 4 most important things you should know about social anxiety – and most importantly, what you can do to stop it from taking over your life.
#1 – Social Anxiety Is Not The Same As Shyness
While social anxiety can resemble shyness, it is not the same. Shyness is usually mild and tends to subside once the initial nerves have settled. On the other hand, social anxiety is a phobia of certain situations, which is more disruptive to everyday life than shyness.
For example, some people are naturally introverted and prefer to be alone or with close, personal friends. They may experience little or no social anxiety but appear ‘shy’. In parallel, extroverts feel energised by social interactions but are not immune from social anxiety disorder. Outgoing people can suffer with social anxiety, too.
The Covid-19 pandemic also made it more difficult than ever for people to socialise – whether they were more shy or outgoing. After months deprived of face-to-face interactions, feeling ‘socially awkward’ is growing post-lockdown phenomenon, especially when combined with health anxiety or phobias. Furthermore, social media has made it increasingly difficult for those who already struggle socially, as they may have become too used to interacting virtually which helps them avoid real-life interactions.
#2 – Feeling Anxious In Social Settings Can Often Be Traced Back To Childhood
According to research by the University of Exeter, social anxiety most commonly starts in childhood or adolescence, and most sufferers have developed the condition before their 20s.
The cause of the disorder can vary from person to person. For some, the anxiety can be traced back to being bullied, teased or isolated at home or school. Others may have been shy and quiet children – which, over time, progressed into apprehension, fear and anxiety.
Sometimes, social anxiety disorder can be triggered by early experiences of childhood trauma, such as:
- Childhood abandonment or neglect
- Physical, sexual, or emotional abuse
- Family or relational conflicts, such as divorce or domestic violence
In some cases, children and young people naturally outgrow social anxiety. However, if it persists into adulthood, however, it is much more likely that symptoms will continue unless treatment is sought.
#3 – Social Anxiety Increases Risk Of Other Mental Health Problems Such As Depression
Social anxiety disorder rarely exists on its own; as many as 4 out of 5 adults with it will experience at least one other mental health condition. As social anxiety usually begins at a younger age, it is not always clear whether comorbid conditions are caused by or exacerbated by it.
For example, people with the disorder are more likely to suffer from nicotine dependence and substance abuse as these are often used as coping mechanisms.
Bipolar and major depressive disorder are more likely to be diagnosed in those suffering from social anxiety disorder. However, it is less clear whether the isolation sufferers experience as a result of avoiding social situations might be a contributing factor. What is clear, however, is that to treat social anxiety disorder successfully, all comorbid conditions need to be considered and treated for the best possible outcome.
People who are neurodiverse often experience social anxiety, too. However, whilst ADHD, autism and social anxiety can occur together, they are very different conditions. Sometimes, autism may be misdiagnosed as social anxiety disorder, as the symptoms can overlap. Similarly, ADHD can also overlap with social anxiety disorder due to rejection sensitivity and issues with executive function.
#4 – Counselling Can Be An Effective Treatment For Overcoming Social Anxiety
Whilst social anxiety disorder is a challenging condition, studies have found promising results with medication and talking therapy. Social anxiety disorder treatment depends on how your anxiety affects your ability to function and enjoy everyday life.
For example, selective serotonin reuptake inhibitors (SSRIs) are usually the first medication used to treat social anxiety, especially when there is already a diagnosis of depression. Other medications such as norepinephrine reuptake inhibitors (SNRIs) may also be used.
Medication usually provides short-term relief, whilst psychotherapy explores the deep-rooted causes of how your social anxiety developed in the first place. Specifically, psychodynamic therapy has been shown to be effective for this. Looking back into the past and identifying why the anxiety arose – perhaps it kept you safe as a child – can help you to develop compassion for yourself and self-awareness. If there have been triggers such as childhood trauma, counselling for social anxiety can help you to unpack and make sense of how these experiences shaped you but are now holding you back.
The Bottom Line
Social anxiety disorder is a chronic mental health disorder that goes far beyond shyness. Whilst it can be debilitating, it doesn’t necessarily have to control you. With the proper treatment, you can unlearn the patterns you have most likely relied on for years when trying to cope in social situations. You may also be struggling with other mental health problems alongside social anxiety, which is why working with the right therapist or counsellor is vital to recovery.
As a BACP-registered integrative counsellor, I am trained to work with a wide range of issues, including social anxiety disorder, panic attacks and phobias. I use a range of therapeutic methods that I tailor to the needs of each client based on their history and goals for the future.
For psychotherapy to be successful, the essential element is the strength of the relationship between you and your therapist. This is why I offer a no-obligation 15-minute chat so that you can get a feel as to whether I’m the right therapist for you. We can talk through your concerns, and you’ll be able to ask me any questions. You can arrange this at a time that suits you by sending me an email.