An old friend was recently in town, and we made plans to get together. I was nervous to see her and her partner; we hadn’t seen each other for years, and it meant a lot that we were connecting again. Then, during our time together, I made a joke that I quickly realized could be harmful. I felt my face turn red. I wasn’t sure how to proceed, so I just tried to act “normal.”
Meanwhile, I kept looking at my friend and her partner’s face to ascertain the damage done, and internally, I struggled not to berate myself. I hate to admit it, but I was barely present for the rest of the dinner. I spent the next day thinking about what I had said, trying to offer myself compassion and feeling quite ashamed. I finally sent an apology text. Historically, I would have just tried to ignore the discomfort and shove it down (only to have it reemerge stronger), so being accountable and acknowledging my perceived misstep was big. My friend was gracious. And beyond that, she denied that either she or her partner were offended at all. In the moment, social anxiety convinced me I was wrong and what I had done was shameful. It derailed my time with my friend, causing me to withdraw and spin out. It’s such a powerful force, and it can cause so much damage when it goes unchecked.
What is social anxiety? And what is social anxiety disorder?
Social anxiety has become a term that is used loosely when we talk about mental health. Just like with depression and anxiety, most people will experience social anxiety at times, as it’s common to sometimes feel uncomfortable in social situations and worry about how others perceive you.
Social anxiety disorder, formerly known as social phobia, is characterized by intense and persistent fear of social situations or interactions. People struggling with social anxiety experience anxiety or fear when they expect to be scrutinized, evaluated, or judged by others. If you experience social anxiety, you likely experience significant distress and anxiety in social settings, fearing embarrassment, judgment, or scrutiny by others. With social anxiety disorder, this fear can be so overwhelming that it interferes with your daily life, work, school, and relationships. Social anxiety disorder is more than just feeling a bit nervous before an event or meeting; it can be debilitating and affect many or every area of a person’s life.
Because the anxiety and fear can be so great, people who suffer from social anxiety disorder can often engage in avoidance, canceling plans to attend a party, or not following up after a date. As a result, many people who experience social anxiety can become extremely isolated and lonely. However, someone with social anxiety is not necessarily someone who dislikes being around others. Those with social anxiety often long to connect with others, and the isolation resulting from the anxiety can further negatively impact their mental health.
Social anxiety disorder can also manifest in physical symptoms like blushing, sweating, trembling, rapid heart rate, nausea, headaches, and difficulty speaking. These symptoms can be so severe and distressing that they further contribute to the person’s anxiety; the symptoms make them feel out of control, and this causes a fear that they won’t be able to do anything, like go to work or school or do various other everyday tasks like go grocery shopping. Anticipatory anxiety is another trait of social anxiety disorder. Social anxiety can make someone obsess and ruminate over something that hasn’t happened yet, like an event or meeting, and often, they will create and worry about the worst-case scenario for its outcome.
Furthermore, social anxiety is by no means an uncommon condition. The condition has often been found to begin in late childhood/early adolescence and extend to the late teen years into adulthood. Some develop the condition later in life. Research indicates that it occurs more in women than men. Close to 15 million adults in the US suffer from social anxiety, which can persist throughout one’s life if left untreated.
The good news is that social anxiety can be managed, and the effects can be mitigated.
What causes social anxiety?
Scientists have yet to determine the exact cause of social anxiety but have theorized that it may originate from various genetic, physical, and biological factors. There may be a genetic predisposition to the development of social anxiety. Individuals with a family history of anxiety disorders, including social anxiety, may be more likely to experience it themselves. Differences in brain structure and neurotransmitter function are also linked to social anxiety. For example, specific brain areas, such as the amygdala (involved in processing fear) and the prefrontal cortex (involved in decision-making and emotional regulation), have been proven to be more sensitive or reactive in individuals with social anxiety.
