Types of Social Anxiety

Are There Different Types of Social Anxiety Disorder?

Not all people with social anxiety are alike. In fact, there are important differences to keep in mind, especially if treatment is to be successful.

If you have ever attended a meetup for people with SAD, you have probably noticed that the number of social situations people struggle with can differ significantly. Some may fear only a few specific scenarios, such as public speaking or dating, while others experience social anxiety symptoms in virtually all social situations.

The same accounts for the main concerns related to these situations. Whereas many affected people fear behaving in a way that makes them look foolish or socially inept, others are primarily concerned about displaying observable anxiety symptoms that would reveal their insecurity to others.

There are different types of social anxiety disorder. One of them is mainly concerned about displaying observable anxiety symptoms.

Therefore, experts have proposed several ways of classifying affected people into different types of social anxiety.

Since these subgroups differ from each other in certain aspects, a classification seems appropriate, especially when it comes to therapeutic approaches.

A person that is socially anxious in almost every situation, for instance, is likely to have different necessities and might choose an approach that differs in duration and therapeutic focus, compared to a person who only experiences public speaking anxiety.

Explainer Video: The Different Social Anxiety Types

Classifying Social Anxiety Into Categories

In the scientific realm, experts do not always agree upon everything. That’s also true for dividing socially anxious people into different types.

There have been numerous proposals by different research teams. Here, we will have a look at 3 different categories that can be used to classify people with SAD into different types.

  1. Classification according to the number of feared social situations
  2. Classification according to the types of feared social situations
  3. Classification according to the focus of the social fears

Category I: Number of Feared Social Situations

The idea this category is based on is to differentiate between social anxiety types by identifying the number of social situations a person fears. By doing that, we end up with 3 different types of social anxiety:

Based in the number of feared social situations, a person suffers from generalized, nongeneralized, or circumscribed social anxiety disorder.

Generalized Social Anxiety Disorder

People affected by generalized social anxiety experience fear in virtually all or most social situations (APA, 2013). This type of social anxiety usually starts in early childhood, before the age of 10 (Mannuzza et al., 1995), and is characterized by behavioral inhibition (BI).

BI refers to a reserved, shy and anxious temperament, especially when confronted with new situations, experiences and people (Kagan, Reznick, & Snidman, 1988).

Generalized social anxiety is associated with a greater comorbidity than the other subtypes (Kessler, Stein, & Berglund, 1998). This means that it often comes along with additional psychological problems, such as depression or generalized anxiety disorder.

People with this type of social anxiety usually display greater difficulties living a “normal” life and the genetic component is believed to have a greater influence than it has for the other subtypes (Stein et al., 1998).

Nongeneralized Social Anxiety Disorder

People with nongeneralized social anxiety also fear most social situations, but they exhibit at least one area of normal social functioning without anxiety (Heimberg, Holt, Schneier, & Spitzer, 1993).

While this may facilitate things a little compared to those suffering from generalized SAD, as professional or personal life can still be sources of well-being and self-esteem, many affected people experience significant functional impairment and hardship.

Circumscribed / Specific Social Anxiety Disorder

Circumscribed social anxiety (also: specific social anxiety) is experienced by people who fear one or very few specific social scenarios only.

Among people with SAD, public speaking anxiety is the most common phenomenon. Individuals who are only concerned about scenarios of this type would qualify for this type of SAD.

Circumscribed social anxiety means that a person experiences SAD symptoms only in very few, specific social situations.

Compared to generalized SAD, the genetic component associated with specific social anxiety is not as eminent. It also tends to start a little later, usually throughout puberty (Mannuzza et al., 1995).

It is also more likely that people with this type of social anxiety report a specific traumatic social experience that marked the start of their social phobia. People with circumscribed SAD may even seem socially confident and their friends and acquaintances often describe them as outgoing and sociable.

It can get complicated when speaking of social anxiety types, since even experts disagree on many questions. In one proposal, the circumscribed (specific) subtype refers to a particular version of nongeneralized SAD.

Category II: Types of Feared Social Situations

Another suggestion for distinguishing between SAD sufferers is based on the types of situations people fear.

Here, the quantity of feared social scenarios is not a determining factor (Spokas & Cardaciotto, 2014). This category differentiates between the following three types of social anxiety.

Social Anxiety in Performance Situations

Performance fears are very common in people with social anxiety disorder (Eng et al., 2000). Some affected people appear to suffer from performance fears only, such as public speaking anxiety.

