Symptoms and Diagnosis of Social Anxiety Disorder

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 typically fall within three different areas.

Social Anxiety Disorder Symptoms
Illustration by Brianna Gilmartin, Verywell​

Physical Symptoms

The physical symptoms of SAD can be extremely distressing. Common ones include:

  • 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)
  • Feelings of unreality (derealization) or feelings of detachment from oneself (depersonalization)

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 fears about the panic attacks themselves.

Cognitive Symptoms

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

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 on 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.

If these negative thought patterns are allowed to continue without treatment, they may also erode your self-esteem over time, so it's important to seek treatment.

Behavioral Symptoms

People with social anxiety disorder also act in certain ways. 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.

In severe cases, if left untreated, 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.

Symptoms in Kids

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.

Diagnosis

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, one 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.

SAD Diagnostic Criteria

  • You have marked fear or anxiety about one or more social situations in which you might be scrutinized by others, such as meeting new people, being observed eating, or giving a speech.
  • You 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.
  • You always experience fear or anxiety in these situations.
  • The fear or anxiety that you experience is out of proportion to the actual threat of the situation.
  • This fear or anxiety has lasted for 6 months or longer.
  • This fear or anxiety causes significant distress or impairment in important areas of your life, such as your work or connections with others.
  • This fear or anxiety cannot be attributed to the 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 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 Seek 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.

A psychiatrist or other mental health professional can help with treatment. The good news is that symptoms respond well to treatment. The physical, cognitive, and behavioral symptoms of SAD can respond well to psychotherapy such as cognitive behavioral therapy (CBT), exposure therapy, and medication. If you have not already been diagnosed with SAD, obtaining a diagnosis and finding an anxiety therapist should be your first priority.

Social Anxiety Disorder Discussion Guide

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Differential Diagnosis

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

  • 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-Onset Fluency Disorder (Stuttering): Childhood-onset fluency disorder is listed as a neurodevelopmental 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 a broader pattern of 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 (Level 1) 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

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Mental Health, "Mental Health Information: Seasonal Affective Disorder"

  2. Anxiety Disorders Association of America, "Anxiety Disorders in Children"

  3. United Kingdom National Health Service, "Diagnosis - Seasonal affective disorder (SAD)"

  4. Melrose S. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depress Res Treat. 2015;2015:178564. doi: 10.1155/2015/178564

Additional Reading

  • Massachusetts General Hospital. School Psychiatry Program & Madi Resource Center. Social Phobia (Social Anxiety Disorder).

  • Hope DA, Heimberg RG, Turk C. Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach Workbook (2nd Ed.). New York: Oxford University Press; 2010.