In addition to the genetic and biological factors associated with social anxiety, several environmental factors must be considered. Research supports that those with adverse childhood experiences (ACEs), like neglectful parents or extreme bullying, are more likely to develop social anxiety. This is also true of individuals with overly critical or overprotective parents. Where a person grows up, the types of societal pressures and cultural expectations they face, and the early childhood observation of anxiety in others (like parents) can all contribute to the development of social anxiety. And social anxiety can be particularly challenging for marginalized groups due to additional factors related to identity, discrimination, and social context.
Evolutionary psychologists indicate that social anxiety provides protective mechanisms, too. One study states that our strong need to compare ourselves to others, our well-developed social ‘antennae’ for what others think of us, and our desire to signal social status result from our need for social selection. Furthermore, evolutionary scientists tend to agree that given the nature of our societies as we’ve evolved and the genuine threats that may have come from rejection (think death, being eaten), social anxiety served to keep us highly attuned to risk, not just of ridicule but to our lives. Unfortunately, while this level of anxiety may have helped us at one time, the stakes for survival have changed, and our level of anxiety is likely mismatched and causing more harm than it is helping.
How does social anxiety affect mental health?
Social anxiety can have wide-ranging effects on mental health. The negative self-perception, social isolation, and avoidance of activities experienced by those with social anxiety can often lead to depression. Constantly fearing negative evaluation, rejection, or humiliation by others can lead to a diminished sense of self-worth and self-esteem. People might also experience more distorted thinking patterns or cognitive distortion, such as overestimating the likelihood of negative outcomes and underestimating their abilities. Most significantly, it has been shown that those with social anxiety and other mental health disorders have an increased risk of suicidal ideation and attempts to die by suicide.
What’s the relationship between social anxiety and alcohol?
The relationship between social anxiety and alcohol is a significant one. In fact, social anxiety disorder more than quadruples the risk of developing an alcohol use disorder, according to research. If we take a moment to think about this relationship, it makes a lot of sense. Alcohol can temporarily reduce anxiety symptoms by affecting the central nervous system, producing a feeling of relaxation. People struggling due to social anxiety may drink before social activities to help themselves manage the stress and feel more prepared, during an activating event, and afterward to cope with negative self-talk about their performance. This can make social situations feel more manageable for individuals with social anxiety.
Unfortunately, the costs outweigh the benefits. Using alcohol to self-medicate can also impair judgment and decision-making, which may ultimately reinforce the negative self-evaluations people with social anxiety are struggling with in the first place when they reflect on or learn about how they were behaving when inebriated. And the relief that alcohol provides is short-lived and may exacerbate the anxiety for other reasons, too. Hangovers, withdrawal symptoms, and the overall impact of alcohol on brain chemistry can lead to increased anxiety, which is the last thing someone struggling with social anxiety needs. And over time, individuals with social anxiety who use alcohol as a coping mechanism may need more alcohol to achieve the same level of relief, leading to alcohol dependence or substance abuse. Additionally, excessive alcohol use and abuse can lead to physical and mental health issues.
What’s the difference between being an introvert and having social anxiety?
As a therapist, I have noticed that often, when people are experiencing social anxiety, they blame it on being an introvert. This is misleading because introversion is not the same as social anxiety, and conflating the two can sometimes stop people from accessing support and getting relief from the symptoms of social anxiety. People who are introverts and those who struggle with social anxiety both desire connections with others. Introverts often prefer to spend time with people in smaller groups or with friends and family one-on-one. They may enjoy social interactions but find them draining over time. If they limit social interactions, it’s not due to fear but the need to preserve their energy or recharge. Being an introvert is not considered a mental health concern, and there are many gifts associated with being an introvert.
Those with social anxiety disorder, however, are managing a mental health condition. They often avoid or dread social situations because they anticipate embarrassment or humiliation. Someone can be an introvert who experiences social anxiety, but it’s essential to recognize that these are two distinct experiences for those struggling or suffering to access appropriate support.
What’s the difference between being shy and having social anxiety?
