'I am not so afraid of the dark night, as the friends I do not know, I do not fear the night above, as I fear the friends below' Stevie Smith

Social anxiety disorder (SAD)

The third post in this series on anxiety focuses on Social Anxiety Disorder (SAD). Although SAD is generally considered to be the most common form of anxiety, there exists some controversy over its adequate diagnosis. I am not altogether surprised, as what strikes me about SAD is that people who suffer from it can often think it is simply who they are, an intrinsic part of their personality that is as indelible as the colour of their eyes.                                                                                                                                                          pexels-photo.jpg

But let me begin by outlining some facts.

Social anxiety disorder is..
..an extreme fear of being being scrutinized and negatively judged and evaluated by others which impairs the ability to function in daily life.

Social anxiety disorder is not..
.. simply being shy, nervous or quiet. Paradoxically, people with SAD want to engage with others socially but their anxiety prevents it.

Uncomfortable nervousness around social situations such as public speaking or talking to people in authority is a so called normal form of social anxiety. Many people have a general sense of shyness or even a lack of self confidence. For others these social anxieties can be profoundly troubling and very difficult to cope with, impacting negatively on everyday tasks and activities such as working and shopping.

Symptoms of SAD can include:

  • a persistent, intense and overwhelming nervousness or dread of feared social situations and/or interaction with others
  • Excessive fear before, during and after social situations
  • A fear of being closely watched
  • Feeling embarrassed or humiliated by one’s actions
  • A persistent fear of being criticized or judged negatively
  • Hypersensitivity to criticism and fear of rejection
  • Excessively self conscious
  • Avoiding eye contact 
  • Excessive and uncontrollable blushing
  • Using drugs or alcohol to manage the fear

Specific fear-laden social situations which generate SAD can include:

  • Meeting strangers
  • Talking in groups
  • Speaking on the telephone
  • Talking with authority figures
  • Eating or drinking in company
  • Shopping
  • Working with others
  • Being the centre of attention
  • Using public toilets


In some extreme situations one or a combination of the above symptoms of SAD can lead to panic attacks. SAD has also been thought to be linked to other mental health conditions such as depression, Obsessive Compulsive Disorder, panic disorder and general anxiety disorder.

It is important to recognise that SAD can vary from person to person in terms of how it appears, its frequency, how long it lasts and what kind of situations trigger it.

Research suggests that SAD typically appears in childhood or adolescence although it can appear or persist well beyond these ages.

The consequences of SAD can include:

  • Reduced self confidence
  • Reduced self esteem
  • Interference with relationships
  • Impaired functioning at home, work, school or college
  • Avoidance of feared situations
  • Increasingly inhibited or defensive behaviours
  • Loneliness and/or depression

It is generally thought that the onset of SAD occurs usually (but not always) in childhood or in adolescence.

The causes of SAD are ..
.. thought to be the result of a combination of genetic and environmental factors, including the behaviour of parents.

Treatment for SAD can..
… take a variety of forms. As with all of the other anxiety disorders examined in this post-series, there can be a focus purely on managing and treating the symptoms of SAD with medication, relaxation and cognitive behavioural therapy (CBT) techniques, rather than addressing the underlying psychosocial factors that can bring about long-term emotional and behavioural change and healing. I will write more about this dual approach to treating anxiety in my conclusions to this anxiety post-series.

The main approaches to treating SAD are ..

  • Medication

GP’s may prescribe anti-anxiety agents or antidepressants. However, recent research indicates that on its own medication does not create long-term benefits. As I have mentioned in other posts, increasingly research finding indicate that talking therapies are at least as, if not more, effective than medication alone.

  • Cognitive Behavioral Therapy (CBT)

CBT has proven successful in dealing with SAD. In a nutshell this approach brings about an understanding of thought patterns,particularly those that are harmful or false. Combined with this is an understanding of behaviours, again focusing on those that are potentially negative or harmful.

  • Counselling and psychotherapy

Although CBT is an effective treatment for SAD, it may not suit everyone. It tends not to address individuals as multidimensional people who are affected in their day to day lives by more than just their thoughts: biology, social and environmental circumstances, past and current relationships (including childhood experiences) and the emotions around these can be equally important factors to consider in working to alleviate SAD.