Social Anxiety Disorder

People with SAD have an irrational fear of being watched, judged, or of embarrassing or humiliating themselves. The anxiety and distress become so extreme that it hinders daily functioning. While it can be a debilitating disorder, appropriate treatment recovery is possible.


People with social anxiety disorder know that their fear is out of balance with the actual situation, but they are still unable to restrain their anxiety. The anxiety may be specific to one type of social or performance situation, or it may occur in all situations.

Some of the situations that are common triggers include communicating with strangers, making eye contact, and initiating discussions. People with social anxiety disorder may experience cognitive, physical, and behavioral symptoms before, during, and after these social and performance situations.

Examples of cognitive symptoms:

  • Fearing situations where you don't know other people

  • Worrying that you will be judged by others

  • Fear of becoming embarrassed or being humiliated

  • Dreading upcoming events weeks in advance

Examples of physical symptoms:

  • Blushing

  • Profuse sweating

  • Trembling hands

  • Muscle tension

  • Racing heart

Examples of behavioral symptoms:

  • Avoiding social/performance activities

  • Leaving/escaping situations

  • Using safety behaviors


Social anxiety disorder usually begins in the adolescent years although it can start in childhood.  While the exact cause of SAD is unknown, it is believed to result from a combination of both genetic and environmental factors.

Imbalances in brain chemistry have been linked to SAD. For example, an imbalance in the neurotransmitter serotonin, a brain chemical that regulates mood and emotions, may play a role in the development of social anxiety disorder.

Over-activity of a structure in the brain called the amygdala has also been linked to social anxiety. People with SAD may be predisposed to an exaggerated fear response and, in turn, increased anxiety.

Several environmental factors may also increase your risk of developing SAD. These include but are not limited to:

  • Having an overly critical, controlling, or protective parent

  • Being bullied or teased as a child

  • Family conflict or sexual abuse

  • A shy, timid, or withdrawn temperament as a child


The most commonly used evidence-based treatments for this disorder are medication and cognitive-behavioral therapy (CBT). Often these two forms of treatment are used together for best results. In addition to CBT, there are a number of other types of therapy that may be used, either in an individual or group format.

Medications used to treat SAD:

  • Benzodiazepines

  • Beta-blockers

  • Monoamine oxidase inhibitors (MAOIs)

  • Selective serotonin reuptake inhibitors (SSRIs)

  • Selective serotonin-norepinephrine reuptake inhibitors (SNRIs)

Talk therapies used in the treatment of SAD:

  • Cognitive-behavioral therapy (CBT)

  • Psychodynamic therapy

  • Interpersonal therapy (IPT)

  • Rational emotive behavior therapy (REBT)

  • Acceptance and commitment therapy (ACT)

In addition to medication and therapy, technology-assisted interventions for SAD include Internet-delivered CBT, virtual reality exposure therapy, and cognitive bias modifications. Some people also use alternative treatments such as dietary supplements or hypnotherapy. In general, research evidence does not yet exist to support the use of alternative treatments for SAD.


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