This subgroup of SAD sufferers exhibits little to no social anxiety in observation and interaction situations (Spokas & Cardaciotto, 2014). It has been reported that people with performance fears only are less impaired, experience fewer additional psychological disorders and are socially-speaking less avoidant (Knappe et al., 2011).

There have been some findings that suggest that people with performance fears only experience more anxiety and stronger physiological reactions when faced with a speech task compared to those with generalized SAD (Tran & Chambless, 1995; Boone et al., 1999).

It has also been pointed out that people with sole performance fears frequently report experiencing a traumatic performance situation which led to their SAD (Stemberger, Turner, Beidel, & Calhoun, 1995).

Many people with SAD who suffer from performance fears only report a traumatic experience which led to their phobia.

Then again, other research teams found similarities in physiological reactions for those with performance-limited SAD and panic disorder, and identified that in many cases a panic attack preceded the onset of the performance fears (Hofmann, Ehlers, & Roth, 1995; Nardi et al., 2009).

Keep in mind that performance fears are very common among people with social anxiety. This specific social anxiety type is characterized by experiencing only performance fears and by a general absence of social fears related to other situations (Eng et al., 2000).

Social Anxiety in Interaction & Observation Situations

While some experts have proposed differentiating between fear of interaction and observation situations, there seems to be a significant overlap between the two types (Cox et al., 2008; Ruscio et al., 2008).

People who fear social interaction situations, such as conversing with co-workers or a person they are attracted to, usually endorse observation and performance fears as well (Cox et al., 2008).

The same has been reported for those suffering from fears of being observed, such as when eating, drinking, writing, or using a public restroom.

For the above reasons, we have grouped these two types into the same section. More research is needed in order to determine whether or not fears of interaction and observation situations qualify as an one single subgroup and if this specifier is helpful at all.

While people who fear observation situations usually also fear interaction situations and vice versa, there are many people who experience anxiety related to performance situations only.

Category III: Focus of the Social Fears

Most people with social anxiety disorder are excessively concerned about behaving in a way that will lead to negative evaluation and rejection. However, there seem to be two important deviations from this apparent core feature of SAD (Spokas & Cardaciotto, 2014).

One of them refers to the subgroup of SAD sufferers whose predominant fear is to display observable, physical signs of social anxiety, while the other relates to those who are mainly preoccupied about the possibility of offending others.

Social Anxiety Focus: Behavior

The fear of acting in a way that may lead to negative evaluation, rejection, disapproval, or humiliation is often seen as the cardinal feature of SAD (Spokas & Cardaciotto, 2014).

Affected people may worry about saying something stupid, committing a mistake, or behaving socially clumsy, and they consider what they do the main reason for concern. Most people with SAD qualify for this social anxiety type.

Social Anxiety Focus: Physical Signs of Anxiety

A considerable proportion of people with SAD report displaying observable signs of anxiety as their primary fear (Bögels & Reith, 1999). Depending on the individual, the main concern may be physical symptoms such as sweating, blushing, or trembling.

Research is still scarce regarding this area, but there have been a couple of findings regarding erythrophobia, the excessive fear of blushing.

Compared to other SAD sufferers, those with erythrophobia show stronger blushing responses during social tasks (Voncken & Bögels, 2009). It has been suggested that increased self-focused attention exacerbates the physiological response, which has important implications for treatment (Bögels, 2006).

Some people with SAD whose main concern relates to observable anxiety symptoms suffer from medical conditions that cause their physical reactions. For instance, essential tremor leads to involuntary shaking, often of the hands.

Individuals afraid of displaying physical anxiety symptoms often report related traumatic experiences, such as being teased for them (Mulkens & Bögels, 1999).

Others may suffer from additional medical conditions which cause the physical symptoms, such as rosacea (skin condition that causes redness), hyperhidrosis (excessive sweating), or essential tremor (involuntary shaking, often in hands; Bögels et al., 2010).

Social Anxiety Focus: Offending Others [Also: Taijin Kyofusho]

While the social anxiety types described so far are primarily concerned with the impression of the self made on others, this subtype’s main focus lies on the possibility of offending others, as well as on the pursuit of avoiding this.

In Japanese culture, a specific type of social anxiety disorder with this core feature has been described. Taijin Kyofusho (対人恐怖症) refers to an excessive fear of interpersonal relations and one of its subtypes is mainly concerned about making other people feel uncomfortable (Iwase et al., 2000). Instead of dreading to be embarrassed around others, this subtype fears embarrassing others.

