OVERVIEW

What is Social Anxiety Disorder?

Social anxiety primarily manifests as excessive and disproportionate fear in situations requiring interpersonal interaction, making the individual's behavior appear awkward and preventing them from performing at their actual social ability level.

In addition to experiencing more negative emotions, individuals with social anxiety disorder often face misunderstandings from others, such as comments like "You're overthinking it" or "You're being too sensitive."

However, social anxiety disorder may require professional psychological intervention or medication to improve.

If you are diagnosed with social anxiety disorder, please seek active treatment. If your friend or family member is diagnosed, offer them patience, encouragement, and care, as this will aid their recovery in both mental and physical health.

Is Social Anxiety Disorder Common?

The prevalence rate ranges between 2.4% and 13.3%, with two peak onset ages: 5 years old and 11–15 years old. However, most seek treatment around the age of 30.

SYMPTOMS

What are the symptoms of social anxiety disorder?

The core concern of social anxiety disorder is the fear of being embarrassed, humiliated, or laughed at when being scrutinized by others. Once they notice or believe others are paying attention to them, they feel extremely uncomfortable, avoid eye contact, and may even feel deeply ashamed. For example, when around someone they are attracted to, they may overanalyze their words and actions, leading to silence, appearing cold or completely disinterested.

Patients may recognize that their reactions are excessive and unnecessary, feeling intense distress but unable to control it. Most actively seek help or medical treatment.

The objects of anxiety and fear for social anxiety disorder patients are often members of the opposite sex, strict superiors, future in-laws, or even acquaintances. In severe cases, it can extend to all social situations and people outside of family members.

Patients with social anxiety disorder often deliberately avoid social interactions, such as refusing to give public speeches, avoiding front-row seating at gatherings, or rejecting blind dates. Some patients confine their lives to a routine between home and work, while more severe cases may completely withdraw from social activities, isolating themselves—unable to attend school, work, or even leave the house, cutting off all contact with society.

Depression may develop, and some patients may turn to alcohol or drugs to alleviate anxiety. The risk of suicide is higher than in the general population.

CAUSES

What are the causes of social phobia?

The exact pathogenesis of social phobia remains unclear. Current research suggests it is closely related to an individual's cognitive patterns and personality traits in social situations.

Social interactions are inevitably driven by motivation, and the formation of this motivation is heavily influenced by one's environment and personality. For example, individuals who prioritize saving face over well-being, perfectionists, those overly concerned with others' impressions and evaluations of them, or those who avoid facing reality are more likely to develop social phobia.

In most cases, the subjects of social phobia are rarely family members, possibly because interactions with family do not require excessive social motivation, and there is no fear of embarrassment in front of them. Additionally, social phobia symptoms may alleviate after middle age. A possible explanation is that, with age, people become less sensitive to social judgments, and the specific motivational needs for social behavior gradually diminish, causing social phobia to lose its foothold.

DIAGNOSIS

How is social phobia diagnosed?

Diagnostic criteria for social phobia:

• Essentially, it involves fear of being scrutinized by others and worrying about embarrassing or poor performance;

• Anxiety, fear, or panic reactions are clearly disproportionate to the actual situation;

• Subjective distress or unnecessary worry that is difficult to control;

• Persists for more than 6 months;

• The individual exhibits significant avoidance of social interactions, which negatively impacts their personal life and work.

Social anxiety or shyness is common in the general population. It may become particularly prominent during certain developmental stages, such as adolescence, or after life transitions like marriage or career changes. However, not all such cases meet the criteria for social phobia.

If your condition meets the above diagnostic criteria, please do not avoid seeking medical help due to "stigma." Struggling with overwhelming emotional issues is not your fault, and you have the right to seek assistance.

What is a social phobia self-test? Is this self-assessment method reliable?

A social phobia self-test refers to a psychological assessment that individuals can complete on their own to evaluate the severity of their social anxiety. These tests are typically in questionnaire form, and in psychology, such assessment tools are often called "scales."

Currently, commonly used psychological assessments for social phobia in China include: the Social Avoidance and Distress Scale (SAD), the Fear of Negative Evaluation Scale (FNE), the Interaction Anxiousness Scale (IAS), the Social Phobia Scale (SPS), and the Social Interaction Anxiety Scale (SIAS).

Research by domestic scholars has confirmed that these scales can effectively assess the degree of social phobia.

TREATMENT

How to Treat Social Anxiety Disorder?

The treatment of social anxiety disorder mainly includes medication and psychotherapy.

Psychotherapy:

• Cognitive-behavioral therapy (CBT) is the primary approach. Under the guidance of a therapist, patients gradually expose themselves to social situations of varying anxiety levels, weakening and eliminating the association between fear triggers and anxiety responses. They learn to resist avoidance behaviors while adjusting their cognitive and behavioral patterns.

• Additionally, virtual reality (VR) technology may make it easier to simulate social scenarios with different fear intensities. For individuals with social anxiety, systematic desensitization through VR combined with online guidance may soon become a viable option.

Medication:

• For medication, newer antidepressants such as SSRIs and SNRIs are the first-line treatment. These drugs typically take 4–6 weeks to show stable effects, and maintenance therapy may last about a year. Stopping medication too early increases the risk of relapse.

Being diagnosed with social anxiety disorder may feel overwhelming, but it's important to follow medical advice and actively pursue treatment. Whenever possible, combining medication with psychotherapy is recommended for better outcomes.

DIET & LIFESTYLE

None

PREVENTION

What are the self-prevention methods for social anxiety disorder?

• The treatment of social anxiety is a long-term process, and the more proactive you are in participating, the greater the potential benefits.

• Exercise diverse and flexible thinking by viewing the same issue from different perspectives.

• In terms of self-awareness, try to recognize and accept your imperfections.

• Practice bravely taking responsibility, admitting, and correcting mistakes—stubbornly saving face and refusing to admit faults will only push people away.

• Avoid excessive focus on outcomes, as stronger intentions can lead to greater anxiety. "Deliberate planting may not bloom, while careless sticking may yield shade."