Social Anxiety Disorder Symptoms

People with social anxiety disorder (SAD) experience significant and chronic fear of social or performance-related situations in which there is the possibility of becoming embarrassed, rejected, or scrutinized.

In these situations, people with SAD almost always experience physical symptoms of anxiety. Although they know their fear is unreasonable, they can't seem to do anything to stop it.

So, they either avoid these situations altogether or get through them while feeling intense anxiety and distress. In this way, social anxiety disorder extends beyond everyday shyness and can be extremely impairing.

Symptoms of Social Anxiety Disorder

Symptoms of social anxiety disorder typically fall within three different areas:

  1. Physical symptoms—what you feel
  2. Cognitive symptoms—what you think
  3. Behavioral symptoms—what you do

Physical Symptoms of Social Anxiety Disorder

The physical symptoms of SAD can be extremely distressing. Below is a list of symptoms that you might experience:

  • Blushing
  • Sweating
  • Shaking
  • Muscle tension
  • Chills
  • Chest tightness
  • Chest pain
  • Trembling voice
  • Shortness of breath
  • Lump in the throat
  • Blurred vision
  • Ringing in the ears
  • Headaches
  • Dry mouth
  • Dizziness
  • Nausea
  • Diarrhea
  • Paresthesias (tingling)
  • Heart racing (tachycardia)
  • Heart pounding (palpitations)
  • Disorientation (depersonalization and/or derealization)

    For some people, these physical symptoms may become so severe that they escalate into a full-blown panic attack. However, unlike those with panic disorder, people with SAD know that their panic is provoked by fears of social and performance-related situations rather than believing that there may be some underlying medical problem.

    Cognitive Symptoms of Social Anxiety Disorder

    Social anxiety disorder also involves cognitive symptoms, which are dysfunctional thought patterns experienced by people with the disorder. Individuals with this condition are bothered by negative thoughts and self-doubt when it comes to social and performance-related situations.

    If these negative thought patterns are allowed to continue without treatment, they may also erode your self-esteem over time . Below are some common symptoms that you may experience:

    • Negative bias: A tendency to discount positive social encounters and magnify the social abilities of others.
    • Negative thoughts: Automatic negative evaluations about yourself in social or performance-related situations.
      • For example, imagine you start a new job or arrive at the first day of a new class. The instructor or manager asks everyone to introduce themselves to the group. Someone with social anxiety disorder may start to have thoughts such as “Everyone else looks so much more relaxed,” “What if I say something dumb?” or “What if everyone notices my voice shaking?” These thoughts start to rapidly spiral out of control to the point that you don't hear anything anyone else has said. When it comes to your turn, you say as little as possible and hope that no one has noticed your anxiety. 
    • Negative beliefs: Strongly held beliefs about your inadequacy in social and/or performance-related situations.

    Behavioral Symptoms of Social Anxiety Disorder

    People with social anxiety disorder also act in certain ways, known as behavioral symptoms. They tend to make choices based on fear and avoidance rather than actual preferences, desires, or ambitions.

    For example, you may have dropped a class to avoid doing a presentation or turned down a job promotion because it meant increased social and performance demands.

    People with generalized SAD are particularly at risk of having a poor quality of life.

    They may have few or no friends, no romantic relationships, drop out of school or quit jobs, and may use alcohol to tolerate anxiety.

    Below are some common behavioral symptoms:

    • Avoidance: The things done or not done to reduce anxiety about being in social or performance-related situations.
    • Safety behaviors: Actions taken to control or limit experiences of social or performance-related situations.
    • Escape: Leaving or escaping from a feared social or performance situation

    Signs and Symptoms of SAD 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. Behavioral inhibition during childhood is often a precursor for later social anxiety.

    In contrast, adolescents with SAD may avoid group gatherings altogether or show little interest in having friends.

    Situational Triggers

    Symptoms of social anxiety disorder may be triggered by different situations for different people. For example:

    Diagnosis of Social Anxiety Disorder

    A diagnosis of social anxiety disorder cannot be made with any lab test or physical exam. As with all mental disorders, a diagnosis is based on whether a person meets certain standardized criteria set by the American Psychiatric Association (APA). To this end, mental health professional will refer to handbook called the Diagnostic and Statistical Manual of Mental Disorders published by the APA. 

    The process of diagnosis entails a review of the patient's mental health history and an interview to evaluate the person's perceptions and experiences. With regards to SAD, the aim of the evaluation would be to determine whether the fear is so severe as to interfere with your daily functioning, school work, employment, or relationships.