It has been suggested that this phenomenon is associated with collectivist cultures which accentuate social harmony and interdependence (Rector, Kocovski, & Ryder, 2006). However, it has been found that people in Western culture who cherish the same values report symptoms of this type as well (Dinnel, Kleinknecht, & Tanaka-Matsumi, 2002).

Taijin Kyofusho, a social anxiety type predominantly found in Japan, has been associated with fear of offending others.

It has been pointed out that fears of offending others could be traced back to SAD’s core fear of being negatively evaluated, as upsetting others increases the risk of being rejected and disapproved of (Magee, Rodebaugh, & Heimberg, 2006).

Be that as it may, thoroughly assessing these fears is beneficial for treatment as this allows for proper coverage in therapy (Spoka & Cardaciotto, 2014). The same accounts for the underlying causes of social anxiety.

Please keep in mind that the types of social anxiety disorder discussed in this section are merely proposals from different research teams and remain subject to discussion. Depending on your health care professional, one or the other form of subtyping may be used, if any.


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. https://doi.org/10.1176/appi.books.9780890425596.744053

Bögels, S. M., & Reith, W. (1999). Validity of two questionnaires to assess social fears: The Dutch social phobia and anxiety inventory and the blushing, trembling and sweating questionnaire. Journal of Psychopathology and Behavioral Assessment. https://doi.org/10.1023/A:1022812227606

Bögels, Susan M. (2006). Task concentration training versus applied relaxation, in combination with cognitive therapy, for social phobia patients with fear of blushing, trembling, and sweating. Behaviour Research and Therapy. https://doi.org/10.1016/j.brat.2005.08.010

Bögels, Susan M., Alden, L., Beidel, D. C., Clark, L. A., Pine, D. S., Stein, M. B., & Voncken, M. (2010). Social anxiety disorder: Questions and answers for the DSM-V. Depression and Anxiety. https://doi.org/10.1002/da.20670

Bögels, Susan M., Rijsemus, W., & De Jong, P. J. (2002). Self-focused attention and social anxiety: The effects of experimentally heightened self-awareness on fear, blushing, cognitions, and social skills. Cognitive Therapy and Research. https://doi.org/10.1023/A:1016275700203

Bögels, Susan M., Sijbers, G. F. V. M., & Voncken, M. (2006). Mindfulness and task concentration training for social phobia: A pilot study. Journal of Cognitive Psychotherapy. https://doi.org/10.1891/jcop.20.1.33

Boone, M. L., McNeil, D. W., Masia, C. L., Turk, C. L., Carter, L. E., Ries, B. J., & Lewin, M. R. (1999). Multimodal comparisons of social phobia subtypes and avoidant personality disorder. Journal of Anxiety Disorders. https://doi.org/10.1016/S0887-6185(99)00004-3

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

Erwin, B. A., Heimberg, R. G., Schneier, F. R., & Liebowitz, M. R. (2003). Anger experience and expression in social anxiety disorder: Pretreatment profile and predictors of attrition and response to cognitive-behavioral treatment. Behavior Therapy. https://doi.org/10.1016/S0005-7894(03)80004-7

Furmark, T., Tillfors, M., Stattin, H., Ekselius, L., & Fredrikson, M. (2000). Social phobia subtypes in the general population revealed by cluster analysis. Psychological Medicine. https://doi.org/10.1017/S0033291799002615

Heimberg, R. G., Holt, C. S., Schneier, F. R., Spitzer, R. L., & Liebowitz, M. R. (1993). The issue of subtypes in the diagnosis of social phobia. Journal of Anxiety Disorders. https://doi.org/10.1016/0887-6185(93)90006-7

Hofmann, S. G., Ehlers, A., & Roth, W. T. (1995). Conditioning theory: a model for the etiology of public speaking anxiety? Behaviour Research and Therapy. https://doi.org/10.1016/0005-7967(94)00072-R

Hook, J. N., & Valentiner, D. P. (2002). Are specific and generalized social phobias qualitatively distinct? Clinical Psychology: Science and Practice. https://doi.org/10.1093/clipsy/9.4.379

Iwase, M., Nakao, K., Takaishi, J., Yorifuji, K., Ikezawa, K., & Takeda, M. (2000). An empirical classification of social anxiety: Performance, interpersonal and offensive. Psychiatry and Clinical Neurosciences. https://doi.org/10.1046/j.1440-1819.2000.00639.x

Kagan, J., Reznick, J. S., & Snidman, N. (1987). No Title. Child Development, 58(null), 1459.

