What is Social Anxiety Disorder?
When being asked “What is social anxiety?“, many people seem to only have a vague idea. While some confuse it with panic disorder, others label it as excessive shyness.
Although moments of panic and traits of shyness relate to it, they are not its distinguishing characteristics. Not everyone with social anxiety disorder (SAD) suffers from panic attacks. Similarly, there are people with SAD that are not shy, but extroverted and outgoing.
Social anxiety refers to an intense fear of being negatively evaluated by others. These excessive concerns are what all people with SAD have in common. Yet, the focus and content of this fear may differ in one way or another between people.
Social Anxiety Definition
According to the Anxiety and Depression Association of America (n.d.), “the defining feature of social anxiety disorder, also called social phobia, is intense anxiety or fear of being judged, negatively evaluated, or rejected in a social or performance situation.“
As you can see, this definition emphasizes that the concerns relate to possible scrutiny by others in social situations. A person with panic disorder may suffer panic attacks in social settings. However, her main concern may be her health and not the social consequences of these events.
Likewise, a person may be very shy but can handle social disapproval appropriately when it occurs. Therefore, she won’t feel overly anxious before an upcoming social event. This also means that her quality of life won’t be drastically impacted, as it is the case for people with SAD.
Social Anxiety vs Social Phobia
The terms social anxiety disorder and social phobia are often used interchangeably. This indicates that SAD is a certain type of phobia. The American Psychiatric Association (2013) defines specific phobias as exaggerated, intense fears of certain things, situations and even places.
In the case of social anxiety the fear is related to social settings. While originally named social phobia, the term is not really applied anymore and has been officially replaced with social anxiety disorder.
People with social phobia mostly recognize that their anxiety is out of proportion and have a hard time understanding their intense fear in certain social settings.
Telling a person with social anxiety that there is no reason to be afraid around other people is just like telling a person with arachnophobia that spiders won’t harm her. Affected people understand that their emotional reaction may be exaggerated, but can’t seem to control it.
Whiteboard Video: Social Anxiety Explained
To get a thorough understanding of what social anxiety disorder is, we recommend watching the following video. We cover the basics, such as the typical symptoms and the most commonly feared situations, as well as introduce you to different explanatory models.
It is important to note that social anxiety is an adaptive, normal and even desirable trait, as long as it is not too intense. Once a it becomes excessive, it creates more problems as it does good for the person. Therapy should not strive to eliminate, but rather decrease its intensity.
Possible Causes of Social Anxiety
As becomes clear, social anxiety results when a person believes that others have very high expectations of her, while simultaneously lacking confidence in being able to meet these standards.
This discrepancy is believed to be the driving force of social anxiety. We have summarized the most commonly accepted explanations in the following table.
|Explanatory Model||Expectations||Perceived Reality|
|#1 Clark & Wells (1995)||To generate a positive impression of the self on others||Little confidence in one’s ability to do so successfully|
|#2 Rapee & Heimberg (1997)||Expectations of others are imagined to be very high.||The presentation of the self as seen by others is imagined to be negative.|
|#3 Gilbert (2001)||Tremendous imagined requirements to gain high social status.||Little confidence in one’s ability to meet these requirements.|
|#4 Moscovitch (2009)||Society is believed to have very high expectations of the self.||The self is perceived as deficient & flawed.|
Keep in mind that while the above table explains the subjective experience of social anxiety, it does not make any assumptions related to the underlying mechanisms that cause this discrepancy in the first place.
Anxiety in Social Situations: The Most Commonly Feared Scenarios
As pointed out before, the concerns about being negatively evaluated by others can differ widely from one person to another. While some people fear participating in larger groups, others are especially afraid of being in a situation with just one other person.
An individual may be afraid of taking classes in an academic environment, but be totally fine with going on a private date with an unknown person. In the same manner, someone afraid of dating might feel completely comfortable speaking up in a larger group.
The following social situations are among the most commonly feared among people with SAD.
