Social Anxiety Disorder

Symptoms

Social anxiety disorder causes unreasonable, debilitating fear of being judged or publicly humiliated. You may avoid or severely limit encounters with other people—which can keep you from daily activities. You may develop physical symptoms such as a rapid heartbeat, shortness of breath, or tightness in your chest when faced with a feared social situation.

When you have social anxiety disorder, common social situations—such as eating in public, writing in front of other people, using a public restroom, or speaking in front of others—can cause overwhelming fear and anxiety.

You may be more afraid of people noticing your anxiety than of the actual feared situation. A vicious cycle can emerge of avoiding or worrying about the social event (such as speaking in public) because you are afraid others will see you as weak, anxious, or foolish—this, in turn, leads to more anxiety. This may lead to avoiding or limiting contact with other people.

Symptoms of social anxiety disorder may differ in adults and children. Adults and teenagers with social anxiety disorder usually recognize their fears of being publicly humiliated are unreasonable or excessive, while children who have this disorder may not.¹

Expressions of anxiety in adults or adolescents include:^{1, 2}

• Having persistent but unreasonable fear of a situation that involves unfamiliar people or being judged by others. The fear is that you will be embarrassed or humiliated by something that you say or do.
• Developing severe anxiety or panic attacks when in the feared situation.
• Recognizing that your fears are excessive or unreasonable.
• Avoiding social situations that you fear, or enduring them with intense anxiety or distress.
• Avoiding or anxiously anticipating feared situations so much it interferes with daily activities and relationships.
• Worrying about being anxious.

Expressions of anxiety in children include:^{1, 2}

• Worrying about being embarrassed in front of their peers, but not usually adults or teenagers.
• Expressing anxiety by frequently crying, throwing tantrums, "freezing" in social situations, or "shrinking back" from unfamiliar people.
• Denying or not realizing the fears are excessive or unreasonable.
• Fearing performance situations, such as having to speak in front of the class. This fear doesn't come and go; it is continuous and lasts for 6 months or longer.

People with social anxiety disorder often underachieve at work or at school to avoid the attention of a promotion or to avoid being forced to participate in a group.¹ They tend to have few friendships and have trouble dating or developing relationships. In prolonged or severe cases, many people develop other psychological conditions (such as depression or substance abuse).³

Social anxiety disorder is among several types of phobias that many people experience, such as agoraphobia or specific phobia (fearing an object, like a spider, or a frightening situation, such as being stuck in an elevator).

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Author:	Jeannette Curtis	Last Updated: August 27, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Lisa S. Weinstock, MD - Psychiatry
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