Shyness is not the same as having social anxiety, although there may be a relationship between the two. Shyness is a personality trait and is also fairly common. Shyness involves feeling hesitant, reserved, or uncomfortable in certain social situations, particularly when meeting new people or being in unfamiliar environments, but it doesn’t necessarily interfere significantly with a person’s daily life. In some cultures, shyness is viewed positively, but unfortunately, this is typically not the case in our society in the US. While someone shy may avoid certain social situations and may take time to warm up, this differs from social anxiety. The distinction here includes the intensity, as social anxiety is more intense and causes extreme distress. And in fact, according to the DSM-V, only a minority (12%) of self-identified shy individuals in the US meet the diagnostic criteria for Social Anxiety Disorder.
How do you manage social anxiety?
The first step in addressing social anxiety is acknowledging that it’s what you’re experiencing. While many who suffer from social anxiety will want to withdraw from whatever is triggering it, which looks different for everyone and could be anything from writing an email to a professor to attending a music festival, they also really desire connection. In these instances, social anxiety is impairing their ability to connect. Instead of trying to deny that you’re suffering from social anxiety or writing it off as shyness, the first step to creating change is to acknowledge the problem. Not sure if what you’re experiencing is social anxiety? Ask yourself if your fear of rejection or embarrassment is one of your worst fears and if the fear of rejection is getting in the way of you doing things you want to do.
Foster social courage:
Dr. Fallon Goodman, a leading researcher on social anxiety, states, “Being socially courageous means pursuing experiences and knowing that your chances of rejection are not zero. Being socially courageous means pursuing experiences because they are important to you and knowing that the successes of those pursuits are not contingent on your worth as a human being.” Pursuing experiences because they’re important to you and prioritizing yourself over social anxiety will gradually help you create the connections you value and make social anxiety less powerful. That doesn’t mean you must jump into the deep end, but instead, try to take baby steps. Identify what feels doable for you while still outside of your comfort zone, and do that. Does that mean holding the door for a stranger? Saying hello to the person looking at you instead of averting your eyes? Returning a text or sending an email? Everyone’s social anxiety will look somewhat different and can be activated by diverse triggers. Notice your triggers and which ones you can begin to challenge.
Respond to your body:
When you pay attention to what activates your social anxiety, observe what is happening within your body. When we feel anxious in social settings, we often try to push through and ignore our body cues, which can exacerbate the anxiety, or we remove ourselves from the social setting entirely. Instead, what would happen if you noticed that your body was having a response and tried to soothe it? This doesn’t necessarily mean removing yourself from the situation causing the social anxiety, although you may need to if it’s too much for your body. But it could also mean you need to take breaks, and that’s totally okay. Soothing yourself could also be focusing on your breathing and slowing your body down, going to the bathroom to run cold water on your hands, or going outside for fresh air.
Have compassion for yourself:
If you struggle with social anxiety, chances are your self-talk is negative and full of criticism. Negative self-talk and social anxiety often go hand in hand, and while it’s a symptom of social anxiety, according to research, it also worsens social anxiety. While it’s far easier said than done, offering yourself compassion when you’re experiencing social anxiety and showing care and kindness in your self-talk can temper social anxiety and improve your relationship with yourself.
Social anxiety is a highly treatable condition. Effective treatment is generally achieved through various therapeutic approaches, lifestyle changes, and, in some cases, medication. Cognitive Behavioral Therapy (CBT) is a well-established and effective therapy for treating social anxiety. Treatment that involves learning and practicing social skills can also help individuals become more confident in social interactions. And Acceptance Commitment Therapy (ACT), another therapeutic modality, uses mindfulness techniques to help individuals accept their thoughts or feelings without judgment, reducing negative thoughts and increasing physical relaxation.
Even though social anxiety is so common, it can still be challenging to recognize it for what it is. Many suffer for years trying to manage it while sacrificing relationships, connections, and experiences. Social anxiety can complicate and sabotage our thoughts, emotions, and behaviors, leaving us trapped in a cycle of self-doubt and isolation.
Please reach out if you need additional support in addressing your social anxiety and responding to yourself compassionately. The path through may not be easy, but the connections out there and the relief are worthwhile, as are you.