What is Social Anxiety Disorder

Social anxiety disorder (SAD), otherwise known as social phobia, is characterized by noticeable or intense fear or anxiety of social situations in which the individual feels they may be negatively evaluated. The anxiety significantly interferes with the individual's daily functioning, including their ability to approach and interact with others at work and in their personal life. Within the U.S. population, about 13% of 18- to 29-year-olds, 14.3% of 30- to 44-year-olds, and 12.4% of 45- to 59-year-olds will meet criteria for SAD at some point, with somewhat higher prevalence in women that in men. Moreover, a large percentage of the U.S. population will experience subclinical symptoms that may still warrant attention and respond to intervention.

 

Social Anxiety Disorder Symptoms

Individuals who meet diagnostic criteria for SAD significantly worry that they will be judged as:

  • Anxious
  • Weak
  • Crazy
  • Stupid
  • Boring
  • Intimidating
  • Offensive
  • Dirty
  • Unlikable

Moreover, individuals with SAD fear that they will exhibit anxiety symptoms in social situations that will lead to this negative judgment, including:

  • Blushing
  • Trembling
  • Sweating
  • Stumbling over words
  • Staring

Example of social situations that could make individuals with SAD excessively anxious include:

  • Giving a presentation at work
  • Attending a social event, such as going out to a bar to meet potential friends
  • Asking someone out on a date or accepting a date offer
  • Giving a speech
  • Meeting new people
  • Eating in public

In response, individuals with SAD may overprepare for performances (e.g., presentations, interviews), exhibit overt signs of anxiety (e.g., trembling, blushing), or intensely worry for long periods in anticipation of certain social situations. When individuals with SAD avoid certain people, places, or situations that make them anxious, their anxiety typically diminishes. However, this pattern of negative reinforcement maintains and can even intensify SAD.

 

How Social Anxiety Disorder is Diagnosed

A SAD diagnosis is typically based on a clinical interview with a psychologist or other mental health provider, and may be augmented by one or more assessment measures (such as the Liebowitz Social Anxiety Scale). These assessment procedures help determine whether SAD is present, how severe it may be, and whether any other conditions (e.g., another anxiety disorder, depression) may be contributing to the individual’s distress. A formal diagnosis is assigned by comparing the results of the assessment to the diagnostic criteria for SAD (see below). A valid diagnosis always involves the clinical judgment of a qualified mental health provider and cannot be determined by testing alone.

 

Impact of Social Anxiety Disorder on Daily Life

SAD always impairs one or more important areas of an individual’s life. For example, an individual with SAD may avoid certain places or certain people, struggle to develop or manage relationships, avoid difficult conversations, exhibit rigid body posture or inconsistent eye contact, and be inadequately assertive in their personal lives and in the workplace. These symptoms, when left untreated, also put the individual at risk for other problems, such as another anxiety disorder, depression, and drug or alcohol abuse.

 

Social Anxiety Disorder is Treatable

The most effective treatment option for SAD is cognitive behavioral therapy (CBT).

While effective SAD treatment should incorporate cognitive approaches to change patterns of maladaptive thinking (e.g., challenge inaccurate or irrational thoughts, cope with distressing thoughts rather than avoid them), the focus of SAD treatment should always be exposure and response prevention (ERP) because it produces the greatest and longest-lasting treatment gains.

With ERP, the individual with SAD is progressively exposed to social situations that cause anxiety and is guided to resist escaping them. Over time, the individual observes how the negative interactions or judgments they were anxious about did not occur as expected; consequently, their anxiety declines.

In addition to ERP and cognitive approaches, relaxation and mindfulness procedures can be used to help the individual with SAD cope with their treatment.

Medication is generally not considered to be a first-line treatment for SAD.

 

What to do Next

If you think you may meet criteria for Social Anxiety Disorder:

 

Social Anxiety Disorder Diagnostic Criteria

DSM-5 Code: 300.23

ICD-10 Code: F40.10

A: Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).

Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

B: The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

C: The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

D: The social situations are avoided or endured with intense fear or anxiety.

E: The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

F: The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

G: The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H: The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

I: The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

J: If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

Specify if:

Performance only: If the fear is restricted to speaking or performing in public.