girl with social anxietyAn estimated 15 million American adults have social anxiety disorder, and 36% of them suffer with symptoms for 10 years or more before seeking help.1 Epidemiological studies have shown that social anxiety disorder is the third leading psychological disorder in the U.S.2 Its onset is almost universally in childhood or adolescence.3 Social anxiety disorder (also known as social phobia), like all mental health disorders, can wreak havoc on the lives of those who suffer from it. It often involves significant shyness and a debilitating fear of certain types of social situations, making it particularly disruptive. If left untreated, the consequences can severely impact every aspect of life, often leaving people feeling hopeless and depressed.

Social Anxiety Symptoms

Symptoms vary from person to person, but the following are some of the most common experienced by people with social anxiety disorder.1,2

  • Blushing
  • Excessive sweating
  • Nervousness
  • Dry throat and mouth
  • Trembling
  • Muscle twitching
  • Nausea or other abdominal distress
  • Rapid heartbeat
  • Shortness of breath
  • Dizziness or lightheadedness
  • Headaches
  • Feeling detached
  • Loss of self-control

Social Anxiety Implications

Isolation/difficulty making friends: Social anxiety disorder causes many, if not most, social interactions to be extremely uncomfortable. The mere thought of meeting new people or speaking in front of others triggers significant anxiety. As a result, most people decide to withdraw and isolate themselves. When people summon the nerve to socialize, their anxiety often undermines well-meaning efforts. The discomfort and awkwardness they exhibit makes people around them feel uncomfortable. Interactions that are less than satisfactory cause pain and embarrassment — and tend to be indelibly etched in the person’s memory.

Damaged self-esteem: Typically, people with social anxiety disorder already have low self-esteem, although suffering from the disorder itself can lead to significantly low self-esteem. Every humiliating or embarrassing interaction reinforces one’s self-doubts and beliefs about being a flawed human being. The longer one suffers from social anxiety disorder, the more deeply ingrained these negative thought patterns become.

“Underachiever” status: Social anxiety prevents people from reaching their full potential and attaining goals. A person could do an excellent job at work, but is afraid to talk to his boss about advancement possibilities within the company. He is overlooked for the promotion and it goes to a colleague who demonstrates self-confidence and assertiveness. Achieving milestones in life involves a good degree of risk-taking, but doing so is too frightening a prospect for people with social anxiety. Instead, they choose the path of least resistance, which may give others the impression that they are unmotivated or lack ambition.

Harsh inner dialogue: Most people with social anxiety disorder subject themselves to a harsh inner dialogue. Self-deprecating thoughts (e.g. “Why can’t I be like everyone else?” or “Why am I such a loser?”) run rampant and mental self-flagellation can be brutal. People with this disorder start believing these damaging thoughts, which reinforces and perpetuates the fear of social situations.

Impaired social skills: A large part of developing good social skills comes from interacting with others based on feedback received. When people act appropriately, they are rewarded with positive interactions from others. Conversely, when they behave awkwardly, show ineptitude, or say or do inappropriate things, there are negative consequences. While social interactions often involve more complex factors, accurately interpreting “feedback” is much easier for some people and a struggle for others. Social anxiety limits interactions, therefore people with this disorder never get the opportunity to develop finely tuned “people” skills.

Skewed perceptions: One of the greatest fears is being humiliated, scrutinized or criticized by others. Therefore it is not uncommon for people with this disorder to have a distorted view of interactions with others. Constructive feedback from a boss may be perceived as harsh criticism. A person may misinterpret group laughter as a personal attack. This hypersensitivity causes people to see everything from a highly skewed viewpoint. Little things that others can easily brush off are very uncomfortable or hurtful.

Difficulties being assertive: In order to successfully navigate life, some degree of assertiveness is necessary. Although a lot of people have difficulty with this, for people with social anxiety, the concept, much less the action of asserting oneself, seems nearly impossible. Sadly, a lack of assertiveness can lead to relationship problems, lost opportunities and a host of other problems.

Social Anxiety — Substance Abuse Problems

About 20% of people with severe social anxiety also suffer from alcohol abuse or substance dependence. A recent study found that the two disorders have a stronger connection among women. Alcohol is often abused because it helps intensely shy or awkward people feel less inhibited. A few drinks may “loosen people up” and transform them from scared wallflowers into social butterflies — perhaps even the life of the party. Alcohol or other substances are also used to provide a temporary escape or to numb the emotional pain associated with social anxiety disorder.4

Social Anxiety — Suicide

More than 90% of suicidal deaths involve a diagnosable illness such as clinical depression and often in combination with anxiety disorders, substance abuse and other treatable mental disorders.5 A prospective study of more than 3,000 patients (ages 14 to 24) showed that adolescents with social anxiety disorder have a higher risk of developing depression as young adults. Furthermore, in adolescents who have both depression and social anxiety disorder, there is a higher risk of subsequent depressive illness with a greater number of suicidal thoughts and attempts.3


More than 1,000 outcome studies have been done on the use of CBT as a primary and adjuvant therapy for psychiatric disorders, and it has been found to be highly effective for social anxiety disorder.6 Social skills training may be incorporated into CBT, focusing on building stronger conversational and listening skills, as well as assertiveness. Some psychiatrists prescribe antianxiety medications or antidepressants, but medication alone is generally not as effective as psychotherapy, especially when it is the only treatment.

If you or someone you love is suffering from social anxiety disorder, rest assured that there is hope. Life is too short to suffer from the serious emotional problems related to this disorder. Contact a mental health professional today for an evaluation. Proper treatment can make a world of difference, opening up a whole new life for people who have suffered in silence from this treatable disorder.


  1. Social Anxiety Disorder. Anxiety and Depression Association of America website. Updated June 2016. Accessed June 17, 2016.
  2. Social Anxiety: Symptoms and Treatment. Social Anxiety Association website. Accessed June 17, 2016.
  3. Stein MB, Fuetsch M, Müller N, Höfler M, Lieb R, Wittchen HU. Social anxiety disorder and the risk of depression: a prospective community study of adolescents and young adults. Arch Gen Psychiatry. 2001;58(3):251-256. doi:10.1001/archpsyc.58.3.251.
  4. Social Anxiety Disorder and Alcohol Abuse. Anxiety and Depression Association of America website. Accessed June 17, 2016.
  5. Suicide and Prevention. Anxiety and Depression Association of America website. Updated May 2016. Accessed June 17, 2016.
  6. What is Cognitive Behavioral Therapy (CBT)? Beck Institute website. Accessed June 15, 2016.