Social anxiety can be defined as nervousness in social situations. Some disorders associated with the social anxiety spectrum include anxiety disorders, mood disorders, autism, eating disorders, and substance use disorders. Individuals higher in social anxiety avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining conversation. Trait social anxiety, the stable tendency to experience this nervousness, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Nearly 90% of individuals report feeling symptoms of social anxiety (e.g. shyness) at some point in their lives. Half of the individuals with any social fears meet criteria for social anxiety disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.
Some feelings of anxiety in social situations is normal and necessary for effective social functioning and developmental growth. Cognitive advances and increased pressures in late childhood and early adolescence result in repeated social anxiety. Adolescents have identified their most common anxieties as focused on relationships with peers to whom they are attracted, peer rejection, public speaking, blushing, self-consciousness, freaking out, and past behavior. Most adolescents progress through their fears and meet the developmental demands placed on them. More and more children are being diagnosed with social anxiety, and this can lead to problems with education if not closely monitored. Part of social anxiety is fear of being criticized by others, and in children, social anxiety causes extreme distress over everyday activities such as playing with other kids, reading in class, or speaking to adults. On the other hand, some children with social anxiety will act out because of their fear. The problem with identifying social anxiety disorder in children is that it can be difficult to determine the difference between social anxiety and basic shyness.
It can be easier to identify social anxiety within adults because they tend to shy away from any social situation and keep to themselves. Common adult forms of social anxiety include performance anxiety, public speaking anxiety, stage fright, and timidness. All of these may also assume clinical forms, i.e., become anxiety disorders (see below).
Criteria that distinguish between clinical and nonclinical forms of social anxiety include the intensity and level of behavioral and psychosomatic disruption (discomfort) in addition to the anticipatory nature of the fear. Social anxieties may also be classified according to the broadness of triggering social situations. For example, fear of eating in public has a very narrow situational scope (eating in public), while shyness may have a wide scope (a person may be shy of doing many things in various circumstances). The clinical (disorder) forms are also divided into general social phobia (i.e., social anxiety disorder) and specific social phobia.
Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by a significant amount of fear in one or more social situations causing considerable distress and impaired ability to function in at least some parts of daily life.:15 These fears can be triggered by perceived or actual scrutiny from others.
Physical symptoms often include excessive blushing, excess sweating, trembling, palpitations, and nausea. Stammering may be present, along with rapid speech. Panic attacks can also occur under intense fear and discomfort. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. It is common for sufferers of social phobia to self-medicate in this fashion, especially if they are undiagnosed, untreated, or both; this can lead to alcoholism, eating disorders or other kinds of substance abuse. SAD is sometimes referred to as an "illness of lost opportunities" where "individuals make major life choices to accommodate their illness". According to ICD-10 guidelines, the main diagnostic criteria of social anxiety disorder are fear of being the focus of attention, or fear of behaving in a way that will be embarrassing or humiliating, avoidance and anxiety symptoms. Standardized rating scales can be used to screen for social anxiety disorder and measure the severity of anxiety.
The first line treatment for social anxiety disorder is cognitive behavioral therapy (CBT) with medications recommended only in those who are not interested in therapy. CBT is effective in treating social phobia, whether delivered individually or in a group setting. The cognitive and behavioral components seek to change thought patterns and physical reactions to anxiety-inducing situations. The attention given to social anxiety disorder has significantly increased since 1999 with the approval and marketing of drugs for its treatment. Prescribed medications include several classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). Other commonly used medications include beta blockers and benzodiazepines. It is the most common anxiety disorder with up to 10% of people being affected at some point in their life.
