What is Social Anxiety?

Social anxiety is one of the most prevalent anxiety disorders in the UK, with many people who suffer from the condition seeking treatment as late as 20 years after the onset of symptoms. Social anxiety is usually present with other forms of mental health conditions and 19% of people in the UK suffering from social anxiety also suffer from depression.

What is social anxiety?

Social anxiety, or social anxiety disorder, is a severe fear or phobia of social scenarios. Social anxiety is not defined as ‘shyness’, anti-social tendencies or introversion, but entails a fear of socialising that is disproportionate. People with social anxiety find it difficult to conversate with people, introduce themselves to people, and even attend a social setting.

It is thought that most people who suffer from social anxiety have a fear that they may be embarrassed, judged or criticised by the people in attendance. They may also worry that they will do something, directly or indirectly, that will bring attention to them.

The condition is not limited to informal social events as it can affect any area of life that involves interacting with people, such as work and school, going to the shop, and any other public interaction.

What causes social anxiety?

It is thought that social anxiety can stem from childhood experiences. Many studies indicate that traumatic experiences can lead to social anxiety in teenage and later years.

Some of these experiences might include:

• Unsettled and inconsistent environments growing up. This might be frequently moving house or feeling anxious about living situations.
• Bullying can instil a fear of rejection and a lowly view of self-worth.
• Divorce or exposure to family trauma such as domestic violence. You can read more about childhood trauma by visiting our knowledge base.
• Overprotective parenting can cause an onset of anxiety in children which can later become irrational. Over cautious parenting plays a strong role in children who develop social anxiety. Psychologically, the child comes to associate danger with avoiding situations.
• Substance withdrawals such as drugs and alcohol can cause anxiety as the individual has to function in a public setting without the use of the substance.
• People who already have a mental illness may be more prone to experiencing social anxiety.

Social anxiety has also been linked to Behaviourally Inhibited Temperament, a childhood condition which presents early in infancy. Children with behaviourally inhibited temperament demonstrate an increased sensitivity to people they are not used to and situations they do not recognise.

Children with the condition process new people and situations as a threat, and their brains create automatic defensive responses and cause the child to distance themselves from the threatening stimuli. Children with behaviourally inhibited temperament are more likely to develop social anxiety disorder as they get older; studies have indicated that children with this condition are between four and seven times more likely to develop social anxiety disorder in their teenage years.

Additionally, individuals who have social anxiety have been found to have neurological hyperactivity. The limbic part of their brain that is responsible for anxiety has been found to be hyperactive, as well as the region that is responsible for social behaviour.

Limited exposure to conversational interactions, perhaps due to technology being the most dominant form of communication in the modern era, plays a large part in the development of social anxiety in young people. This is a dominant cause of a fast increase in social anxiety in young people today.

People no longer need to meet in person or spend time in a collective environment to function; almost everything can be done virtually. The more time people are spending online, the more insecure they are becoming when considering in-person communication. An increasing number of young children can navigate their way through a complex digital app, but struggle to understand social cues and norms, or function confidently in an in-person scenario.

How can social anxiety affect your life?

As an individual begins to feel uncomfortable, they create a set of beliefs that reinforce negative perceptions of social situations and perpetuate their low sense of self-worth.

These may be statements such as:

• ‘I will embarrass myself’.
• ‘I won’t be able to hide my nerves’.
• ‘I will not fit in’.
• ‘No one will like me’.
• ‘I will say or do something silly’.
• ‘Everyone will stare at me’.

As an individual continues to reinforce that they will not do well in a social situation, they withdraw from society, irrationally convinced that it would be better for everyone else if they were not present.

Social anxiety is also triggered by certain events, which can cause mental and physical symptoms.

These triggers might be:

• Being in a busy, crowded place.
• Public speaking.
• Speaking to an authority figure.
• Interviews.
• Going on dates.
• Leaving the house.
• Someone else’s facial expression.
• Being somewhere with many unfamiliar people.

Social anxiety impacts everyday life, as it affects relationships, self-perception and one’s ability to carry out tasks. People with social anxiety feel as though they are constantly being judged by others and this limits their ability to function well. Avoidance of certain situations can lead to isolation, limited relationships and an inability to go to work or school, amongst other disruptions.

When does social anxiety happen?

Social anxiety develops in childhood or teenage years, usually before the age of 20. The most common age is 13 for the onset of symptoms. Signs of social anxiety are usually gradual, rather than sudden. However, the disorder can develop instantly after a traumatic experience, at any age.

What are the signs and symptoms of social anxiety?

The symptoms of social anxiety centre around interacting and communicating with people.

People with social anxiety disorder may display any or all of the following symptoms:

• Crippling worry about meeting new people.
• Worry about making conversation.
• Worry about eating in front of people. The individual may noticeably disappear when it is time to eat or avoid attending any meal plans at all.
• Noticeable physical displays of anxiety in social situations, such as sweating, shaking, blushing or stuttering.
• An inability to carry out actions when people are looking.
• Lack of eye contact.
• Panic attacks.
• Nausea.
• Increased heart rate.
• Unsettled stomach.
• Dizziness.
• Crying.
• Tension in muscles.
• Mind blank.
• Mutism.
• Confusion.
• Freezing.
• Withdrawal from social settings.
• The individual may only ever communicate through text.

