Social Phobia: Symptoms, Causes, Complications, Risk Factors, Diagnosis and Treatment

It is an excessive emotional discomfort, fear, or concern for social situations.

The individual is concerned about being evaluated or examined by others, and there is a greater fear of interacting with others.

Social phobia is sometimes referred to as social anxiety disorder. A phobia is an irrational fear of certain situations, objects, or environments.

Data on social anxiety

  • People with social anxiety disorder are disproportionately nervous in social situations.
  • Symptoms may include abdominal discomfort, lightheadedness, and a “negative cycle” of feeling anxious about any feeling of anxiety. Panic attacks may also occur.
  • It is more common in women than in men.
  • Treatment may include psychotherapy and medication.


A person with a social anxiety disorder may have a great fear of shame in social situations. This fear can affect personal and professional relationships.

Social anxiety often occurs early in childhood as a regular part of social development and may go unnoticed until the person is older. The triggers and the frequency of social anxiety vary according to the individual.

Many people feel nervous in certain social situations, such as giving a presentation, going on a date, or participating in a competition. This is normal and would not qualify as a social anxiety disorder.

Social anxiety becomes a medical condition when daily social interactions cause excessive fear, self-consciousness, and shame.


Trivial and everyday tasks, such as filling out a form with people around you and eating in public places or with friends, can be very stressful for someone with social anxiety.


There may be physical, emotional, and behavioral symptoms. Social anxiety can affect daily tasks, including school life, work, and other activities.

Behavioral and emotional signs and symptoms include:

  • Avoid situations where the individual feels they can be the center or focus of attention.
  • Fear of being in situations with strangers.
  • Fear about how they will present themselves to others.
  • Excessive fear of shame and humiliation, being teased and criticized, or others who realize that a person with social anxiety disorder looks anxious.
  • Fear of being anxious worsens anxiety.
  • Fear of meeting people with authority.
  • Severe anxiety or panic attacks when experiencing the dreaded situation.
  • Refrain from certain activities or talking to people for fear of embarrassment.
  • A blank mind in social situations that cause anxiety.
  • Children with possible social anxiety disorder tend to worry about feeling embarrassed in front of their peers, but not adults.

Physical signs and symptoms include:

  • Heart palpitations.
  • Abdominal pain.
  • Avoid eye contact
  • Blush.
  • Crying, tantrums, clinging to parents, or isolation in children.
  • Cold, damp hands
  • Confusion.
  • Cry.
  • Diarrhea.
  • Difficulty speaking, sometimes including a trembling voice.
  • Dry mouth and throat.
  • Excessive sweating
  • Muscle tension.
  • Nausea.
  • Tremble.
  • Perturbation of walking, in which the individual cares so much about how they walk that they lose their balance or maybe stumble when a group of people passes.

An individual with a social anxiety disorder may also:

  • Being too sensitive to criticism
  • Have low self-esteem
  • Have bad social skills.
  • Do not be assertive.
  • Speak negatively about themselves, with inaccurate and counterproductive thoughts.
  • People with social anxiety disorder sometimes have poor performance at school or work to avoid the attention of being promoted or having to participate in group tasks. In severe or chronic cases of social anxiety, the person may develop other psychological conditions, such as depression.

A person with a social anxiety disorder may find the following situations extremely difficult to cope with:

  • Be introduced and talk with new people.
  • Go to a room where the groups are already established.
  • Make eye contact
  • Order a meal in a restaurant.
  • Start a conversation.
  • Use a public telephone or a public toilet.
  • Write in front of other people.

People with social anxiety disorder usually know that their anxiety is irrational. However, in many cases, anxiety persists and does not improve without proper treatment.


Experts say that social anxiety disorder has both environmental and genetic causes.

Genetic causes: given that the condition appears to be hereditary, genetic links are being investigated. Ongoing investigations seek to discover how much of this is genetic and how much is acquired.

Chemicals in the body: Scientists are currently investigating what chemicals in the body could promote the development of social anxiety disorder. Serotonin, a brain chemical, can play a crucial role when the levels are not correct or an individual is compassionate.

Brain structure: some researchers believe that the amygdala in the brain may play a role in response to fear, resulting in excessive reactions.

Climate and demographics: Mediterranean countries have lower social anxiety disorder rates than Scandinavian countries. This could be due to a warmer climate and a higher population density.

The warmer climate can reduce the avoidance of social situations and increase contact with other people. Others suggest that cultural factors can contribute to reducing rates of social anxiety.


Depression can be a complication of social anxiety.

Social anxiety disorder can persist throughout a person’s life if left untreated. Your anxieties may end up dominating your lifestyle.

This can interfere with daily life, school work, professional relationships, and general happiness.

In severe cases, the person can leave work, and school and isolate.

There is also the risk of alcohol or substance abuse, depression, and suicidal thoughts.

Risk factor’s

Social anxiety disorder usually begins in early or mid-adolescence, but sometimes it can start much sooner or later.

The following factors may increase the risk of developing social anxiety disorder:

Gender: the disorder is significantly more common among women than among men.

Genetics: the risk of developing the condition may be higher if the parents or siblings of a person have the condition.