Signs and symptoms
Blushing is a physiological response unique to humans and is a hallmark physiological response associated with social anxiety. Blushing is the involuntary reddening of the face, neck, and chest in reaction to evaluation or social attention. Blushing occurs not only in response to feelings of embarrassment but also other socially-oriented emotions such as shame, guilt, shyness, and pride. Individuals high in social anxiety perceive themselves as blushing more than those who are low in social anxiety. Three types of blushing can be measured: self-perceived blushing (how much the individual believes they are blushing), physiological blushing (blushing as measured by physiological indices), and observed blushing (blushing observed by others). Social anxiety is strongly associated with self-perceived blushing, weakly associated with blushing as measured by physiological indices such as temperature and blood flow to the cheeks and forehead, and moderately associated with observed blushing. The relationship between physiological blushing and self-perceived blushing is small among those high in social anxiety, indicating that individuals with high social anxiety may overestimate their blushing. That social anxiety is associated most strongly with self-perceived blushing is also important for cognitive models of blushing and social anxiety, indicating that socially anxious individuals use both internal cues and other types of information to draw conclusions about how they are coming across.
Individuals who tend to experience more social anxiety turn their attention away from threatening social information and toward themselves, prohibiting them from challenging negative expectations about others and maintaining high levels of social anxiety. A socially anxious individual perceives rejection from a conversational partner, turns his or her attention away, and never learns that the individual is actually welcoming. Individuals who are high in social anxiety tend to show increased initial attention toward negative social cues such as threatening faces followed by attention away from these social cues, indicating a pattern of hypervigilance followed by avoidance. Attention in social anxiety has been measured using the dot-probe paradigm, which presents two faces next to one another. One face has an emotional expression and the other has a neutral expression, and when the faces disappear, a probe appears in the location of one of the faces. This creates a congruent condition in which the probe appears in the same location as the emotional face, and an incongruent condition. Participants respond to the probe by pressing a button and differences in reaction times reveal attentional biases. This task has revealed mixed results, with some studies finding no differences between socially anxious individuals and controls, some studies finding avoidance of all faces, and others finding vigilance toward threat faces. There is some evidence that vigilance toward threat faces can be detected during short but not longer exposures to faces, indicating a possible initial hypervigilance followed by avoidance. The Face-in-the-crowd task shows that individuals with social anxiety are faster at detecting an angry face in a predominantly neutral or positive crowd or slower at detecting happy faces than a nonanxious person. Results overall using this task are mixed and this task may not be able to detect hypervigilance toward angry faces in social anxiety.
Focus on the self has been associated with increased social anxiety and negative affect, however there are two types of self-focus: In public self focus, one shows concern for the impact of one's own actions on others and their impressions. This type of self-focus predicts greater social anxiety. Other more private forms of self-consciousness (e.g., egocentric goals) are associated with other types of negative affect.
Basic science research suggests that cognitive biases can be modified. Attention bias modification training has been shown to temporarily impact social anxiety.
Trait social anxiety is most commonly measured by self-report. This method possesses limitations, however subjective responses are the most reliable indicator of a subjective state. Other measures of social anxiety include diagnostic interviews, clinician- administered instruments, and behavioral assessments. No single trait social anxiety self-report measure shows all psychometric properties including different kinds of validity (content validity, criterion validity, construct validity), reliability and internal consistency. The SIAS along with the SIAS-6A and -6B are rated as the best. These measures include:
- Fear of Negative Evaluation (FNE) and Brief form (BFNE)
- Fear Questionnaire Social Phobic Subscale (FQSP)
- Interaction Anxiousness Scale (IAS)
- Liebowitz Social Anxiety Scale-Self Report (LSAS-SR)
- Older Adult Social-Evaluative Situations (OASES)
- Social Avoidance and Distress (SAD)
- Self-Consciousness Scale (SCC)
- Social Interaction Anxiety Scale (SIAS) and brief form (SIAS-6A and -6B)
- Social Interaction Phobia Scale (SIPS)
- Social Phobia and Anxiety Inventory (SPAI) and brief form (SPAI-23)
- Situational Social Avoidance (SSA)
- Avoidant personality disorder
- Highly sensitive person
- Major depressive disorder
- Obsessive-compulsive disorder
- Selective mutism
- Social inhibition
- Social isolation
- Social rejection
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