An Overview of Social Anxiety Disorder

Explore causes, symptoms, and treatment for different types of SAD

Social anxiety disorder (SAD) involves a fear of social and performance situations in which others may negatively judge you. Although it's common for people to experience some nervousness or feel "butterflies" in their stomach, most people with the disorder are extremely self-conscious and have physical symptoms such as nausea, shaking, or feeling faint when they are around people or performing. Luckily, there are strategies that help take control of the situation.

Social anxiety disorder
Illustration by Brianna Gilmartin, Verywell

Types

The current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) differentiates between what used to be known as generalized versus specific SAD by adding the specifier "performance only," meaning that a person only experiences anxiety in performance situations.

Generalized Social Anxiety

Those with fears about most social and performance situations were previously categorized as having generalized social anxiety disorder in the DSM-IV, including the following:

They are usually uncomfortable around anyone but their closest family members or friends.

Generalized SAD is considered to be more severe than performance-only social anxiety disorder and is usually accompanied by greater impairment in day-to-day functioning.

Performance-Only Social Anxiety

A person with performance-only SAD will have anxiety and fear linked to only performance situations. For instance, a person could have a fear of public speaking but experience no anxiety in casual social gatherings.

This form of social anxiety can still be extremely harmful, as it may limit you from career advancement or other performance-related achievements.

People who only fear performance situations tend to be different from those with generalized social anxiety disorder in terms of how old they are when they first experience anxiety, the physical symptoms they experience, and how they respond to treatment.

Symptoms and Diagnosis

The symptoms of social anxiety disorder fall into three categories:

  • physical (e.g., blushing, sweating, and shaking)
  • cognitive (e.g., negative thoughts and beliefs)
  • behavioral (e.g., avoidance and safety behaviors)

A proper diagnosis for SAD requires that a number of specific criteria are met in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Related disorders include selective mutism and childhood-onset fluency disorder (stuttering). Selective mutism refers to the failure to speak in situations, such as a child who never speaks in school. Stuttering reflects problems with verbal fluency or being able to speak without a stutter in front of other people.

Causes

The causes of social anxiety disorder are believed to be a combination of genetic factors, environmental factors (e.g. observational learning), societal factors (e.g., cultural influences), and brain structure/biological factors.

While these factors may involve risk for developing the disorder, not everyone who has one or more risk factors will be diagnosed with SAD.

Treatment

Regardless of whether you have generalized or performance-related symptoms, effective treatment is available. Cognitive-behavioral therapy (CBT), a form of psychotherapy that addresses current problems and reframes negative thinking, can be very helpful.

Through CBT, you will learn strategies and techniques to help you cope with different situations. After completing cognitive behavioral therapy, many people with anxiety say that it changed their lives and opened doors for them; they can do things they never thought they could, like travel or perform in front of others.

In some cases, particularly for those with severe generalized social anxiety disorder, a doctor may recommend that you try medication. This can help to calm your mind and decrease some of the physical aspects of your anxiety, allowing you to better focus on therapy and begin to make progress.

Look for a therapist who specializes in anxiety disorders. Without a background in these conditions, your therapist may not fully understand your symptoms or may minimize or too easily dismiss what you are feeling. A healthcare provider who understands social anxiety disorder and cognitive behavioral therapy will work with you to develop effective strategies to manage the disorder.

Coping and Self-Help

Self-help strategies for social anxiety disorder include social coping strategies such as learning to be assertive, emotional coping strategies such as learning to calm panic when it starts, and day-to-day coping strategies such as asking for accommodations at work. Self-help strategies are best used for mild to moderate social anxiety.

In Children and Teens

Social anxiety disorder in children and teens may appear differently than in adults. Young children with the disorder may cling to a parent, have a tantrum when forced into a social situation, refuse to play with other kids, cry, or complain of an upset stomach or other physical problem.

In some cases, children may even be too frightened to speak in certain situations. In contrast, adolescents with SAD may avoid group gatherings altogether or show little interest in having friends.

In any case, strategies similar to those used in adults can help.

A Word From Verywell

It is important to understand the type of social anxiety disorder diagnosis you have been given. Work with your doctor or mental health professional to learn more about your diagnosis and what it means in terms of your treatment and prognosis. If your diagnosis includes the "performance only" specifier, treatment tailored to the specific performance situations that cause you anxiety is preferred.

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