Keep in mind that these are just the most common examples. As long as a person experiences anxiety in social situations due to the fear of disapproval, we can speak of social anxiety.
Depending on the particular situation(s) a person fears, the consequences on her quality of life may be dramatic. A person afraid of participating in large groups might refrain from pursuing higher education and accept a job way below her professional potential and aspirations.
In order to speak of social anxiety disorder, the quality of life must be significantly impacted.
The Most Common Physical Symptoms of Social Anxiety
While it is crucial to identify the social situations people with SAD fear, it is equally important to understand the physical symptoms of anxiety.
It is not always a specific external situation a person fears, but rather the manifestation of social anxiety symptoms in any given social scenario. If a person is afraid of displaying physical signs of anxiety, such as excessive sweating, the feared physical symptom should be identified.
Even though the physical symptoms of social anxiety can be regarded a secondary manifestation of SAD, in many cases they end up being the primary concern of the individual.
For example, someone might be afraid of making a spelling mistake while giving a speech. This leads to intense anxiety, which in turn leads to a racing and pounding heart. Now the person is afraid that the audience might notice her nervousness by displaying physical symptoms, such as a shaky voice, sweaty palms or shortness of breath.
In cases like this one, affected people are ashamed of their physical symptoms of anxiety and can become obsessed with controlling them. Like this, a side effect of social anxiety has turned into the main concern of the individual.
The following list summarizes the most common physical symptoms for social anxiety disorder:
- tachycardia – a racing heart
- accelerated breathing – shortness of breath
- trembling extremities – legs, hands, or fingers
- disproportionate sweating – palms, face, torso, or armpits
- facial blushing
- dizziness & vertigo
- stuttering or incapacity to speak
- dry mouth
- tight chest
- feeling of choking
- difficulties “letting go” (restroom)
- erectile dysfunction
- loud bowel sounds
Note: These are just the most common examples. The development of symptoms depends on each individual and can differ strongly from one person to another.
While most people with social anxiety are especially afraid of doing or saying something “stupid”, others may be particularly concerned with offending other people or with displaying observable anxiety symptoms, like the ones described above. That’s why experts have proposed to distinguish between different types of social anxiety disorder.
Typical Behaviors in People With Social Anxiety
There are several behaviors and mental activities people with social anxiety usually engage in. While some experts believe these habits cause social anxiety in the first place, there is a general consensus that they play an important role in maintaining the disorder.
The following tendencies of people with SAD represent some of the major challenges when it comes to overcoming social anxiety.
- Avoidance of Feared Social Situations When Possible
- Engagement in Safety Behaviors When Confronted With Feared Situation
- Anticipatory Anxiety: Worrying About Future Situations
- Post-Event Processing: Excessive Dwelling About Past Situations
Given the intense fear people with SAD experience in certain social situations, it is only natural they avoid them when they get the chance.
Anxiety has a protective function and is meant to warn us of potential danger. However, in the case of SAD the alarm also goes off when there is no real threat. The brain signals the body to go into high alert in order to prepare the fight-flight-freeze response. When there is a way to flee, most affected people usually do so.
We want to point out, however, that many people with social anxiety do face the feared situations, even if they could avoid them. When faced with the feared social situations, socially anxious people typically engage in so-called safety behaviors.
When people with social phobia are confronted with a feared social situation, they commonly try to attenuate their anxiety or ward off the worst-case outcomes using certain strategies. These strategies are referred to as safety behaviors, as they provide some sense of perceived security to the individual.
A person afraid of social gatherings might drink lots of alcohol on a party in order to be more talkative. The alcohol not only calms down her nerves, but also let’s her act in a way she would like to be perceived by others – as outgoing, extroverted, open-minded, or funny. This very common safety behavior may bring results in the short run, but is it indeed smart to make use of it?
Many experts agree on the maintaining force of safety behaviors. Using certain strategies, such as drinking alcohol in order to socialize, or checking things on the smartphone when not knowing what to say to others, gets in the way when it comes to making new, possibly positive experiences.
