What are the Signs and Symptoms of Social Anxiety?

Many people describe themselves as shy, either in general or in specific social situations. Shyness has its roots in social anxiety, and when the symptoms are relatively mild the two terms can be used interchangeably.

But shyness should not be confused with social anxiety disorder, a debilitating mental health condition that impacts every area of a person’s life. Shyness is a form of social anxiety, but social anxiety disorder is not synonymous with shyness.

Shyness represents one end of the social anxiety spectrum, where unpleasant symptoms are not severe enough to cause significant distress or patterns of avoidant behavior. Social anxiety disorder occupies the other end of the spectrum, and those who suffer from its pervasive and persistent symptoms are forced to adapt their patterns of behavior to cope with stifling feelings of anxiety.

Severe social anxiety is also known as social phobia, which is a testament to the deep, intense fears people with social anxiety experience, and the extreme measures they take to avoid exposure to stressful situations.

Social anxiety disorder is the second most common form of anxiety disorder in the United States, trailing only specific phobias. Approximately seven percent of the adult population will suffer from social anxiety disorder in any given year, and the lifetime incidence among adults is just above 12 percent.

While most mental health disorders develop in young adults, the onset of social anxiety disorder usually takes place in childhood. The median age of onset for the disorder is just 13, and three-quarters of social anxiety sufferers first experience its most disabling symptoms between the ages of eight and 15.

Unfortunately, young kids with severe social anxiety often get labeled as shy, which can prevent them from getting the specialized medical attention they need.

As is often the case with anxiety disorders, social anxiety disorder is frequently accompanied by co-occurring mental and behavioral health conditions, including depression, panic disorder, agoraphobia, bipolar disorder, avoidant personality disorder, and substance use disorders. Up to seven-in-ten social anxiety disorder sufferers will also experience at least one co-occurring condition at some time in their lives, which highlights the serious and life-altering nature of severe social anxiety.

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The symptoms of social anxiety disorder are distinctive and unique, and impossible to ignore for those who suffer from them. Others tend to notice that something is amiss with social anxiety sufferers as well, and they may correctly identify it as discomfort around people, but they usually don’t suspect the intensity of the anxiety that this misunderstood condition can cause.

For social anxiety sufferers, social encounters frequently produce a strong and instantaneous physical response, and the physiological symptoms or extreme stress and fear they experience are both unpleasant and difficult to control.

The physical symptoms of severe social anxiety include:

• Elevated heart rate
• Sweating of the palms
• Blushing
• Shakiness, trembling
• Chest tightness or a choking sensation
• Dry mouth
• Dizziness or fear of fainting
• Awkward, stumbling speech
• Muscle pain and tension, usually in the upper body
• Slowed thinking processes; an inability to focus or concentrate

Severe social anxiety produces effects similar to those experienced during panic attacks, or when people are involved in accidents or otherwise feel threatened with bodily harm. What is notable is that these reactions occur during social encounters that most would consider benign or harmless.

Severe social anxiety responses are overwhelming and disproportionate to any potential threat. They reflect an irrational fear of being judged, rejected, or laughed at by others.

The physical signs and symptoms of social anxiety disorder can be powerful, but the psychological and emotional symptoms of the disorder are just as significant and disabling.

Severe social anxiety produces excessive self-consciousness during interactions with other people, and the self-reflections of social anxiety sufferers tend to focus exclusively on worst-case scenarios.

The psychological and emotional symptoms of social anxiety disorder include:

• Intense fear of being negatively judged, based on inadequate social performance
• Constant worry about saying or doing something embarrassing
• Feelings of severe awkwardness or inferiority around authority figures
• A fear that others will notice the social anxiety sufferer’s discomfort and reject them because of it
• Extreme reluctance to express opinions or initiate conversations, motivated by a fear of being dismissed as stupid or pushy
• A disproportionate (and uncomfortable) feeling of giddiness or satisfaction at being praised or applauded by others
• A powerful desire to never be the center of attention
• Anticipatory anxiety: a debilitating fear of social situations before they arise
• Feelings of shame and inferiority during actual social encounters
• Harsh self-judgments following conversations or other interactions with people

The fears of socially anxious people are not based on a realistic assessment of the possibilities.