    In order to be diagnosed with SAD, you must meet the following criteria:

    1. You have marked fear or anxiety about one or more social situations in which you might be scrutnized by others, such as meeting new people, being observed eating, or giving a speech.

    2. You must fear that you will humiliate or embarrass yourself and be rejected by others based on how you act or because you display symptoms of anxiety.

    3. You must always experience fear or anxiety in these situations.

    4. The fear or anxiety that you experience must be out of proportion to the actual threat of the situation.

    5. This fear or anxiety must have lasted for 6 months or longer.

    6. This fear or anxiety must cause significant distress or impairment in important areas of your life, such as your work or connections with others.

    7. This fear or anxiety cannot be attributed to effects of a drug/medication, is not explained by another mental disorder, and is not related to a medical condition.

    If you only experience these fears when speaking or performing in public, then the specifier "performance only" will be added to your diagnosis of social anxiety disorder.

    Other Diagnostic Tools

    In addition to using the diagnostic criteria of the DSM-5 to render a diagnosis, mental health professionals sometimes use rating scales to help assess the level of social anxiety or specific types of symptoms. This can be particularly helpful in the case of treatment, as your symptoms can be assessed before and after to determine whether things have improved. Some examples of other assessments that are used for SAD include the Mini Social Phobia Inventory and Liebowitz Social Anxiety Scale. As part of cognitive-behavioral therapy, the Subjective Units of Distress Scale is also used.

    When to See a Psychiatrist for Help

    If you live with social anxiety, you may wonder whether your symptoms are severe enough for you to be diagnosed with social anxiety disorder (SAD).

    It may be hard to know whether what you are experiencing is an illness that can be diagnosed. As a rule of thumb, if the symptoms you are experiencing are significantly affecting aspects of your daily life—such as relationships, work, or school—in a negative way or you find yourself avoiding situations because of anxiety, a trip to the doctor may be in order.

    How Will a Diagnosis Be Made?

    A trained mental health professional will assess your specific symptoms and determine whether they meet the diagnostic criteria for SAD. You might also be given questionnaires to complete as part of assessing your baseline level of symptoms.

    What Sort of Treatment Will I Be Offered?

    Although the symptoms of social anxiety disorder can greatly affect your quality of life, the good news is that they respond well to treatment. The physical symptoms are well-suited to exposure therapy or medication and the cognitive and behavioral symptoms are good candidates for psychotherapy such as cognitive-behavioral therapy (CBT). If you have not already been diagnosed with SAD, obtaining a diagnosis and finding an anxiety therapist should be your first priority.

    Related Conditions

    There are many conditions that share similarities with social anxiety disorder. Often, these may be diagnosed along with SAD. Such conditions include the following:

    • Selective mutism: Selective mutism involves a failure to speak in specific social situations (e.g., at school) and is usually diagnosed in childhood. Children with this disorder will fail to speak at school but may talk with their family at home.
    • Childhood-Onsert Fluency Disorder (Stuttering): Childhood-onset fluency disorder is listed as a communication disorder but can also cause anxiety about speaking in public.
    • Avoidant personality disorder: This disorder involves the same symptoms as social anxiety disorder but to a stronger degree with more avoidance.
    • Panic disorder: Panic disorder involves unexpected panic attacks that appear to come out of the blue. Unlike those with SAD, people with panic disorder may suspect a medical cause for their anxiety.
    • Agoraphobia: Agoraphobia is diagnosed alongside panic disorder and refers to a fear of having a panic attack in a place from which it would be hard to escape. People with social anxiety disorder may also be diagnosed with panic disorder and agoraphobia, but these are separate conditions.
    • Autism spectrum disorder: Autism spectrum disorder involves impairment in social communication across a range of context. Children who have high-functioning autism may also have social anxiety.

    A Word From Verywell

    While only a trained mental health professional can provide a diagnosis, reading about the symptoms of the disorder will help inform whether what you are feeling is typical of those with SAD.

    If you do find that your symptoms match a diagnosis of SAD, try not to feel too upset. Many mental health concerns are very amenable to treatment and social anxiety disorder falls into this category. Getting help may feel hard at first, but it will very much be a step in the right direction and worth it in the end.

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    Article Sources
    • Hope DA, Heimberg RG, Turk C. Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach Workbook (2nd Ed.). New York: Oxford University Press; 2010.
    • Massachusetts General Hospital. School Psychiatry Program & Madi Resource Center. Social Phobia (Social Anxiety Disorder). Accessed July 19, 2016.