Social Anxiety Disorder

Social Anxiety Disorder Symptoms and Diagnosis

Social Anxiety Disorder Symptoms

People with social anxiety disorder (SAD) experience significant and chronic fear of social or performance-related situations in which there is the possibility of becoming embarrassed, rejected, or scrutinized. 

In these situations, people with SAD almost always experience physical symptoms of anxiety. Although they know their fear is unreasonable, they can't seem to do anything to stop it. So, they either avoid these situations altogether or get through them while feeling intense anxiety and distress.

Common Signs and Symptoms of Social Anxiety Disorder

Symptoms of social anxiety disorder typically fall within three different areas:

  1. Physical symptoms—what you feel 
  2. Cognitive symptoms—what you think  
  3. Behavioral symptoms—what you do

Physical Symptoms of Social Anxiety Disorder

The physical symptoms of SAD can be extremely distressing. Below is a list of symptoms that one might experience:

  • Shaking
  • Muscle tension
  • Chills
  • Chest tightness
  • Chest pain
  • Trembling voice
  • Shortness of breath
  • Lump in the throat
  • Blurred vision
  • Ringing in the ears
  • Headaches
  • Dry mouth
  • Dizziness
  • Nausea
  • Diarrhea
  • Paresthesias (tingling)
  • Heart racing (tachycardia)
  • Heart pounding (palpitations)
  • Disorientation (depersonalization and/or derealization)

For some people, these physical symptoms may become so severe that they escalate into a full-blown panic attack. However, unlike those with panic disorder, people with SAD know that their panic is provoked by fears of social and performance-related situations rather than believing that there may be some underlying medical problem.

Cognitive Symptoms of Social Anxiety Disorder

Social anxiety disorder also involves cognitive symptoms  which  are dysfunctional thought patterns experienced by people with the disorder. Individuals with this condition are bothered by negative thoughts and self-doubt when it comes to social and performance-related situations.

If these negative thought patterns are allowed to continue without treatment, they may also erode your self-esteem over time . Below are some common symptoms that one may experience:

  • Negative bias: A tendency to discount positive social encounters and magnify the social abilities of others.
  • Negative thoughts: These are automatic negative evaluations about oneself in a social or performance-related situation. For example, imagine you start a new job or arrive at the first day of a new class. The instructor or manager asks everyone to introduce themselves to the group. Someone with a social phobia may start to have thoughts such as:
    • “Everyone else looks so much more relaxed.”
    • “What if I say something dumb?”
    • “What if everyone notices my voice shaking?”
    • Thoughts start to rapidly spiral out of control to the point that you don't hear anything anyone else has said. When it comes to your turn, you say as little as possible and hope that no one has noticed your anxiety. ​(Negative thoughts often occur so automatically that one is not even aware of them.)
  • Negative beliefs: Strongly held beliefs about your inadequacy in social and/or performance-related situations.

Behavioral Symptoms of Social Anxiety Disorder

In addition to physical and cognitive symptoms, people with SAD also act in certain ways, known as behavioral symptoms. They tend to make choices based on fear and avoidance rather than actual preferences, desires, or ambitions.

For example, you may have dropped a class to avoid doing a presentation or turned down a job promotion because it meant increased social and performance demands.

People with generalized SAD are particularly at risk of having a poor quality of life. They may have few or no friends, no romantic relationships, drop out of school or quit jobs, and may use alcohol to tolerate anxiety.

Below are some common behavioral symptoms:

  • Avoidance: The things done or not done to reduce anxiety about being in social or performance-related situations.
  • Safety behaviors: Actions taken to control or limit experiences of social or performance-related situations.
  • Escape: Leaving or escaping from a feared social or performance situation

Signs and Symptoms of SAD in Children and Teens

Social anxiety disorder in children and teens may appear differently than in adults. Young children with the disorder may cling to a parent, have a tantrum when forced into a social situation, refuse to play with other kids, cry, or complain of an upset stomach or other physical problem. In some cases, children may even be too frightened to speak in certain situations. 

In contrast, adolescents with SAD may avoid group gatherings altogether or show little interest in having friends.

Situational Triggers

Symptoms of social anxiety disorder may be triggered by different situations for different people. For example:

Diseases and Conditions Similar to SAD

There are many conditions that share similarities with social anxiety disorder. Often, these may be diagnosed along with SAD.

Such conditions include:

When to See a Doctor

If you live with social anxiety, you may wonder whether your symptoms are severe enough for you to be diagnosed with social anxiety disorder (SAD).

It may be hard to know whether what you are experiencing is an illness that can be diagnosed. As a rule of thumb, if the symptoms you are experiencing are significantly affecting aspects of your daily life—such as relationships, work, or school—in a negative way or you find yourself avoiding situations because of anxiety, a trip to the doctor may be in order.

A trained mental health professional can assess your specific symptoms and determine whether they meet the diagnostic criteria for SAD. 

Although the symptoms of SAD can greatly affect your quality of life, the good news is that they respond well to treatment. The physical symptoms are well-suited to exposure therapy or medication and the cognitive and behavioral symptoms are good candidates for psychotherapy such as cognitive-behavioral therapy (CBT). If you have not already been diagnosed with SAD, receiving help should be your first priority.

A Word From Verywell

While only a trained mental health professional can provide a diagnosis, reading about the symptoms of the disorder will help inform whether what you are feeling is typical of those with SAD.

If you do find that your symptoms match a diagnosis of SAD, try not to feel too upset. Many mental health concerns are very amenable to treatment and social anxiety disorder falls into this category. Getting help may feel hard at first, but it will very much be a step in the right direction and worth it in the end.


Hope DA, Heimberg RG, Turk C. Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach Workbook (2nd Ed.). New York: Oxford University Press; 2010.

Massachusetts General Hospital. School Psychiatry Program & Madi Resource Center. Social Phobia (Social Anxiety Disorder). Accessed July 19, 2016.

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