But the force of those fears can be overpowering, leaving those suffering from social anxiety disorder desperate to avoid situations that might trigger painfully self-conscious thoughts and feelings.

While poor performance and a lack of well-developed social skills can limit social anxiety sufferers in many ways, it is their avoidance of situations they find highly stressful or potentially threatening that really holds them back.

Forming friendships or romantic relationships, pursuing the career of their dreams or applying for jobs, attending college or graduate school, taking art or music lessons, getting involved in sports, or volunteering to help causes they support can all be problematic for social anxiety disorder sufferers.

Regardless of their true interests or ambitions, they feel compelled to choose paths that minimize their exposure to “dangerous” social situations—even though doing so sabotages their happiness and dooms them to spending their lives alone.

The list of social situations that make social anxiety sufferers nervous and avoidant include:

• Parties and/or intimate gatherings with people they don’t know well
• Interactions with authority figures, or well-known and accomplished individuals
• Being introduced to new people in settings where conversation is expected
• Taking or making phone calls
• Asking for assistance in stores, in restaurants, from public servants, or from people on the street
• Job- or school-related interviews
• Performing in front of an audience (playing a sport or musical instrument, public speaking, etc.)
• Family reunions where more distant relatives are present
• Encounters with people they knew in the past (old school mates, co-workers, etc.), who might judge them for their lack of life progress
• Standing in line at stores, banks, or government offices with people who want to chat
• Dating or any situation that offers the possibility of more intimate interpersonal interactions
• Internet chatrooms or forums, where negative feedback or personal criticism can be expected

If they’re accompanied by, or have the assistance of, family members or friends, social anxiety sufferers may be able to cope with situations that would otherwise overwhelm them. But continuously relying on the help and support of others only reinforces the hold social anxiety has over their lives, and until they can learn to do things on their own their social phobia will remain in charge.

Despite the depth and intensity of its symptoms, severe social anxiety is highly responsive to treatment. The first step is to receive an accurate diagnosis for the condition (a mental health professional should be consulted when social phobia symptoms are experienced), and once that takes place the recovery process can begin.

And the age of diagnosis is irrelevant—anyone can eventually overcome the most disabling symptoms of social anxiety disorder, if they’re willing to ask for help.

Recovery programs for social anxiety sufferers usually include a combination of psychotherapy (individual, group, and family), medication (anti-depressants or anti-anxiety drugs), social and life skills training, and holistic mind-body techniques for stress management and improved emotional control. Long-term care for social anxiety is a necessity in most cases, with counseling and therapy at the forefront of the recovery program.

For those who feel overwhelmed by severe social anxiety symptoms, and for those with co-occurring mental or behavioral health conditions, inpatient treatment programs administered by mental health professionals in a residential treatment facility can be tremendously beneficial.  

In this peaceful environment, social anxiety sufferers will receive full, complete, and unconditional support from staff and peers alike. Evidence-based therapies and complementary treatment services will be provided by experts who understand the depth of suffering that severe social anxiety (and any accompanying disorders) can cause.  

In addition to formal treatment, social anxiety sufferers need compassion and moral support from loved ones.  But while they may try to be sympathetic, family members and friends often fail to understand the depth of a social anxiety sufferer’s fears of embarrassment and rejection. Consequently, the advice they offer may be overly simplistic and subtly tainted by frustration or disapproval, which only reinforces their loved one’s social anxiety and the low self-esteem and feelings of insecurity that underlie it.

The symptoms of severe social anxiety can be powerful and intimidating, and friends and family members must accept and acknowledge this if they are to play a constructive role in a social anxiety disorder sufferer’s recovery.

Ultimately, it is up to the social anxiety sufferer to embrace their treatment regimen with deep commitment and a positive attitude. If they do so, while receiving consistent support from therapists, peers and loved ones, they can eventually learn to manage their social anxiety and reduce its control over their lives. When they reach this stage, they will be able to form new relationships, improve old ones, and finally pursue their dreams without worrying obsessively about what others might think.

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