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Beyond Shyness: When Social Anxiety Threatens to Take Over Your Life

by Robert Von Nordheim
social anxiety - water

Shyness… or social anxiety? Until recently, these terms were used interchangeably. It was thought that most socially awkward people had quirks that could be overcome with individual effort; otherwise, they were just “unfriendly,” with no interest in normal social activity.

Today, however, researchers in psychology and neuroscience recognize social anxiety as a disorder that can affect a person’s behavior and interactions. It’s also more common than once thought – in fact, it’s the 3rd most common psychiatric disorder in America.

So, what is the difference between normal shyness and being socially anxious, and what can you do about it? The issue poses many problems, but just as many solutions.

social anxiety - water

What is Social Anxiety?

People experiencing social anxiety are uncomfortable in situations where they feel they’re being evaluated; they worry about being judged or embarrassing themselves.

Without help, a socially anxious person may have trouble being assertive, as well as low self-esteem, underdeveloped social skills, and hypersensitivity to criticism. As a result, they may do poorly at work and school and struggle with forging relationships; they are also at higher risk for substance abuse, alcoholism, and suicide.

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Socially anxious people tend to stick closely to a daily routine and avoid interacting with strangers. Like most people, they have friends and loved ones; however, these connections are much harder to make and maintain.

When forced into a new or unfamiliar situation, socially anxious people may begin shaking, blushing, or sweating uncontrollably; they can even experience arrhythmia or panic attacks. Others show no external symptoms – outwardly calm, but inwardly nervous. They may rely on coping mechanisms instead, like drinking, smoking, flirting, or overeating.

Causes of Social Anxiety

Many different factors can contribute to social anxiety. Some cases are inherited. Often individuals with social anxiety have family members who also have some level of anxiety. Because of this, it is quite common for some anxiety symptoms to be learned from other family members making often difficult to determine if the symptoms are organic or modeled in the environment.

Brain chemistry also plays a role.

For some, anxiety is triggered by low levels of the neurotransmitter serotonin which helps to regulate mood and emotions. Without serotonin, our brains cannot respond normally to social situations, causing us to feel confused and stressed.

Serotonin imbalance is also linked to mood disorders such as depression and bipolar disorder, which have many of the same symptoms as social anxiety; in fact, many people suffer from a combination of these disorders.

Finally, in the brain, a structure in the brain called the amygdala (uh-MIG-duh-luh) can play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.

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Though social anxiety usually manifests during the teen years, it can also develop later in life if an individual experiences a negative or traumatic event. For instance, those who experience teasing and bullying or types of rejection and humiliation may be more prone to social anxiety disorder. Family discord or sexual abuse are also strongly associated with developing social anxiety disorder.

Treatments Available

Though social anxiety has long gone unrecognized, it can now be managed with a number of different treatments.


Anxiety medications help people feel relaxed and calm, so they have the clarity of thought to challenge their unrealistic fears. Patients can now take anti-anxiety medications to restore their serotonin balance, such as Zoloft and Prozac; people with mild symptoms, meanwhile, can take beta blockers to suppress the physical effects of nervousness (like blushing, sweating, and shaking).

These drugs do have a number of serious side effects, such as headaches, nausea, insomnia, and mood swings. Zoloft, meanwhile, has been linked with a number of sexual problems, including diminished sex drive and erectile dysfunction. Benzodiazepines and antihistamines are also very common medication treatments that may help treat social anxiety.

As with any medication, consult a doctor and obtain a prescription before using them.


Others respond better to therapy and life coaching, which allows them to practice normal social interaction without the fear of criticism or rejection.

With a psychologist’s help, patients can identify past experiences that may have contributed to their condition, giving them closure; they can also learn helpful stress management techniques through Cognitive Behavioral Therapy (or CBT). In this treatment, patients learn to challenge their negative thinking, face their fears and change their lifestyle. They engage in many new social situations, gradually gaining self-confidence and sociability.

A patient who is extremely nervous around women, for example, may start by creating a profile on a dating website or having dinner in public with a close female friend; with time and effort, they may be expected to ask out someone who they’re secretly attracted to.

These treatments can also be supplemented with medication, depending on your needs and symptoms.

