Home » anxiety disorders » Social anxiety disorder: Symptoms, causes and treatment

Social anxiety disorder, also known as social phobia, can have a major impact on your life. Where others approach social affairs whistling, you experience a lot of anxiety in certain situations or even your daily activities. This can be very annoying. A social phobia can restrict you in your functioning or even prevent you from living the life you want. How do you regain your grip? With the right attention to your symptoms, they can be reduced and even remedied. Read on if you want to know more about what social anxiety disorder is, what causes it and what treatment can help you.

What is a social anxiety disorder?

With social anxiety disorder, you are so afraid of reactions and criticism from others that it limits you. Social affairs, such as parties, networking events and dinners, for example, can make you nervous. But speaking in or in front of a group, such as during a meeting or a presentation, also upset you. If you find yourself in a social situation, you may suffer from a variety of anxiety symptoms.

The extreme anxiety you experience can lead to panic attacks. This can cause you to start avoiding dreaded social situations to avoid feeling the anxiety and avoid panic attacks. You make up excuses to avoid going to a party or call in sick on the day you have to present. Because you are so afraid of reactions and criticism from others, you often don’t dare tell them what is going on. This can cause you to become increasingly isolated.

Symptoms of a social anxiety disorder

Most of the symptoms you may experience in social anxiety disorder are similar to the symptoms of other anxiety disorders. Common symptoms in an anxiety disorder include nervousness, anxious thoughts, restlessness, abdominal pain, palpitations, trembling and excessive sweating. Do you also start sweating, trembling and get a stomach ache when thinking about a social situation? Then read more about the symptoms of anxiety disorder here.

In addition to these symptoms, there are also some that occur specifically in social anxiety disorder. In addition to anxiety in social situations, with this disorder you can, for example:

  • experience difficulties in making social contact;
  • be very preoccupied with what another person thinks of you;
  • being afraid that someone else will think you are weird.

Social anxiety disorder causes

No clear cause can be given for the development of social anxiety disorder. However, there are several factors that can play a role in the development of a social phobia:


One possible cause of social anxiety disorder, is heredity. Some people are more predisposed to develop social anxiety disorder than others. If social anxiety disorder runs in your family, you are more likely to develop it too. This may be partly due to heredity, but also because your environment plays a role in the development of a social anxiety disorder. For example, if you have an anxious mother, this can affect your behaviour as a child, but even when you are an adult, it can still affect you.

Past events

Certain (negative) past events can also contribute to the development of a social anxiety disorder. For example, if you were bullied in the past, this can still affect you for a long time. Your confidence in yourself and others is affected and you feel extra vulnerable in social contact because of this.

But you can also think of a one-off negative experience, such as a blackout during a presentation, an unpleasant moment during a meeting or an embarrassing situation during a party. The event gave you a very unpleasant feeling and you obviously don’t want to go through this again, this can fuel anxiety.

Certain groups

Anyone can get a social anxiety disorder and it usually develops in childhood, but certain groups are more susceptible to developing an anxiety disorder. These include people who:

  • live alone;
  • are unemployed;
  • have addiction problems;
  • are less educated;
  • have a trauma.

It is good to realise that these circumstances make you more sensitive, but it does not necessarily mean that you will actually develop a social anxiety disorder.

What are the treatment options for social anxiety disorder?

As it is a condition with a chronic course, which does not recover spontaneously, adequate treatment is of great importance. Usually, cognitive behavioural therapy is chosen as the first step.

What is cognitive behavioural therapy?

Cognitive behavioural therapy (CBT) is the form of psychotherapy whose effectiveness in social phobia has been best established. Social phobia involves thoughts (cognitions) that are not real. For example, a patient’s thought that everyone will think he is weird because he is blushing. CBT focuses on these kinds of thoughts. The patient is helped in a very practical way to replace these unreal thoughts with real thoughts (= cognitive restructuring). For example, the thought that it is weird to blush can be replaced by the thought that most people blush sometimes and so it is not weird to see someone else blush. Exposure to socially phobic situations (= exposure) is also practised. Here, patients are encouraged and guided to deal with increasingly difficult situations in steps. People with social phobia appear to focus their attention more on what others think of them than on what is actually happening. With exercises, this can be brought back to realistic proportions (= task concentration training).

CBT is given by a psychologist or psychiatrist. Treatment lasts 3 to 6 months on average, with weekly meetings. In between, the patient also has to do exercises and “homework” by himself. In 60-70%, there has been a marked reduction in symptoms after CBT. CBT can be applied to the specific subtype as well as generalised social phobia.


Is therapy not helping or not enough? Or do you have a social anxiety disorder as well as depression? Then, together with your doctor, you can opt for drug treatment.

Medicines for depression (antidepressants) can help with a social anxiety disorder. Your doctor will explain how and how often you should take the medicines. It is important that you always take the medicines on time. You can use tools for this, such as a schedule or a special pillbox.

In the first weeks, you may experience side effects, such as:

  • more anxiety
  • To counteract this, you can take sedatives (benzodiazepines) such as diazepam or oxazepam. These drugs are narcotic and addictive. You should therefore avoid taking them or, at most, use them for 1 to 2 weeks.
  • dry mouth
  • gastrointestinal complaints
  • drowsiness or insomnia
  • sweating
  • less desire to have sex
  • In the longer term, you may gain weight.
  • The side effects vary from drug to drug and usually disappear over time.

After a few weeks, it will become clear whether the medicines work well for you. If so, you will continue taking them for at least a year.

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