Social anxiety is often conflated with shyness or introversion. When people with social anxiety open up about their fears, they're often met with unintentionally dismissive phrases like "stop worrying so much" or “just be yourself.” As a therapist, I can tell you that these well-intended "words of encouragement" often make people feel even more isolated and misunderstood than they already did. Social anxiety is not just nervousness -- it’s a deep, persistent fear that can make even simple interactions feel overwhelming. Healing is possible, but it takes time, patience, and the professional support. In this article, we’ll explore what social anxiety is, why it should be taken seriously, and its most effective treatment approaches.
What is social anxiety?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM5-TR), social anxiety is a consistent fear or anxiety of at least one social setting that lasts for longer than six months. As a result of fear of being negatively perceived, those social situations are avoided or face with acute anxiety.
Are social anxiety and anxiety the same things?
No, they are not the same. Social anxiety is a type of anxiety disorder that specifically revolves around social interactions. Anxiety encompasses a broader range of worries that go beyond social situations.
Are social anxiety and shyness the same thing?
No. Social anxiety and shyness are not the same thing. Shyness is a common personality trait, whereas social anxiety is a diagnosable mental health condition that severely impacts daily functioning. According to the DSM5-TR, in the United States, only 12% of people who identify as shy also meet the criteria for social anxiety.
What does social anxiety look like?
Social anxiety doesn't necessarily look the same for everyone. For some, social anxiety might look like blushing, avoiding eye contact, speaking softly, or hesitating to join conversations. For others, it might look like completely avoiding social situations or work events, delaying getting married or having kids, or self medicating through substance use.
What does social anxiety feel like?
Emotionally, social anxiety might feel like an intense fear of being judged or rejected by others, worrying about saying something embarrassing, overthinking social interactions, or a strong desire to avoid social situations altogether. These feelings may manifest physically as increased heart rate or palpitations, sweating or shaking, dry mouth or difficulty speaking, nausea or stomach discomfort, muscle tension, or restlessness.
Where does social anxiety come from?
Social anxiety is shaped by a combination of environmental influences, genetic predisposition, and individual temperament. According to the DSM5-TR, risk factors for developing social anxiety include:
Environmental: Exposure to certain environmental factors can lead to a higher likelihood of developing social anxiety disorder. In particular, experiences of being socially victimized or bullied and other traumatic events in childhood can increase the risk of developing social anxiety.
Genetic: There is a genetic component to social anxiety. According to the DSM5-TR, people who have parents, siblings, or children with social anxiety disorder are 2x to 6x more likely to have social anxiety themselves that people who don't have a close relative with social anxiety.
Temperamental: There are also temperamental factors that lead to a higher likelihood of someone developing social anxiety. Specifically, there is some evidence to suggest that people who are more cautious, who tend to be fearful of being perceived negatively, and who are risk adverse have a greater likelihood of developing social anxiety.
Can social anxiety cause depression?
Yes, research suggests that social anxiety disorder can cause depression. In particular, the isolation and negative self-talk that often come with social anxiety can lead to a depressed mood and feelings of worthlessness. For this reason, early identification and treatment of social anxiety can be crucial in preventing the onset or exacerbation of depressive symptoms.
How does social anxiety affect students?
Students with social anxiety might avoid raising their hand in class, dread group projects, or skip presentations, which can negatively impact both their academic performance and their confidence. Research suggests that students who have social anxiety disorder are more likely to drop to out of high school and are less likely to pursue higher education. Therapy can help students struggling with social anxiety to unlock their full potential.
How does social anxiety affect relationships?
Social anxiety can make building and maintaining relationships difficult. According to a study conducted in 2002, social anxiety is associated with an impairment in close relationships because individuals with social anxiety tend to:
Avoid Expressing Emotions: A tendency to avoid vulnerability may result in difficulty sharing feelings, which can hinder emotional intimacy and leave relationships feeling surface-level.
Avoid Conflict: Fear of upsetting others or being criticized may cause individuals to avoid addressing issues, leading to unresolved tension or a lack of authenticity in relationships.
Fear Rejection: A heightened sensitivity to rejection may result in overanalyzing interactions or withdrawing from relationships, even when there’s no real threat of rejection.
Exhibit Dependence: Being overly reliant on close relationships for reassurance can strain those relationships over time
While these behaviors can create barriers to meaningful connection, therapy can help individuals with social anxiety foster healthy and balanced relationships.
How does social anxiety affect daily life?
By definition, social anxiety negatively impacts daily life. According to the DSM5-TR, a diagnostic criteria of social anxiety is that the "fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning." This might look like not being able to maintain a job, avoiding essential tasks like grocery shopping or running errands, or withdrawing from social connections and support systems.
Can social anxiety go away?
Yes. With the right treatment, social anxiety can improve significantly. A 2024 study found that both Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) Therapy are effective in treating social anxiety.
As an EMDR trained therapist, my approach to treating social anxiety is trauma-informed and personalized to your unique experiences. We'll start by exploring the root causes of your social anxiety. The goal isn’t just to push through your anxiety. Instead, we'll work to rewire brain in order to create long lasting change. Curious to learn more? Don't hesitate to reach out if you're based in New York and have questions about the process.
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