Kashdan, T. B., & Collins, R. L. (2010). Social anxiety and the experience of positive emotion and anger in everyday life: An ecological momentary assessment approach. Anxiety, Stress and Coping. https://doi.org/10.1080/10615800802641950

Kashdan, T. B., & Hofmann, S. G. (2008). The high-novelty-seeking, impulsive subtype of generalized social anxiety disorder. Depression and Anxiety. https://doi.org/10.1002/da.20382

Kashdan, T. B., McKnight, P. E., Richey, J. A., & Hofmann, S. G. (2009). When social anxiety disorder co-exists with risk-prone, approach behavior: Investigating a neglected, meaningful subset of people in the National Comorbidity Survey-Replication. Behaviour Research and Therapy. https://doi.org/10.1016/j.brat.2009.03.010

Kessler, R. C., Stein, M. B., & Berglund, P. (1998). Social phobia subtypes in the National Comorbidity Survey. American Journal of Psychiatry. https://doi.org/10.1176/ajp.155.5.613

Knappe, S., Beesdo-Baum, K., Fehm, L., Stein, M. B., Lieb, R., & Wittchen, H. U. (2011). Social fear and social phobia types among community youth: Differential clinical features and vulnerability factors. Journal of Psychiatric Research. https://doi.org/10.1016/j.jpsychires.2010.05.002

Magee, L., Rodebaugh, T. L., & Heimberg, R. G. (2006). Negative evaluation is the feared consequence of making others uncomfortable: A response to Rector, Kocovski, and Ryder. Journal of Social and Clinical Psychology. https://doi.org/10.1521/jscp.2006.25.8.929

Mannuzza, S., Schneier, F. R., Chapman, T. F., Liebowitz, M. R., Klein, D. F., & Fyer, A. J. (1995). Generalized Social Phobia: Reliability and Validity. Archives of General Psychiatry. https://doi.org/10.1001/archpsyc.1995.03950150062011

Mulkens, S., & Bögels, S. M. (1999). Learning history in fear of blushing. Behaviour Research and Therapy. https://doi.org/10.1016/S0005-7967(99)00022-4

Nardi, A. E., Lopes, F. L., Freire, R. C., Veras, A. B., Nascimento, I., Valença, A. M., … Zin, W. A. (2009). Panic disorder and social anxiety disorder subtypes in a caffeine challenge test. Psychiatry Research. https://doi.org/10.1016/j.psychres.2008.06.023

Perugi, G., Nassini, S., Maremmani, I., Madaro, D., Toni, C., Simonini, E., & Akiskal, H. S. (2001). Putative clinical subtypes of social phobia: A factor-analytical study. Acta Psychiatrica Scandinavica. https://doi.org/10.1034/j.1600-0447.2001.00128.x

Rector, N. A., Kocovski, N. L., & Ryder, A. G. (2006). Social anxiety and the fear of causing discomfort to others. Cognitive Therapy and Research. https://doi.org/10.1007/s10608-006-9050-9

Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008). Social fears and social phobia in the USA: Results from the National Comorbidity Survey Replication. Psychological Medicine. https://doi.org/10.1017/S0033291707001699

Spokas, M. E., & Cardaciotto, L. (2014). Heterogeneity Within Social Anxiety Disorder. In The Wiley Blackwell Handbook of Social Anxiety Disorder. https://doi.org/10.1002/9781118653920.ch12

Stein, M. B., Chartier, M. J., Hazen, A. L., Kozak, M. V., Tancer, M. E., Lander, SheilaçFurer, P., … Walker, J. R. (1998). A Direct-interview Family study of Generalized Social Phobia. The American Journal of Psychiatry. https://doi.org/10.1176/ajp.155.1.90

Stein, M. B., Torgrud, L. J., & Walker, J. R. (2000). Social phobia symptoms, subtypes, and severity: Findings from a community survey. Archives of General Psychiatry. https://doi.org/10.1001/archpsyc.57.11.1046

Stemberger, R. T., Turner, S. M., Beidel, D. C., & Calhoun, K. S. (1995). Social Phobia: An Analysis of Possible Developmental Factors. Journal of Abnormal Psychology. https://doi.org/10.1037/0021-843X.104.3.526

Tran, G. Q., & Chambless, D. L. (1995). Psychopathology of social phobia: Effects of subtype and of avoidant personality disorder. Journal of Anxiety Disorders. https://doi.org/10.1016/0887-6185(95)00027-L

Voncken, M. J., & Bögels, S. M. (2009). Physiological blushing in social anxiety disorder patients with and without blushing complaints: Two subtypes? Biological Psychology. https://doi.org/10.1016/j.biopsycho.2009.02.004

References

Share This Article

Conquer Social Anxiety