Some life experiences: it is said that children who have experienced bullying, ridicule, humiliation, or rejection are more susceptible to social anxiety compared to other people. Factors can also include sexual abuse, a family conflict, or other negative experience.

Personality: It is believed that children who have strayed, are moderate, shy, or repressed are more likely to develop a social anxiety disorder.

A stern test: some people may experience social anxiety for the first time when they have to make an important presentation. Actors may experience stage fright or social phobia when they are on stage.

Humans are social animals, and the negative spiral of thoughts that contribute to social anxiety can become a mild annoyance when talking to large groups of people about a serious mental health problem. Learning to enjoy socialization before the thought process reaches this stage is vital for a better quality of life.


A doctor, often a primary care physician, can perform a physical assessment and an essential psychiatric examination. The physical exam helps the doctor rule out any physical cause of the symptoms.

A family doctor will probably refer the person to a mental health professional, usually a psychiatrist or psychologist.

The mental health professional will ask the person with suspected social anxiety to describe the symptoms, when they occur, how often, and for how long they have been occurring. Then they can ask the patient to complete a questionnaire.

The symptoms must meet the criteria of the Diagnostic and Statistical Manual (DSM) for social anxiety before a diagnosis can be made, which includes:

  • Avoid situations that can produce anxiety.
  • A persistent fear of social situations in which they believe they will be scrutinized or act in a shameful or humiliating way.
  • Excessive or disproportionate levels of anxiety for the situation.
  • Daily life is affected by anxiety.
  • Social situations cause much anxiety.


Social anxiety disorder is lifelong for many people; it usually changes how severe it is. Treatments can help people control their symptoms and gain confidence.

Psychotherapy and medications are considered the most effective treatments.


This is a psychological treatment that uses a wide variety of techniques to help the person to see himself and his problems more realistically and overcome them and face them effectively.

There are many types of psychotherapy, including cognitive therapy, interpersonal therapy, psychodynamic therapy, and family therapy.

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) has been shown to improve symptoms significantly.

CBT helps the patient to realize that it is their thoughts, rather than other people, that determine how they react or behave. In this type of psychotherapy, the patient learns to recognize and change negative thoughts about oneself.

This type of therapy has two main parts:

  • A cognitive element designed to limit distorted or disproportionate thinking.
  • An element of behavior designed to change the way people react to objects or situations that trigger anxiety.

The individual can also receive exposure therapy, in which they gradually work to face the situations they fear.

With cognitive exposure administered, the patient safely confronts situations or places that cause problems, often in the therapist’s company.


Selective serotonin reuptake inhibitors (SSRIs) are the most common medications for people with social anxiety disorder.

It is believed to be the safest and most effective treatment for persistent symptoms. Examples may include:

  • Paroxetine (Paxil, Paxil CR).
  • Sertraline (Zoloft).
  • Fluvoxamina (Luvox, Luvox CR).
  • Fluoxetine (Prozac, Sarafem).

Possible side effects may include:

  • Headaches.
  • Insomnia .
  • Nausea.
  • Sexual dysfunction

A doctor may prescribe serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor, Effexor XR). Usually, they begin by prescribing a small dose, which gradually increases. It may take up to 3 months for any improvement in symptoms to be noticed.

Benzodiazepines are a class of medications that are also used as anti-anxiety medications. Examples include alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepine courses are usually short because they can cause dependence.

Side effects may include:

  • Confusion.
  • Drowsiness.
  • Daze.
  • Loss of balance
  • Memory loss.

Beta-blockers help block the stimulating effects of adrenaline. Usually, they are prescribed for specific situations, such as having to make a presentation. They are not used for continuous treatment.

Decrease anxiety

Stimulating positive thoughts before a potentially intimidating social encounter, such as listening to music you love, will help positive fuel emotions during the encounter.

One of the factors that worsen the symptoms of social anxiety is the fear of becoming anxious.

The more anxious a person feels about social situations, the less likely they are to be exposed to them.

However, being exposed to social situations is necessary to overcome anxiety, and the less a person is exposed to social interaction, the more extreme the anxiety becomes.

It is essential to break the cycle of anxious thoughts. There are proven steps to help prepare a person for social interactions that may make them feel nervous before facing them.

These include:

Stimulate positive thoughts before social commitments: activities that make you happy can release chemicals that make you feel good in the brain that relax you during potentially stressful encounters. Listen to the music you love, watch a bit of television or play video games. Maybe participate in some smooth exercise or meditation.

Rethinking negative thought processes: Telling yourself that you are a shy person will reinforce current anxieties about talking to people or being in public. Thoughts feed patterns of behavior. A technique carried out in cognitive behavioral therapy involves guiding patients through the process of reframing.

Writing these thought processes can help. For example, “I am a shy person” can become “I acted like a shy person in the meeting.” It helps people know that they can change how they perceive themselves and how others see them.

Not to depend on alcohol or narcotics: not only can they form a dependency later in life, but they also do not help the problem at the center of social anxiety. Try to manage negative feelings in social situations without chemical products or follow a medically compatible course of medications prescribed by a doctor.

While some cases of social anxiety can be so severe that these steps will not resolve the condition without treatment, they can help a person address social interaction with a positive mindset.