Social Anxiety Disorder: Symptoms, Causes, and Treatment

Anxiety disorder is a clinical condition where a person experiences intense anxiety or worry that it might disrupt one’s daily activities.

Social Anxiety Disorder (SAD), is a type of anxiety disorder. SAD also known as social phobia, is also a clinical condition. It is characterized by significant anxiety or fear in any social situation & preoccupation with thoughts about how to manage those situations.

The person with Social Anxiety Disorder (SAD) has an overwhelming and irrational fear of being judged by others. Social interactions provoke anxiety in them leading them to constant worry that people are scrutinizing and criticizing their actions. As a result, they are overly cautious about their words and actions. Often, they also try to avoid any social interactions possible to prevent potential judgements. 

In addition to feeling uncertain about social situations, they often have persistent and preoccupied thoughts about past interactions. Those interactions keep replaying constantly in their mind. They also evaluate their self-worth based on their performance. Habitually, they question themselves, “Why can’t I handle these situations like others?”, “Why can’t I talk or socialize as easily as others do?”, “Why do I struggle to even start a simple conversation?”, and “Why can’t I fit in?”. These self-critical thoughts make them feel even worse, reinforcing their socially withdrawn behaviour.

Comorbidity of Social Anxiety Disorder 

Social anxiety disorder (SAD) is a widespread condition affecting people globally, with research showing that women are twice as likely to be affected as men. It’s quite common but if not addressed early, the symptoms of social anxiety disorder can become more severe and difficult to manage over time. 

SAD often coexists with other psychiatric disorders and may not be identified until a clinician conducts a thorough case history. Researchers have found comorbidity of SAD with Major Depression, Panic Disorder,  Post-traumatic stress Disorder(PTSD), Substance Abuse Disorder, Agoraphobia, Obsessive-compulsive disorder (OCD), Bipolar Disorder, Generalized Anxiety Disorder etc.

The presence of other mental health conditions alongside social anxiety can make it harder to diagnose and treat. This is why it’s important for doctors to carefully review a person’s full history and symptoms. Getting a clear and early diagnosis, along with the right tailor-made treatment, is key to managing and reducing the effects of social anxiety disorder.

More than just shyness

It’s normal to feel anxious at times, but it’s a different case when it comes to a disorder. People with Social Anxiety Disorder have a constant, intense fear of being judged by others. This stress is overwhelming and becomes too much to handle, so they try to avoid social situations as much as possible. They might find ways to escape from various scenarios, such as avoiding phone calls, making small talk, maintaining eye contact, attending job interviews, or even going shopping. The mere thought of being in public makes them shiver and cause distress.

However, some people have selective anxiety, i.e. feeling anxious only in specific situations rather than all social contexts. In contrast, those with severe Social Anxiety Disorder tend to evade all social interactions.

Symptoms

In SAD, the fear often manifests as physical symptoms. Some of these symptoms include,

• Dizziness
• Sweating
• Nausea
• Dry throat
• A blank mind
• Sweaty palms
• Stomach pain
• Difficulty speaking
• Shaking or trembling
• High blood pressure
• Accelerated heartbeat
• Shallow or rapid breathing
• Self-doubt and uncertainty 
• Preoccupied with thoughts about being judged by others.

Causes

There isn’t a single clear cause for the disorder, but it may result from a combination of factors. Here are some factors listed below,

Biological factors

• Genetics: It plays a significant role in the disorder. If a family member has a history of the condition, the likelihood of developing SAD is higher. The inherited genes might end up in the predisposition of the disorder. However, genetics alone don’t determine the disorder, it might raise the risk of developing it.
• Brain Structure: Amygdala, is a small, almond-shaped structure in the brain that aids in processing emotions particularly, fear and stress. It helps in responding to threats by triggering the fight-or-flight response. With SAD, individuals are extremely cautious with a pervasive sense of doom leading to an overactive amygdala, which can contribute to heightened anxiety in social situations. 

Social factors

• Past experiences: Childhood experiences such as being bullied, teased or any kind of abuse can also lead to the disorder. Negative experiences during formative years can impact the formation of self-esteem and self-confidence, leading to heightened fear and anxiety in the face of social situations.
• Parenting: Also when parents overprotect their shy children, it can lead to social anxiety later in life. This overprotective behaviour can limit the child’s opportunities to face social challenges independently. The child’s lack of experience in handling social situations can increase the child’s fear and anxiety about interacting with others. As a result, the child may grow up feeling less confident and more apprehensive in social settings, potentially leading to social anxiety disorder.

Personal factors

• Temperament: Naturally shy People may be more prone to developing SAD. 
• Appearance: Similarly, those with facial disfigurements that attract attention can also be at higher risk, as their appearance might make them feel self-conscious and anxious in social settings.
• Environment: Additionally, individuals who have experienced a deeply embarrassing or hurtful event may find that a particular event increases their fear of social interactions. Thus, such personal factors can also contribute to developing SAD.

