Social anxiety disorder is the fear of interaction with other people due to self-consciousness and feelings of being negatively judged. The condition is also known as social phobia.

It is normal to feel a little nervous in certain situations such as a job interview or when taking an exam; the butterflies are temporary and go away when the situation is over. For a person suffering from social anxiety disorder (SAD) that familiar nervous feeling is brought on by simple, everyday encounters with other people. The sufferer imagines that people he or she meets are scrutinizing and judging them, causing fear, humiliation, self-consciousness and embarrassment. Some people confuse shyness with social anxiety, but the two are very different. In rare instances, SAD sufferers may have specific fears such as using a public bathroom, eating at a restaurant or using a phone in the presence of others.

People with SAD can be at ease with people most of the time, but specific situations such as walking down an aisle in public or having to address a group of people can trigger intense anxiety. They blush easily and are convinced that all eyes are upon them.

Risk Factors

SAD is one of the most common mental disorders. It usually begins in the early to mid-teen years or in adulthood. Several factors can increase the risk of developing SAD including:

  • Family history: SAD is more likely if parents or siblings have the condition
  • Negative experiences: children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to SAD. Family conflict or sexual abuse may also contribute
  • Temperament: children who are shy, timid, withdrawn or restrained when facing new situations or people may be at greater risk
  • New social or work demands: meeting new people, giving a speech in public or making an important work presentation may trigger SAD symptoms for the first time
  • A health condition that attracts attention: facial disfigurement, stuttering, Parkinson’s disease and other health conditions can increase feelings of self-consciousness and may trigger SAD in some people


As with other mental health disorders, SAD likely arises from a complex interaction of environment and genes. Possible causes include:

  • Inherited traits – Anxiety disorders tend to run in families. It is not clear how much of this may be due to genetics and how much to acquired behavior
  • Brain structure – A structure in the brain called the amygdala may play a role in controlling the fear response, causing increased anxiety in social situations
  • Environment – SAD may be a learned behavior acquired by witnessing the anxious behavior of others. There may be an association between SAD and parents who are more controlling or protective of their children

Effects of SAD

SAD patients are aware that their feelings are irrational and extreme, but the fear controls them and they continue to avoid public and social occasions as much as possible. Even if they struggle to confront their fear and go forward with an event, they will feel extremely anxious beforehand and intensely uncomfortable throughout. Afterward, the feeling may remain as they worry about their performance, how they may have been judged or what others may have thought of them. Those suffering from SAD might turn down a promotion or fail a class because the situation involves public presentations.


  • A significant and persistent fear of social performance in which the person is exposed to scrutiny and unfamiliar people
  • Fear of humiliation and embarrassment
  • Exposure to a social situation in a person with SAD can trigger a panic attack
  • Fear of offending  someone
  • Intense fear of talking with strangers
  • Self-consciousness about  anxiety
  • Fear of physical symptoms such as blushing, sweating, trembling or having a shaky voice
  • Avoiding being the focus of attention
  • Experiencing anxiety in anticipation of an event
  • Critical post-event analysis of performance
  • Always expecting the worst from a social situation

Physical signs and symptoms can sometimes accompany SAD and may include:

  • Rapid heartbeat
  • Upset stomach or nausea
  • Difficulty breathing
  • Dizziness or lightheadedness
  • Confusion or feeling “out of body”
  • Diarrhea
  • Muscle tension
  • Avoiding normal social situations

Common, everyday activities that may be difficult to endure for a person with SAD:

  • Using a public bathroom
  • Interacting with strangers
  • Eating in front of others
  • Making eye contact
  • Initiating conversations
  • Dating
  • Attending parties or social gatherings
  • Missing work or school
  • Entering a room in which people are already seated
  • Returning items to a store

Complications – if left untreated, SAD can cause:

  • Low self-esteem
  • Trouble being assertive
  • Negative self-talk
  • Hypersensitivity to criticism
  • Poor social skills
  • Isolation and difficult social relationships
  • Low academic and employment achievement
  • Substance abuse
  • Suicide or suicide attempts

If you suspect you or a loved one may be suffering from SAD see your doctor for a diagnosis. A doctor can suggest a psychiatrist, psychologist or other qualified clinician who can recommend appropriate treatment. Medication may be prescribed and therapy at a residential or outpatient facility.

When researching a treatment center, make a list of questions to ask. Things to look for in a good treatment center include a thorough patient assessment including a search for underlying conditions. This approach to treatment is referred to as dual diagnosis. Examples of underlying conditions include depression, bipolar disorder, substance abuse, panic disorder and schizophrenia. All conditions must be treated concurrently to achieve the optimum outcome.

A treatment plan should be designed for each patient, targeting their specific needs and goals. A good treatment center will offer individual and group therapy. Cognitive therapy teaches patients how to redirect their thought processes to achieve a healthier outcome. Individual therapy offers one-on-one, non-judgmental discussion in a private setting. Medication will be prescribed at the discretion of the clinician.

Group therapy is beneficial as patients share their experiences and listen to those of others. It is encouraging to meet people with similar problems, hear their stories and see that they are on the road to recovery.

Cognitive testing is another important means of assessing brain wellness. The cognitive connection to mental health is measured with a painless procedure involving the mapping of the brain to assess areas that would benefit from treatment.

A reputable treatment center will involve family members in the treatment process and will also provide continuing care for patients post-treatment. There should be a designated phone number for patients to call in addition to a contact email address. Continuing care provides support and encouragement for those who are finished with their treatment. Numerous facilities even have reunions and events for patients and their family members to attend in order to help keep up the support structure they need to succeed out in the real world.

Most treatment centers accept health care insurance plans, which makes treatment affordable.

For further information, please call Anxiety Treatment Centers of California at 855-972-9459.