Social Anxiety Disorder: Symptoms, Types, and Treatment

What Is Social Anxiety Disorder (Social Phobia)?

Social Anxiety Disorder is also called social phobia. As the name suggests, the phobia is about having an extremely overwhelming fear of social situations.

Social phobia is significantly different from shyness or nervousness – these both are common emotions that we all feel at some point in our lives.

However, social anxiety is so intense that it could completely disrupt a person’s personal, social, and professional life. Anxiety counselling can help manage social anxiety and not let it affect all aspects of one's life.

Personally, a person may find it hard to buy things, leave their room or talk to friends on call. In a relationship, the person may avoid their partner or become distant. 

Common signs of social anxiety include fear of being judged by others, scrutinised, or humiliated in public. These symptoms can manifest in different ways and in different areas of life, such as:

• Public speaking
• Job interviews
• Hanging out with friends or family
• Causal social gatherings (ie parties, concerts)
• Shopping
• Eating in a restaurant

In some cases, the anxiety is specific to performance-based activities, such as playing a musical instrument or participating in sports events.

Treatment options include cognitive behavioural therapy (CBT) and medication, which can help manage symptoms and improve social interactions.

Early intervention is crucial for better outcomes, so if you or someone you know struggles with social anxiety disorder, seeking professional help is a step in the right direction.

Symptoms of Social Anxiety

Understanding social anxiety is easier when you know the signs. These signs show up in three main ways: how you feel (emotional), how your body reacts (physical), and how you act (behavioural).

a) Emotional Signs

• Scared of being judged: You worry a lot about what others think of you.
• Feeling panicked: Sometimes, you feel terrified of attending social events.
• Feeling bad about yourself: You often think you are not good enough.
• Thinking negative: You often think of negative thoughts, which makes you feel even more nervous.

b) Physical Signs

• Heartbeats: You feel your heart racing when around people.
• Shaking: Your hands or voice might shake.
• Feeling sick: You feel like you might throw up before going to a social event.
• Sweating: You sweat a lot, even if it is not hot.

c) Behavioural Signs

• Avoiding people: You avoid places where you have to talk to people.
• Hard to speak: You find it tough to say what you are thinking.
• Stiff body: You stand or sit in a way that makes you look closed off.
• Eye contact: You find it hard to look people in the eyes.

Knowing these signs can help you or someone you know get the right help. Talking to a professional Therapist can make things a lot better.

What is the Difference Between Having a Social Anxiety Disorder and Being Shy?

Social anxiety disorder and shyness are often confused, yet they differ in several key aspects. The primary distinction lies in the level of impairment each condition has on daily functioning.

Social anxiety disorder leads to significant disruptions in routine activities, affecting personal and professional areas of life. Shyness, conversely, presents as situational discomfort that generally does not affect normal functioning.

Three core elements differentiate social anxiety from shyness:

• Degree of interference: Social anxiety has a debilitating impact on routine activities, while shyness is less intrusive and more situational. For example, a person might hesitate to speak at a specific meeting due to unfamiliar attendees. Yet, they confidently interact in smaller and familiar settings. This hesitation is situational, which is a characteristic of shyness.
• Intensity of fear: The fear associated with social anxiety is often overwhelming and paralysing, unlike shyness – which includes mild unease or nervousness.
• Avoidance behaviour: Social anxiety frequently results in completely avoiding social situations, whereas shyness may cause hesitancy but not total withdrawal.

If symptoms are persistent and intense, consultation with a healthcare professional online or a counsellor in Singapore for proper diagnosis and treatment is imperative. People should not confuse social anxiety disorder with shyness because they require different therapeutic approaches.

Symptoms of Social Anxiety in Children

Navigating social environments can be a scary task for children with social anxiety. This condition manifests as an overwhelming fear of social interactions in children, often leading to avoidance behaviours.

The apprehension can be paralysing, whether participating in classroom discussions, joining group activities, or even attending family gatherings.

The impact of social anxiety extends beyond mere discomfort. As children hesitate to ask questions or seek help, it may affect their academic performance.

Strains in social relationships make it difficult to form meaningful connections. Self-esteem takes a hit, further perpetuating the cycle of anxiety.

Early intervention is key, and professional guidance from psychologists or therapists is often recommended.

Online CBT has shown promise in treating social anxiety in children. Additionally, creating a supportive home environment can make a world of difference.

Open communication, patience, and understanding can empower your child to face social challenges head-on.

Causes of Social Anxiety

Since social anxiety does not have a single cause, it can be hard to understand why we are socially anxious.

Researchers and medical professionals agree that both biological and environmental elements could simultaneously contribute to the onset of social anxiety.

