Dealing with social anxiety disorder (social phobia)

Are you so afraid of public settings?

Are you afraid of being judged by others?

Is your self-consciousness disrupting your daily activities?

Are you usually afraid of meeting new people?

Social anxiety disorder also known as social phobia, is a type of anxiety disorder that causes extreme fear in social settings, like fear of being watched and judged by others. It could also mean a persistent fear of social situations like public speaking where embarrassment is most likely to occur. This disorder can make it really difficult to meet new people and attend social events.

It’s normal to feel anxious sometimes but it does not affect our daily activity. With social anxiety disorder, it affects our daily life like work, school or developing new relationships. All these can be really affected.

Social anxiety is more than shyness. When a person has social anxiety disorder, there is this extreme fear of being watched, judged, embarrassed, or rejected by others. These symptoms are so severe that they usually interfere with the person’s daily life. Also, shyness is usually short-term and does not necessarily disrupt one’s life.

You may avoid all social situations, including asking questions, job interviews, eating in public places, shopping, using public restrooms, etc.

According to the Anxiety and Depression Association of America (ADAA) approximately 15 million American adults have social anxiety disorder. These symptoms often start developing around age 13.

Research has shown that SAD is the second most common anxiety disorder. It has a high lifetime rate of substance abuse (13.5%) and major depression (9.8%) with early age of onset documented.

Symptoms of Social Anxiety Disorder

Social interaction may cause some series of symptoms

Some physical symptoms are:

  • Increased heart rate
  • Nausea
  • Trembling
  • Shortness of breath
  • Muscle Tension
  • Profuse sweating
  • Difficulty speaking
  • Dizziness
  • Blanking out
  • Blushing

Some psychological symptoms might include

  • Fear of being judged by others
  • Intense worry about embarrassing yourself
  • Worrying for days or weeks before an event
  • Anticipating anxiety before an event
  • Missing out on school or work due to anxiety
  • Avoiding social situations or trying to blend into the background if you must attend
  • Worrying that other people will notice you are stressed or nervous
  • Expecting that the worst will happen
  • Might need alcohol to face a social situation

Symptoms of social anxiety may not occur in all situations. It can occur selectively. For example, symptoms may only occur when you’re eating in front of people or talking to strangers. It could occur in all settings if you have social anxiety disorder.

Causes of Social Anxiety Disorder

The exact cause of social phobia is not known.

Studies suggests that biological, genetic/inherited, and environmental factors play a role. It is equally common among men and women. It begins around age 13, sometimes emerging out of a childhood history of shyness. It appears to run in families.

However, current research supports the idea that it is caused by a combination of environmental factors and genetics. It could be linked to bad experiences like bullying, sexual abuse, rejection, etc.

Neurotransmitters Involved in Social anxiety disorder 

In people with social anxiety disorder, there are a few chemical imbalances in your brain. These chemicals are known as neurotransmitters. The brain uses these chemicals to transmit signal.

These neurotransmitters include:

  • Serotonin
  • Dopamine
  • Norepinephrine
  • Gamma-aminobutyric acid (GABA)

People with social anxiety disorder have been shown to have some of the same imbalances as people with panic disorder. Understanding how these brain chemicals are linked to social anxiety disorder is important to figure out the best treatment for this condition.


SAD can cause you to avoid social situations, which could eventually affects your social and interpersonal relationships leading to:

  • Low self-esteem
  • Negative thoughts
  • Negative talks to self.
  • Depression
  • Sensitivity to criticism
  • Poor communication and social skills.
  • Difficulty building relationships


Social anxiety disorder can be treated through 3 major ways they include:

  1. Cognitive behavioral therapy 
  2. Medication or
  3. Both.

You will need about 12 to 16 therapy sessions. The goal is to build self confidence, learn skills that will help you manage the situations that scare you the most, so you can easily face this situations whenever they arise.


Some of the medications that can be administered by your doctor are some antidepressants which can help you treat your social anxiety disorder. This group of drugs include SSRIs (selective serotonin reuptake inhibitors), example Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), etc.

Another group is called SNRIs (selective serotonin and norepinephrine reuptake inhibitors). Some examples of drugs that fall into this category are Duloxetine (Cymbalta), Venlafaxine (Effexor), etc.

Keep in mind that medicine alone won’t start working immediately. It will take approximately 2 to 6 weeks before it kicks in. 


Other treatment options include

Cognitive behavioral therapy

In this therapy session, you will learn how to control your anxiety through relaxation and deep breathing. It also emphasizes on how you control negative thoughts.

Exposure therapy

This type of therapy slowly exposes you to these social settings that you are afraid of so you are able to better respond to them next time you are faced with something similar instead of avoiding them.

Group therapy

This therapy helps you learn social skills and techniques to interact with people in social settings. Participating in this therapy with others who have the same fears may make you feel less alone. It will give you a chance to practice your new skills through role-playing


Here are some practical steps to reduce the impact of symptoms of anxiety:

  • Get help early: Anxiety, like many other mental health conditions, can be harder to treat if you wait.
  • Try some relaxation techniques, such as breathing exercises to reduce stress.
  • Exercise such as
    • Walking
    • Jogging
    • Yoga
    • Running
  • Keeping track of your personal life can help you and your doctor identify some of the things that trigger your anxiety.
  • Try to do things you enjoy.
  • Limit Alcohol intake.
  • Avoid things like alcohol and caffeine (coffee, chocolate, and soda) because they are stimulants and may worsen anxiety. If you are addicted to any of these substances, try quitting. If you are are finding it difficult to quit on your own, see your doctor to assist you in finding a treatment program or support group to help you.

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