Social Anxiety Disorder

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Social Anxiety Disorder


Probably everyone has experienced shyness and some degree of social phobia at some point in their lives. This is particularly likely to have occurred when going into unfamiliar social contexts like a new school or workplace; and/or having to perform socially with new people or for people with perceived greater importance or social standing. For those with Social Anxiety Disorder they experience these feelings when trying to engage with everyday activities. This leads them to retreat from other people and avoid situations where any expectations can be placed on them to interact.

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Social Anxiety Disorders in adults and children

Situations that can be stressful include:

meeting new people
initiating conversations and talking in front of others
being watched particularly when doing something
speaking on the telephone
talking to people in authority
going to school or a work place
eating or drinking in front of anyone other than close family
going to shops
eye-to-eye contact
social gatherings and parties
using public toilets
complaining about a poor service or faulty goods

Adults are also likely to:

have low self-esteem
feel insecure about their relationships
fear being criticised
misuse drugs or alcohol to try to reduce their anxiety

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Social Anxiety Disorder in young children

Young children may:

frequently cry when new adults or children appear
freeze becoming immobilised
be wary of other children and tend to play alone
cling to parent and avoid socialising
not talk in social situations (selective mutism)
have temper tantrums when faced with new social situations or these are suggested
be risk avoidant - needs lots of encouragement to use playground equipment
show continuing separation anxiety when taken to nursery or school

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Physical Symptoms

Social Anxiety Disorder can cause a range of physical symptoms that can include:

skin flushing or blushing
feeling short of breath
feeling sick (nausea)
churning feeling in stomach (butterflies)
fast thumping heartbeat
feeling faint
difficulty talking and shaky voice
trembling or shaking
Confusion or feeling 'out of body'
Muscle tension

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Emotional Symptoms

Emotional symptoms of social anxiety disorder include:

feeling intensely self-conscious and easily embarrassed
obsessively worrying about social events for days, weeks or months before they occur
fear that others are judging them - paranoia that everyone is talking negatively about them
fear of doing something wrong and being humilated - predicting the worst possible outcome from any social situation
fear that others are aware that they are feeling anxious and notice physical symptoms such as blushing or stress in the voice.

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The extent to which each individual with Social Anxiety Disorder is able to cope with their condition determines the impact on their everyday functioning. Treatments focus on helping individuals with their symptoms and supporting them to overcome their anxieties. There are two approaches that have been found to effective for both adults and children:

Cognitive Behaviour Therapy. This approach involves attending sessions with a therapist who helps the patient replace negative cycles of thoughts and feelings with more positive interpretations of the situations that cause them distress.

Medication. Drugs are prescribed that work by reducing the excitability of the amygdala, part of the brain concerned with processing fear responses. The behaviours of Social Anxiety Disorder can be described as flight or freeze responses to stress and the amygdala is involved in this. Inhibiting these responses reduces the physical symptoms of anxiety enabling the individual to cope better when faced with difficult and stressful situations.

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You may also be interested in the following pages:

Emotional Regulation

Feeling Anxious Social Stories


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Mayo Clinic (2015) Social Anxiety Disorder. Available at: (Accessed: 05.07.2015)
NHS Choices (2015) Social anxiety disorder (social phobia) Available at: (Accessed: 05.07.2015)
SelfGuide.Org (2015) Social Anxiety Disorder and Social Phobia Available at:  (Accessed: 05.07.2015)

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