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Can you imagine feeling trapped in a social situation where you are so frightened of being watched or judged by others that you freeze up?

Diagnosing social anxiety disorder (SAD) can be initially challenging because it seems to share symptoms with shyness. SAD is a mental disorder characterized by unrealistic fear of humiliation, embarrassment and poor performance in front of others in specific social settings.

Going to events, looking people in the eyes, speaking in front a group, using a public restroom, eating, drinking in front of others or meeting a person in a position of authority can trigger dreaded symptoms.

So many people quietly endure this pain every day, believing there is no hope for them to get better. One manifestation of this disorder is the individual who constantly questions what could go wrong with an upcoming presentation in front of others, producing feelings of terror and panic, possibly coexisting with panic attacks.

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How is Social Anxiety Disorder (SAD) different from other anxiety disorders?

One way to differentiate SAD from other anxiety disorders is to confirm that the arousal panic state happens only when the individual is in the presence of others and not when alone. In addition, these feelings should be debilitating enough to cause impairment and distress in various areas of one’s life, such as attending school, keeping a job, having friends and being active in the community.

Along with these thoughts and feelings, distinctive physical symptoms of anxiety are as follows: racing heart, palpitations, trouble talking, muscle contraction, trembling, sweating, cold hands, stomach upset, blushing. Since the person suffering from SAD is already so self-conscious about their overall performance, these symptoms appear to only further this perception of self and worsen the situation.

Once this cognition is ingrained in one’s mind, a tendency towards avoidance and withdrawal from social settings should be expected. Anticipating the feared situation and suffering in advance are also characteristics of this and other anxiety disorders.


When does Social Anxiety Disorder (SAD) begin?

The onset normally happens in adolescence, but can also start in early childhood. Even though the causes are uncertain, the originating event may be a traumatic event or experience. Having SAD can be really difficult for children because they normally lack the ability to recognize the irrationality of those fears, even when they are not in the feared situation. Overall, other negative aspects of the disorder include low self-esteem, depression, use of alcohol and drugs, academic and occupational difficulties, and problems with interpersonal adaptation.

The causes of social anxiety have both psychosocial and biological influences. Social and environmental causes include learned behavior as a result of watching parents or others. Psychological causes include emotional trauma from early-life experiences. Biological factors include genetic predisposition, imbalance of the neurotransmitters GABA, serotonin and or dopamine, an overactive amygdala, or a faulty functioning nervous system. A person suffering from SAD will often experience lack of confidence and spontaneity, making living a difficult task to perform.

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How can clinicians treat Social Anxiety Disorder (SAD)?

To enhance treatment success, the clinician should emphasize that this disorder is highly treatable if one is committed to treatment. The focus should be on learning various techniques for relaxation (mindfulness, breathing strategies, guided visualization) and disconnection from the fearful thoughts.

The next step would consist of working on regaining confidence and feeling of control in everyday activities. Gradually this would expand to larger settings where the feared situations are presented more often (exposure). The final treatment goal would involve mastering this assurance by succeeding in academic settings, attending work regularly, and becoming involved in a range of social situations with a sense of belonging and comfort, forming and keeping meaningful friendships and relationships.

The most commonly applied treatment interventions combine the use of medication, cognitive behavior therapy (CBT), eye movement desensitization and reprocessing (EMDR), somatic experiencing, psychodynamic therapy and group therapy. A combination of strength-based approaches and CBT has shown great results, since they both identify that the control and potential for change reside within (and not outside of) the individual. The main reason we get caught in negative patterns that end up dominating our lives is unrealistic thinking.

The prospects for people who suffer from SAD are favorable; when individuals pursue treatment they can bring happiness and enjoyment to their lives.



Hamilton, J (2018). The Ultimate Guide to Understanding Social Anxiety [Blog post].
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Kvarnstrom, E (2017). Treating Social Anxiety Disorder: Why Therapy is Essential [Blog post].
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Richards, T. A. (2018). What is It Like to live with Social Anxiety [Blog post].
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About the Author

Nelida Louden is a Licensed Marriage & Family Therapist at Well Clinic in San Francisco.

According to Nelida, “Trusting our potential for growth and capacity for constructive change is the first step toward long lasting healing”

Learn more about Nelida and schedule an appointment today »



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