• Biological factors: Biologically, imbalances in neurotransmitters (eg serotonin and dopamine) can affect mood regulation. When there is an imbalance, a person may feel more anxious and find social interactions intimidating.  
• Genetics: Genes may also influence imbalances in the brain and mood. For example, if any of your family members have or have social anxiety, you may have a higher chance of developing the condition.
• Environmental factors: Your upbringing (ie family dynamics, childhood experiences) and life experiences could significantly influence how you respond to the world. A history of emotional or physical abuse, negative peer interactions (eg harassment or bullying), or excessive gaslighting by parents can cause social anxiety.

In some cases, these negative experiences can lead to symptoms similar to post-traumatic stress disorder (PTSD).

PTSD is a mental health condition where social anxiety also becomes prominent and comorbid (ie having both disorders at the same time).

It is crucial to note that while genetics may predispose you to social anxiety, environmental factors often act as triggers.

Hence, your experiences and your personality traits could be risk factors for social anxiety. 

Family Dynamics and Social Anxiety

Research shows that there is a strong link between family dynamics and social anxiety.

Developing a fear of social situations because of negative family experiences and problematic parents can be especially hard to overcome.

Below are some reasons why one could develop social anxiety in certain households:

• Constant criticism
• Lack of emotional support
• Overprotectiveness]
• Judgements

For example, if you grew up in a family where expressing emotions was discouraged, you may find it challenging or unnatural to interact openly with others. This can manifest as a fear of judgement or embarrassment in social settings.

Similarly, excessively critical parents may intentionally or unintentionally make their children feel like they are ‘not enough’ and make them second-guess themselves in public.

For example, every single action could either satisfy or disappoint the parents. This type of parenting teaches children that it is not okay to be themselves in public.

Additionally, fear of bringing shame or dishonour to your family can make social interactions feel like walking on eggshells.

This is particularly common in cultures that highly value tradition and conformity. Therefore, the pressure to fit in can increase feelings of anxiety.

Understanding the root cause of your social anxiety is the first step towards controlling it effectively. If you identify with any of these family dynamics, consider seeking professional help.

Therapists can offer coping strategies that are tailored to your unique situation. In fact, family counsellors can also help you navigate your family dynamics and social situations more effectively.

Types of Social Anxiety

Understanding that the severity and triggers can vary from person to person is crucial. Some of the most common types of social anxiety are:

Situation-Specific Social Anxiety: Anxiety is triggered only in particular settings, such as public speaking or eating in public. The person is usually comfortable in other social scenarios.

Generalised Social Anxiety: This form is more pervasive, affecting a person in multiple social situations, from casual conversations to professional meetings. It is not limited to specific events.

Mild Social Anxiety: Symptoms are present but manageable. The individual can still engage in social activities, albeit with some discomfort.

Moderate Social Anxiety: Here, the symptoms are more acute, leading to avoidance of some social situations. However, the individual may still participate in others.

Severe Social Anxiety: This is characterised by intense symptoms, including panic attacks, that make social interactions overwhelmingly distressing. Often, the person avoids social situations entirely.

Whether it is medication or cognitive behavioural therapy in Singapore, tailored approaches can significantly improve the quality of life.

Therapy for Social Anxiety

If you have social anxiety, you are not alone. Anxiety disorders are treatable with the right intervention and social support.

Research shows that a combination of psychotherapy and medication is usually the most effective type of treatment for anxiety.

At TYHO, our Therapists are experts in evidence-based therapeutic approaches such as CBT.

During CBT-focused therapy, you may be focusing on replacing negative thought patterns and behaviours.

Medications like antidepressants or anti-anxiety medication can also be prescribed to manage symptoms.

However, do note that only medical doctors (ie psychiatrists) are qualified to prescribe and manage medications. Always consult your doctor before starting meds.

Lastly, lifestyle changes, such as regularly working out and practising mindfulness techniques, can help support these treatments.

Always consult a professional counsellor for a personalised therapeutic plan. They may consider factors such as your personal history, family history, intensity of symptoms, and your personality to develop a plan.

The goal is not just to handle symptoms but also to improve your quality of life!

Psychotherapy

Psychotherapy offers effective strategies for managing social anxiety.

CBT is an evidence-based approach that alters negative thought patterns and behaviours. It equips individuals with practical skills to navigate social situations more confidently.

Exposure therapy, a subset of CBT, involves gradual confrontation with anxiety-inducing scenarios, often used along with other relaxation techniques.

Another approach is ACT, also known as acceptance and commitment therapy. Unlike CBT, ACT employs mindfulness and goal setting to help individuals cope with their anxiety rather than directly challenging it. Although ACT is a relatively newer method, it offers an alternative for those who find traditional CBT less effective.

Group therapy, often CBT-based, provides a supportive environment for practising social skills and confronting fears collectively.