To realize that you can socialize without being drunk, or that others might actually approach you and start a conversation when you are not starring at your phone, can be important experiences.
Safety behaviors are believed to deprive people with SAD from making such corrective experiences and strengthen the belief that one can only endure the feared situation thanks to making use of them.
Socially anxious people often find themselves worrying about future situations that haven’t even occurred yet. Just the thought of being in the feared situation provokes significant levels of anxiety in many people.
It is important to keep in mind that some concern about future situations, such as giving a talk, is normal and can be very helpful. In the case of social anxiety, however, people get caught up in their worrying.
A person that is afraid of public speaking and has to give a talk might worry excessively about it already days or weeks before the event. She might imagine the worst case scenarios, making mistakes, or being disapproved of.
Disproportionate concerns like this pass the line of helpful worrying. Engaging in anticipatory anxiety tends to make the situation seem worse to the person than it already did before and it sets the stage for self-fulfilling prophecies.
Ruminating about the impression made on others in past social situations is another typical tendency among people with social anxiety.
“Did I say something stupid?” or “They must have seen I was horrified” are questions that might pop up in the mind of a person with SAD after giving a speech, for instance.
Similarly to anticipatory anxiety, post-event processing tends to exacerbate the social fears of a person. By focusing exclusively on the negative parts of their social performance, people with SAD deprive themselves of the chance to prove wrong certain ideas about their social ineptness.
Therefore, it has been suggested that this type of mental activity is another maintaining factor of social anxiety.
Anxiety Symptoms & The Ironic Thought Process
Another typical feature among people with SAD is the attempt to fight the anxiety symptoms that arise in social situations. This natural impulse aims to result in some form of control over the physical reactions of the body. Unfortunately, besides not being helpful, it often ends up being counterproductive.
Ever tried not to think of a pink elephant? No? Then try it now, as hard as you can! And…
Yep, there it is! The same thing happens when you try to suppress negative thoughts, emotions, or physical reactions.
Wegner (1997) was the first to scientifically study this paradox and named it the ironic thought process. Attempts to suppress certain thoughts, feelings or sensations usually backfire. Wegner discovered that this is especially true when a person is exposed to high levels of stress.
When a person with social anxiety faces a feared situation, her stress levels are elevated. Trying to control her thoughts or physical reactions at this point is likely to be a lost cause, making them even stronger.
As counter-intuitive as it may seem, but acceptance of negative thoughts, sensations and physical reactions usually yields better results than trying to fight these phenomenons. Mindfulness and acceptance-based approaches have become more commonplace in psychotherapy for social anxiety disorder, as they address this phenomenon.
Similar and Co-Occurring Disorders
Even though there are many people who suffer solely from social anxiety, it has been pointed out that SAD often comes along with other mental health problems, such as substance use or depression (Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992).
Many people consume alcohol or marijuana to decrease their social anxiety, for instance. This can result in adding another layer to the problem and making it even harder to address the problem at its core.
Symptoms of depression are another common problem which sufferers often encounter after having lived with this debilitating disorder for some time.
It is important to identify whether or not a person suffers from additional psychological problems, since this may have important effects on treatment.
Also, some people may think they suffer from social anxiety, when in reality they are struggling with another, albeit similar, disorder. Due to a strong overlap of their symptoms, this often leads to confusion and makes it hard to differentiate between social anxiety and similar psychological disorders. Having a look on the official diagnostic guidelines helps in this process.
Social Anxiety Disorder DSM-5 Diagnosis
In order to thoroughly answer the question “What is social anxiety?“, we believe it is important to include the official diagnostic criteria. SAD was officially recognized as a psychological disorder in 1980. Since then, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has changed the diagnostic criteria several times. According to the American Psychiatric Association (APA, 2013), the current social anxiety disorder DSM-5 diagnostic criteria are defined as follows:
A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing: will lead to rejection or offend others).
