Social Anxiety Disorder: What is it? How To Treat It?

What is social anxiety disorder?

Social Anxiety Disorder


Social anxiety disorder is the fear of social situations that involve interactions with other people, it could be said it is a fear and anxiety of being negatively judged and evaluated by other life. It affects many areas of a person’s life and may be confused with a panic disorder as people can experience anxiety attacks but not panic attacks. A high rate of alcoholism and other substance abuse, family difficulties and problems, a lack of personal relationships as well as a difficulty in obtaining or continuing with employment are among a number of very common experiences held by people with social anxiety disorder.

Social anxiety disorder is one of the five major anxiety disorders as listed in the DSM-5 and affects  1 in 8 Irish adults at any one time.


What are the symptoms of social anxiety disorder?

Experience significant distress/dread in the following situations:

What are the symptoms of social anxiety disorder

  • Being introduced to other people
  • Being teased or criticized
  • Being the centre of attention
  • Being watched or observed while doing something
  • Having to say something in a formal, public situation
  • Meeting people in authority (“important people/authority figures”)
  • Feeling insecure and out-of-place in social situations (“I don’t know what to say.”)
  • Embarrassing easily (e.g., blushing, shaking)
  • Meeting other peoples’ eyes is difficult if not impossible for some
  • Having difficulty swallowing, writing, talking, making phone calls if in public
  • Anxiety – to an extent they may not be able to attend work/school
  • High levels of fear, nervousness
  • Automatic negative emotional cycles

Physical symptoms

  • Racing heart
  • Blushing
  • Excessive sweating
  • Dry throat and mouth
  • Trembling and muscle twitches
  • A feeling that the heart is either pounding too hard or fluttering (palpitations)
  • Abdominal pain and/or stomach upset
  • Clammy hands
  • Cold hands
  • Confusion
  • Crying
  • Difficulty talking; this may include a shaky voice
  • Muscle tension
  • Nausea
  • Walk disturbance
  • A child with SA may underachieve in school to avoid attention, may cling to parents, throw tantrums, shut down or off.

Causes of Social Anxiety Disorder

There is no clear cause as yet but a variety of different ones are being investigated and some of the following have strong links to causes.

Negative Experiences:  

  • Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder.
  • Other negative events in life, such as family conflict or sexual abuse, may be associated with social anxiety disorder.

Genetic Causes: As the condition is more common to run in families.

Chemical: Scientists are currently undergoing research into what natural body chemicals might be playing a part. Some scientists are suggesting that serotonin, a brain chemical, may play a key role when its brain levels are not right or if the patient is extremely sensitive.

Brain: Some experts believe the amygdala (part of the brain) may play a role in fear response, resulting in an excessive reaction in patients.

Diagnostic Criteria for Social Anxiety Disorder from  The ICD-10 Classification of Mental and Behavioural Disorders World Health Organization, Geneva, 1992 (in other words the technical stuff)

All of the following criteria should be fulfilled for a definite diagnosis:

(a) the psychological, behavioural, or autonomic symptoms must be primarily manifestations of anxiety and not secondary to other symptoms such as delusions or obsessional thoughts;

(b) the anxiety must be restricted to or predominate in particular social situations; and

(c) avoidance of the phobic situations must be a prominent feature. Includes: * anthropophobia * social neurosis Differential Diagnosis Agoraphobia and depressive disorders are often prominent, and may both contribute to sufferers becoming “housebound”.

Treatment for Social Anxiety Disorder

Treatment for Social Anxiety Disorder

Remember one size doesn’t fit all, so find a solution between your GP and therapist that suits you. In saying that Cognitive-behavioral therapy is recommended for treatment. This can be combined with medication if needed.

Cognitive Behavioural Therapy is not one set method but rather a combination of various techniques, its central goals are to identify irrational beliefs and thought patterns and replace them with more realistic views. Changing negative automatic thinking in the long-term requires practice and repetition for several months. But it is a very effective treatment as it builds new neural pathways in the brain making it easier for you to recognise negative thought patterns much quicker, replace or correct them as needed with more rational and realistic ones.

Things that can be tackled by CBT: (list not inclusive)

  • Misperceptions you may have about your abilities and self-worth.
  • Tackle and look at any guilt, embarrassment, or anger over past situations.
  • How to be more assertive.
  • Tackling perfectionism and being able to be more realistic in thoughts and about what can be done.
  • Dealing with procrastination related to social anxiety.
  • The behavioural method used is Exposure training for SAD, it has to be a very gradual process as the individual needs time to adjust to each situation and the phrase toughen up or man up won’t work.

It is the combination of cognitive and behavioural therapy that changes the brain and allows you to overcome social anxiety

Medication: discuss this with GP first but it is also recommended to try therapy before taking any medication. A word of caution here only your GP will be able to advise on this, as they will know you and your medical history better than I will. Types of medications used are Benzodiazepines and Antidepressants.


  1. Learn relaxation
  2. Change your lifestyle.
  3. Challenge negative thoughts.
  4. Build up your relationships, dump negative people too.
  5. Face your fears – exposure therapy slow and steady here.

Other help and support

Do you need to relax? How to relax in your everyday life

Social Anxiety Ireland

Social Anxiety UK


Did you know we offer therapy for Social Anxiety Disorder? Call today 089 4373641

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