symptoms and treatment of social anxiety


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Several years ago, Carol* contacted me about the anxiety and bouts of sadness that she had been experiencing for most of her life. When we met, she was in her late 30’s, single, and working in the education system.

For Carol, coping just meant she “learned to live with it.” Her anxiety affected several areas of her life, but it was most disruptive in social interactions. Though she had always been shy, around the age of 11 or 12, she began experiencing significant social distress. When she was around people, she became very sweaty, self-conscious, and worried about embarrassing herself. She avoided asking questions in class or asking for help. Over the years, her social life became more and more limited. Carol kept a few friends but struggled with making new friends. She made excuses to avoid parties or gatherings. Her anxiety affected her self-esteem and grades at school.

Even throughout college, social anxiety continued to haunt her. As a result, Carol’s career options were severely limited. She found a job within the school system where there was minimal social interaction.

Her primary care doctor had known about Carol’s struggles for many years but didn’t know the source of her anxiety. At the doctor’s urging, Carol finally decided she needed to try seeking help.

What is social anxiety disorder?

  • According to the DSM V, social anxiety disorder is characterized by chronic, persistent fear or anxiety in the face of social situations in which the individual might get judged by others.
  • Also known as SAD, social anxiety disorder usually presents during adolescence

How do I know if I have social anxiety disorder?

Here are some common ways people with SAD might describe themselves:

  • “I’m afraid of embarrassing myself if I try to chat with others.”
  • “The interviewer will think I’m too dumb for this job.”
  • “I shouldn’t go to this party; they’ll all think I’m lame.”
  • “I could call customer service… but I’d get humiliated on the phone.”
  • “I’ll go home right after class so that I don’t have to see anyone I know.”
  • “If I have to talk in front of people, my heart starts racing and my palms start sweating.”

Do any of these statements sound familiar?

Isn’t social anxiety just being shy?

  • Shyness can happen with or without a diagnosis of social anxiety disorder.
  • Some people we might call “shy” are merely introverted and prefer less social interaction.
  • In contrast, those who experience SAD feel daily distress toward social situations that inhibit their ability to pursue career opportunities, make friends, and participate in group activities.
  • According to some studies, up to one third of self-identified “very shy” people experience shyness without fear of social settings.

How common is social anxiety disorder?

  • According to some studies, up to 7% of the population in the United States alone suffer from SAD
  • An estimated 4% internationally will experience social anxiety disorder in their lifetime.

So, I have social anxiety disorder. Now what?

  • There are three major interventions that are supported by the research: group therapy, cognitive behavioral therapy, medication
  • Therapy is a very effective form of treatment – medications are not always necessary.

I worked with Carol for about 6 months using cognitive behavioral therapy (CBT). Carol was relieved to know that there was a diagnosis for what she was struggling with. She had never heard of social anxiety disorder; she had always assumed that she was just shy.

Initially, Carol was ambivalent about medications, but open to therapy. Over the ensuing weeks, we discussed how her thoughts and beliefs affected her anxiety and how the avoidance increases anxiety. We also worked on exposure therapy, a gradual exposure to stressful situations. After several months, her symptoms greatly improved. She was applying for new jobs that were closer to her interests and started going to church. She even stayed for fellowship where she could meet more people. Her mood had significantly improved as well.

Despite her progress, she was still having anxiety that, though tolerable, still limited her enjoyment with various activities. She decided to try medication. I started Carol on a medication for social anxiety disorder called Lexapro. Her anxiety improved significantly. She felt more comfortable at work, created a profile on a dating site, and had the confidence to apply to several new job positions.


Social anxiety disorder can very challenging to cope with and rarely has an easy fix. However, with treatment, people can make significant improvement and move towards their professional and personal goals. So, if you are feeling stuck with social anxiety, don’t give up—seek help. Relief could be right around the corner. Dr. Shapiro provides online treatment, both practical therapy and medication management.

*Disclaimer: Details of cases have been altered to protect the confidentiality of any and all individuals.







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