C. The social situations almost always provoke fear or anxiety.
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmoφhic disorder, or autism spectrum disorder.
J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from bums or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Specify if: Performance only: If the fear is restricted to speaking or performing in public.
Individuals with the performance only type of social anxiety disorder have performance fears that are typically most impairing in their professional lives (e.g., musicians, dancers, performers, athletes) or in roles that require regular public speaking. Performance fears may also manifest in work, school, or academic settings in which regular public presentations are required. Individuals with performance only social anxiety disorder do not fear or avoid nonperformance social situations.
“Do I Have Social Anxiety“? – Take The Social Anxiety Test
By now, you should have a basic understanding of what it means to suffer from social anxiety. However, you might still be wondering whether or not you are affected.
While an official diagnosis should always be administered by a qualified mental health professional in person, there are several free social anxiety tests you can take online to get a good idea about your situation.
It is important to note that not all tests for social anxiety you can find online have been designed by professionals. Therefore, we caution to take results obtained in such questionnaires too seriously.
The following test has been professionally designed, approved and applied all over the world to test for symptoms of social anxiety. The social anxiety test offered here is the self-report version of the Liebowitz Social Anxiety Scale, which measures SAD in teenagers and adults.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Anxiety and Depression Association of America. (n.d.). Understand the facts: Social anxiety disorder. Retrieved from https://adaa.org/understanding-anxiety/social-anxiety-disorder
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. Social Phobia: Diagnosis, Assessment, and Treatment. https://doi.org/10.1016/S0005-7967(97)00022-3
Cox, B. J., Clara, I. P., Sareen, J., & Stein, M. B. (2008). The structure of feared social situations among individuals with a lifetime diagnosis of social anxiety disorder in two independent nationally representative mental health surveys. Behaviour Research and Therapy. https://doi.org/10.1016/j.brat.2008.01.011
Eng, W., Heimberg, R. G., Coles, M. E., Schneier, F. R., & Liebowitz, M. R. (2000). An empirical approach to subtype identification in individuals with social phobia. Psychological Medicine. https://doi.org/10.1017/S0033291799002895
Gilbert, P. (2001). Evolution and social anxiety: The role of attraction, social competition, and social hierarchies. Psychiatric Clinics of North America. https://doi.org/10.1016/S0193-953X(05)70260-4
Gilbert, P. (2014). Evolutionary models: practical and conceptual utility for the treatment and study of social anxiety disorder. In The Wiley Blackwell Handbook of Social Anxiety Disorder. https://doi.org/http://dx.doi.org/10.1002/9781118653920.ch2
Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy. https://doi.org/10.1080/16506070701421313
Leary, M. R., & Jongman-Sereno, K. P. (2014). Social Anxiety as an Early Warning System: A Refinement and Extension of the Self-Presentation Theory of Social Anxiety. In Social Anxiety: Clinical, Developmental, and Social Perspectives: Third Edition. https://doi.org/10.1016/B978-0-12-394427-6.00020-0
Moscovitch, D. A. (2009). What Is the Core Fear in Social Phobia? A New Model to Facilitate Individualized Case Conceptualization and Treatment. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2008.04.002
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy. https://doi.org/10.1016/S0005-7967(97)00022-3
Schneier, F. R., Johnson, J., Hornig, C. D., Liebowitz, M. R., & Weissman, M. M. (1992). Social Phobia: Comorbidity and Morbidity in an Epidemiologic Sample. Archives of General Psychiatry. . 01820040034004
Wegner, D. M. (1997). When the antidote is the poison: Ironic mental control processes. Psychological Science, 8(3), 148-150.
Wong, J., Gordon, E. A., & Heimberg, R. G. (2014). Cognitive-Behavioral Models of Social Anxiety Disorder. The Wiley Blackwell Handbook of Social Anxiety Disorder. https://doi.org/10.1002/9781118653920.ch1
Share This Page With Your Community