Social Anxiety Disorder: Symptoms, Causes and Treatments

Difference Between Shyness and Social Anxiety Disorder

Feeling shy when interacting with others is an extremely common experience; even classic extroverts sometimes feel nervous in certain social situations (such as talking with people in authority, public speaking in front of a thousand people, etc.).

Social Anxiety Disorder, also known as social phobia, is a more severe problem that manifests as an intense fear of social situations and avoidance of them. Social anxiety may include fear of interacting with others, such as giving a speech, attending social events, or talking to strangers. Social anxiety can cause people to avoid most social situations, affecting their quality of life and interpersonal/romantic relationships.


Physical symptoms

Blushing, nausea, shaking, muscle tension, inability to speak fluently, empty mind, dizziness, crying, and heart racing.

Mental symptoms

Extreme worry and nervousness, high level of self-consciousness to avoid embarrassing or offending others, a strong fear of being judged negatively by others, and fear of being caught nervous and appearing embarrassed.

Behavioural symptoms

Avoid any social situations that may cause anxiety, including but not limited to social gatherings, talking to strangers, going out on a date, attending classes and meetings, giving speeches, eating in front of others, doing interviews, going to public restrooms, and making eye contact with people.

If people have to be in those anxious social situations, they may try to avoid talking as much as possible and feel stressed due to the abovementioned symptoms.

Social anxiety disorder usually begins in the teenage years, but the symptoms may not get enough attention, be misunderstood as mere shyness, and not be treated on time.


Prolonged and severe social anxiety disorder can lead to a range of negative outcomes including, but not limited to, low self-esteem, inability to be assertive, hypersensitivity to criticism from others, social inadequacy, loneliness, or inability to handle relationships and intimate relationship problems, compromised academic performance and career development, substance abuse, and suicide.


Like other mental disorders, such as depression and other anxiety disorders, social anxiety disorder is caused by environmental, biological, psychological, and behavioural factors. Specifically:

Environmental factors: Negative experiences such as childhood trauma, chronic bullying and exclusion.

Biological factors: Traumatic brain injury, genetics, chronic disease, substance abuse.

Psychological factors: self-criticism, perfectionism, low self-esteem.

Behavioural factors: avoidance of social situations, inadequate social skills.

For more information on the causes of social anxiety disorder, click here to view the causes of anxiety disorders.

Why Social Anxiety Disorder May Last for a Long Time

Sometimes social anxiety disorder can last for years or even decades; some of the reasons are as follows:

Avoidance of Fear: People often reduce social anxiety by avoiding social situations, but this can intensify fear. In addition, avoiding social situations will also prevent one’s social skills from improving, thereby deepening the fear of socializing and forming a vicious circle.

Low self-esteem: Long-term social anxiety may lead to low self-esteem, which can exacerbate feelings of fear.

Lack of timely intervention: If people realize they may suffer from social anxiety, they should seek change on time. It can be intentionally making a change themselves or getting help from professionals. If social anxiety disorder does not receive timely and effective intervention, it may persist for a long time.


Due to the complex causes of social anxiety disorder, the treatments are diverse and usually include the following types:

Drug Treatments

Common medications include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), antipsychotics, benzodiazepines and anxiolytics, etc. However, it’s worth noting that not all people with social anxiety disorder need medication, and every drug has some adverse reaction and dependency. Therefore, people with social anxiety need to communicate closely with their family doctors or psychiatrists regarding questions like “do I need to take medication”, “what medications to take” and “what are the adverse reaction and withdrawal symptoms of the medication”.


A large number of studies have shown that psychotherapy is effective in treating social anxiety disorder, such as Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Exposure Therapy, etc. However, each approach is unique, and many professionals combine multiple approaches simultaneously. Therefore, finding the right professional and treatment you like is very important.

Psychotherapy for social anxiety disorder mainly includes understanding your symptoms, learning to relax your body, looking at things from a more comprehensive perspective, learning effective social skills, properly coping with anxious feelings, and practicing socialization in a graduated manner. Therefore, people can break the vicious cycle of social avoidance reinforcing social anxiety.

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