Anxiety and Hormones

Imbalances in neurotransmitter systems can disrupt hormonal regulation, potentially affecting mood. Problems with neurotransmitters such as serotonin, dopamine, and glutamate may contribute to feelings of anxiety or fear. For instance, some hormones associated with anxiety include,

• Testosterone 
• Estrogen
• Progesterone 
• Cortisol
• Thyroid hormones

Testosterone 

According to the National Comorbidity Survey, women are more likely to experience anxiety disorders, than men. This difference is partly attributed to lower testosterone levels in women. Testosterone helps regulate the brain’s response to perceived social threats. It also boosts GABA (gamma-aminobutyric acid) and serotonin, two brain chemicals that are important for managing stress. With lower testosterone levels, women may find it harder to handle social situations as men do, leading to increased anxiety. This is one of the reasons why women experience social anxiety more than men.

Estrogen

Women are more prone to SAD due to fluctuations in estrogen levels. Estrogen, a hormone that regulates mood and fear responses, is usually higher in women. Thus elevated estrogen boosts serotonin production and promotes good mood. However, studies show that as women approach their menstrual cycle, their estrogen levels fall. This drop leads to a reduction in serotonin, which can cause mood swings and make women more vulnerable to SAD.

Progesterone 

High levels of progesterone can lead to feelings of depression or anxiety. Progesterone stimulates the amygdala, which triggers the fight-or-flight response, making individuals more alert and cautious. As progesterone level increases, the amygdala becomes overactive leading to the overstimulation of the fight-or-flight response. This heightened state of vigilance (an overactive amygdala) causes individuals to perceive the outside world as a constant threat, which can create ongoing anxiety. Thus, contributing to Social anxiety disorder.

Cortisol

Cortisol, known as the stress hormone, is a steroid hormone that signals our brain when something is perceived as harmful. It is released in response to threats, overwhelming situations, or loss of control. This can lead to increased physical symptoms and heightened stress in social situations, causing more cortisol to be secreted. In social anxiety disorder, the person’s increased tension leads to higher cortisol production. As cortisol levels rise, the person’s anxiety also tends to increase. 

Thyroid hormones 

Thyroid hormones can make social anxiety worse by increasing anxiety and causing physical symptoms like:

• Shakiness
• Sweating
• Palpitations
• Increased heartrate

Treatment

Treatment for social anxiety disorder often involves medications and therapies. It’s important to consult with mental health professionals, as the severity of the disorder varies for each person. Therefore, treatment plans should be customized for each individual. Treatments might include,

1. Cognitive Behavioral Therapy

Cognitive Behavioral Therapy also known as CBT, aims to identify and change negative or false thoughts and behaviors in social situations. It teaches individuals to gain control over their thoughts and actions. With professional guidance, people can more easily manage and cope with their disorder.

2. Exposure Theory

Exposure therapy is a type of behavioural therapy. It’s essential for treating social anxiety disorder. It involves gradually exposing individuals with SAD to social situations that they’re uncomfortable with, waiting until they feel comfortable. This process helps their brain learn that the situations they were once afraid of are manageable over time.

3. Anxiety management techniques 

Relaxation training and breathing exercises can help manage symptoms. Some techniques might include,

• Mindful breathing 
• Guided imagery
• Progressive muscle relaxation
• Butterfly hug to help stay grounded.

4. Applied relaxation 

Applied relaxation is a method that helps people learn how to relax easily in everyday social situations. It begins with traditional progressive muscle relaxation training and progresses through a series of steps that teach individuals how to use these relaxation techniques on demand in various real-life settings. The final step involves practising these skills in actual social situations to make them effective.

5. Social skills training

Social anxiety can make communication challenging for individuals. Social skills training helps people develop the abilities needed to manage and overcome their anxiety in social situations. This training focuses on building confidence, improving interpersonal communication etc which can assist individuals with SAD to handle social situations better.

Medications

Medications for Social Anxiety Disorder often include:

• Antidepressants 
• Mood stabilizers like Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs) 
•  Anxiolytics like benzodiazepines, and beta-blockers.

However, medications should only be taken under the prescription of a Healthcare professional. 

Complications 

If left untreated, the disorder might lead to:

• Isolation
• Depression
• Substance abuse
• Suicidal ideations
• Reluctance to leave the house
• Post-traumatic stress disorder(PTSD)
• Difficulty forming or maintaining relationships 

In conclusion, social anxiety disorder is a common and serious condition that can get worse if not treated early. It involves intense fear of social interactions often leading to socially withdrawn behavior. It profoundly affects one’s quality of life. Early diagnosis helps manage and prevent the condition from getting worse. Treatment usually involves support from family, friends, and others. Having a strong support system can help with recovery. Remember, with proper care and support, social anxiety disorder can be managed effectively.