Social Anxiety Disorder

Social Anxiety Disorder involves intense, persistent fear or anxiety about social situations where you might be scrutinized or judged by others. This fear often centers on concerns about acting in a way, or showing anxiety symptoms, that will be negatively evaluated—leading to embarrassment, humiliation, or rejection.

Common feared situations include meeting new people, speaking in public, eating or drinking in front of others, or even simple interactions. You may experience significant anxiety anticipating these situations, endure them with intense fear, or avoid them altogether. Physical symptoms like blushing, sweating, trembling, rapid heartbeat, or nausea are common during feared situations.

A core feature of SAD is fear of negative evaluation:

• Excessive self-consciousness in social situations that makes every interaction feel like a performance under scrutiny.
• Heightened attention to perceived social threats where you notice every frown, pause, or shift in body language.
• Negative self-view and perception of being socially inadequate that persists despite evidence to the contrary.
• Overestimation of likelihood and consequences of negative evaluation where you predict catastrophic outcomes from minor social missteps.
• Anticipation that others will judge you harshly even when there's no objective reason to believe this.

Understanding what keeps social anxiety going is essential for treatment:

• Self-Focused Attention: When anxious, your attention shifts inward to monitoring how you appear, which actually impairs your social performance.
• Safety Behaviors: Subtle avoidance within situations (avoiding eye contact, speaking quietly, rehearsing sentences) that prevents full engagement and learning.
• Post-Event Rumination: Mental replay of social interactions focusing on perceived failures.
• Negative Self-Imagery: Distorted mental image of how you appear to others—far more negative than reality.

Biased Information Processing

• Attentional bias: You preferentially attend to threatening social cues (frowns, rejection signals).
• Interpretation bias: Ambiguous social situations are interpreted negatively.
• Memory bias: Better recall of social failures and negative feedback.

A diagnosis is typically made by a mental health professional based on a clinical interview and assessment of symptoms according to criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The professional will explore the specific situations that trigger your fear, the nature of your fear (fear of negative evaluation), the extent of your avoidance behaviors, and the level of distress and functional impairment caused by your anxiety.

Symptoms must typically be present for at least six months and not be better explained by another mental disorder, medical condition, or substance use. Rating scales may sometimes be used to gauge severity.

You can practice coping strategies alongside formal treatment:

1. Face Feared Situations Gradually

Create a hierarchy of feared situations from least to most anxiety-provoking. Systematically approach rather than avoid—starting with lower-anxiety situations and progressing as confidence builds. Practice is key: social skills improve with repeated exposure.

2. Reduce Safety Behaviors

Drop subtle avoidance like avoiding eye contact, speaking quietly, or mentally rehearsing every sentence. These behaviors prevent you from learning that feared outcomes don't happen. Engage fully in social situations.

3. Focus Outward

Shift attention from self-monitoring ("How do I look? What do they think of me?") to the external environment and other people. Listen actively to what others are saying rather than analyzing your own performance.

4. Challenge Negative Thoughts

Question predictions ("Will people really think I'm stupid?"). Notice how often feared outcomes actually occur. Evidence usually contradicts catastrophic predictions.

5. Stop Post-Event Rumination

Don't replay social situations searching for what went wrong. This mental review is biased and increases anxiety for future interactions.

6. Accept Physical Symptoms

Blushing, sweating, or trembling are uncomfortable but not dangerous. Fighting symptoms increases them. Others notice symptoms far less than you think.