Young children may display other symptoms such as:

• Tantrums.
• Extreme attachment to their parent or guardian.

How is social anxiety diagnosed?

There has been a conversation in recent times surrounding the low rates of diagnosis of social anxiety disorder, though the cause of this is unclear. It is thought that doctors are failing to recognise the symptoms, but also that the individuals who are suffering are reluctant to seek help. Many people with social anxiety are only given a diagnosis of depression.

In order to be diagnosed with social anxiety disorder, the individual must have a consistent fear of social situations, rather than a specific event or a specific person. Consistency in this case is usually indicated by a period of six months or more.

The individual is usually asked to take a survey in which they have to rank their fear in different circumstances, such as going to a party, doing something whilst being watched, speaking in a meeting etc. The scores are then calculated and indicate the existence and prevalence of social anxiety within that individual.

How to manage social anxiety

Social anxiety disorder is treatable in many ways; although, as with many mental health related conditions, there is no ‘cure’ as such. Treatments are available to help individuals manage their symptoms.

The following treatments are used to help people overcome social anxiety:

Medication

There are a number of medications used to help ease social anxiety symptoms.

These include antidepressants, beta-blockers and anti-anxiety drugs.

• The most commonly prescribed anti-anxiety drugs are Benzodiazepines. These medications are not designed for long-term use and are prescribed to offer a short-term solution. Anti-anxiety medications can cause addiction, and the individual should be monitored closely whilst using them.
• Beta-blockers quite literally block the function of adrenaline, which helps to decrease physical symptoms such as sweating and trembling. Again, these are not intended for long-term use, but for particular circumstances.
• Antidepressants such as fluoxetine or duloxetine can be prescribed as a more long-term method of treatment, as the effects of these medications usually take a few months to be noticeable. As these are broad-spectrum medications, the patient must be monitored to assess the efficacy of the medication, and whether they should be given a different one.

A doctor or specialist will assess the individual and decide what short- or long-term medications need to be prescribed based on an individual basis.

Therapy

Talking therapy can be a useful treatment tool for people suffering from social anxiety. The most used method of therapy for people with this condition is Cognitive Behavioural Therapy (CBT).

This arms people with methods of identifying triggers and changing their behaviour when presented with those triggers. It can help people as it pre-empts the individual to anticipate when social anxiety may occur. You can read more about Cognitive Behavioural Therapy by visiting our knowledge base.

Some specialists believe that exposure therapy is an effective way of treating the root causes of social anxiety. It operates on the premise that in order to overcome a fear, the fear itself must be addressed, rather than solely focusing on coping methods and redirecting the fear. The therapist works with the patient to progressively face social situations that cause them anxiety.

Other treatments

Alternative treatments such as yoga and meditation help to increase mindfulness, which can reduce anxiety generally and help an individual to remain in the present. Specialists recommend exercise and may put the patient on an exercise schedule or refer them to the gym. Exercise is linked to the reduction of anxiety and an increase in hormones that make you content and relaxed.

Can social anxiety control your life?

Without treatment, social anxiety can be extremely debilitating. In its most extreme form, it inhibits an individual from living their life ‘normally’. They will go to huge lengths to avoid any social setting, which can leave them with very few friends, and a large amount of education missed if they have been avoiding attending school.

Whilst social anxiety is not a condition that shortens life span, many studies show the importance of community and socialising to a fulfilled and content life. People with social anxiety are at a higher risk of self-harm and suicide, which can be linked to isolation and low self-esteem. If you or someone else is experiencing feelings of self-harm or suicide, trained Samaritans are available to listen and offer support 24/7.

Additionally, if social anxiety is left undiagnosed and untreated, it may lead to substance abuse, which can have detrimental effects. People with social anxiety disorder are more than twice as likely to die from an unnatural cause.

Whilst people with social anxiety disorder may have previously had or may develop depression, social anxiety can also trigger agoraphobia. Agoraphobia is an anxiety disorder that involves the individual feeling a deep sense of fear when they are in a situation that might be hard to escape from. You can read more about agoraphobia by visiting our knowledge base.

Who can help?

There are a number of services available through the NHS, for which a doctor can make a referral, such as counselling and therapy. There are also other platforms of support that help people with social anxiety.

• Anxiety UK is a charity dedicated to helping people with different forms of anxiety, including support groups, stress relief services and therapy sessions. Support groups can be a really useful tool for individuals who are suffering from social anxiety, and is a social setting where they may feel slightly more comfortable.
• No More Panic is a charity that supports people with different anxiety disorders, offering advice and support via forums and chat rooms.
• Young Minds caters for young people with a variety of mental health challenges, including social anxiety disorder. They offer support and information to young people, parents and those who work with young people.