Each therapeutic approach has its merits. A therapist or counsellor can guide you in selecting the most suitable treatment.

Medication

Medications are often effective in managing symptoms.

However, only medical doctors such as psychiatrists can prescribe medications. Before diagnosing, a doctor or therapist may evaluate several factors, ike:

• Your medical history
• Other medications taken
• Specific symptoms
• Any other psychological condition or physical health issues you may have

Starting medication for the first time may cause certain side effects such as:

• Dizziness
• Nausea
• Vomiting
• Constipation
• Headaches
• Dryness

Hence, you should always discuss the side effects and your medical issues with your doctor.

Below are some common medications that your doctor may prescribe for social anxiety disorder:

• Selective serotonin reuptake inhibitors such as fluoxetine, sertraline, and citalopram.
• Serotonin-norepinephrine reuptake inhibitors such as venlafaxine and duloxetine.
• Benzodiazepines such as lorazepam and alprazolam.
• Beta-blockers such as propranolol and metoprolol.

How Is Social Anxiety Disorder Diagnosed?

Diagnosing social anxiety disorder involves a comprehensive evaluation by a qualified healthcare provider, such as a psychiatrist, psychologist, or clinician.

The primary diagnostic tool is the DSM-5, which outlines specific criteria for this condition. These criteria emphasise a persistent, intense fear or anxiety in social settings because they believe others will judge or humiliate them negatively.

The diagnostic process usually starts with an in-depth interview to understand the individual’s symptoms and history. Questions may cover the nature of the anxiety, specific triggers, and the impact on daily life.  

A key point in the diagnosis is the duration of symptoms. According to DSM-5, the symptoms must be present for at least six months to consider a diagnosis. This ensures that the issue is not a short-term problem (that requires a different therapeutic approach) but a persistent disorder requiring long-term treatment.

The diagnosis may also involve self-report questionnaires or scales created to measure the severity of social anxiety symptoms. These tools can provide additional data to support the diagnosis and to create treatment options.

Is there a test to diagnose social anxiety disorder?

Diagnosing social anxiety disorder typically involves a comprehensive evaluation by a professional therapist. Clinicians often conduct a clinical interview, asking the individual a series of questions to assess symptoms and behaviours.

Professionals may use standardised questionnaires, like the Social Phobia Inventory (SPIN), to measure the severity of the condition.

In some cases, they conduct a physical examination to rule out other medical issues causing the symptoms.

Consulting a qualified mental health counsellor for an accurate diagnosis and appropriate treatment options is essential. Visit our TYHO Therapists‘ profiles, watch their videos, and read client reviews if you need help picking a suitable therapist. 

Overcoming Social Anxiety

Social anxiety can make you feel like there is no escape from your fear. However, this condition is something that you can overcome with professional support and guidance.

Alongside professional support, it can be helpful to follow certain effective self-care tools.  

Here are some tips that you can adopt to manage anxiety symptoms on your own:

a) Challenge Your Thought Patterns

If you dread social interactions, negative thoughts are likely fuelling your anxiety. Thoughts like “I’ll embarrass myself” or “People will judge me” are common culprits.

To tackle this, identify these automatic negative thoughts and question their validity. Ask yourself, “Is my thought based on facts or assumptions?” More often than not, you will find these thoughts are not rooted in reality.

Avoid falling into unhelpful thinking traps such as:

• Mind Reading: Assuming you know what others are thinking about you.
• Fortune Telling: Predicting negative outcomes for future social events.
• Catastrophising: Exaggerating the impact of potential social mistakes.
• Personalising: Believing that unrelated events or conversations are about you.

Recognising these thought patterns is the first step towards changing them.

b) Shift Your Focus

When anxiety increases in a social setting, it is natural to become self-focused. You might think everyone scrutinises you, but this is rarely the case.

Instead of dwelling on your nervousness, shift your focus to your surroundings or the people you are with.

For example, an effective method to do this is to list our 5 blue objects in the room, or 5 circle objects. You can pick any colour, shape, or theme to practise this exercise!

Engage in conversations, listen actively, and try to form genuine connections. This shift from a critical internal lens to an external focus can significantly reduce your level of anxiety.

c) Be Present

Instead of fretting about what you will say next or replaying past mistakes, try to stay in the moment.

Listen to what’s being said around you, enjoy the company, and let conversations flow naturally. This will not only make you feel more relaxed but also make you a better conversationalist.

Remember, you are not alone. It is easy to think you are the only one feeling anxious, but the truth is many people feel the same way in social situations. Even if someone notices your nervousness, it is unlikely they will think less of you for it.

By adopting these strategies, you will find that social situations become less intimidating and more enjoyable. The journey to recovery takes time and practice, but the changes and outcomes are well worth the effort!