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With the help of medication and therapy, most socially anxious people can easily manage their symptoms and lead happy, healthy, productive lives; however, they are never completely “cured.” Even after years of therapy, a socially anxious person may sometimes feel overwhelmed, suffering from “off” days or caving under especially stressful circumstances.

With a supportive network of friends and family, however, they can keep these setbacks to a minimum and take control of their social lives.

The Takeaway

Social anxiety can impact your life in many ways; it can limit your opportunities, place strain on your personal relationships, and negatively affect your self-image. However, with strength, dedication, and a little extra help, a person can transform this into a positive experience. They will truly appreciate the benefits of socialization and friendship and gain sympathy and sensitivity to the social needs of others.

Being socially anxious can be serious and life-changing, but for the millions of people which it affects, the outlook has never been better.

Concerned that you or a loved one might have social anxiety? You can start by taking a survey like this one, offered by the Anxiety and Depression Association of America (ADAA). If you are experiencing symptoms or would like to learn more about it, discuss it with your doctor – he or she may be able to recommend medication, therapists, or other treatments.

This article was reviewed and approved by Dr. Kimberly Williams.

  1. “Prozac.”
  2.  “Social Anxiety Disorder (Social Phobia).” Mayo Clinic. 23 August 2011.
  3. “Social Anxiety Disorder.” Web MD.
  4. “Zoloft (Sertraline).”
  5. Cleland, Sue. “Living with Social Anxiety Disorder.” Anxiety Disorders Association of Victoria. 2003.

Photo by seanmcgrath

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Jess January 3, 2014 - 6:12 pm

Social anxiety has literally taken my life from me. I can’t even talk to family members, it’s that bad. I have few to no friends and social networking sites are pretty much my only escape, as I can be whoever I want to be on the internet and no one will know who I really am. My teachers know nothing of my social anxiety and think I’m just addicted to the internet- they’ve even told my parents to take my internet away from me, which pushed me into a state of depression for three weeks. I couldn’t even leave my room and I only ate a sandwich once every two days and drank a cup of water every day. My teachers also put me in the worst situations. Group work? Fuck no. I’m not doing that- I can’t do that. I get bullied a lot and have frequent panic attacks and I feel there is nothing I can do. I can’t tell my teachers, my parents, no one. Not even the few people I’ve allowed myself to trust. I just… I just can’t. I figured since none of you probably know who I am, I could safely post this here to let off some steam. It’s really hard going through social anxiety.

Nicola January 24, 2014 - 4:19 pm

Hi Jess. I already feel a connection to you through your struggles. I suffer from anxiety and it led to a problems with alcohol which ended up with a stint in rehab where my issues really came to light. I don’t want this reply to be about me though. I mention this because I’m worried that your condition may lead you down a darker path especially when you say you are not eating properly. I am not expert but I am here to say that things can get better but you need to talk to a professional and most importantly be honest. Drinking was my only way of coping until I studied my behaviour and saw that I could manage things differently, but I need help with that. Medication can help too.

Six months after getting sober I found out I had cancer so I was really in a potentially bad place but strangely if I hadn’t been to rehab and had a support group I probably wouldn’t be here today. I feel that I sailed through treatment compared to some. I have panic attacks still and some days seem dark but I know these things will pass and if they don’t then maybe someone can help. I have faith in others and I enjoy life but I put limits on the things I do in order to reduce my stress. I am open with my friends about the pressure I feel and expect them to understand. If they don’t it is their problem. I want you to feel my sense of calm too. (It is not constant but can we ever expect that?) I was really messed up with anxiety. Please don’t hide.

emma October 1, 2013 - 7:17 pm

I suffer greatly from social anxiety in fact I would go as far as to say it is ruining my life. In someways a physical illness would be easier to cope with as people make snap judgements when they see someone physically shake e.g drug addict. I sometimes wish I could flick a switch in my brain to turn off this feeling. The feeling that sometimes makes me anxious to see friends and family. People need to understand how greatly this affects people.

cmoss95 December 5, 2013 - 7:02 pm

I get it. I’ve suffered from social anxiety for years, starting as a preteen. I have the same group of friends for over 20 years. Anyone outside of that frightens me. People in general scare me. I miss out on events that I enjoy because the first thing I ask is “how many people will be there?”. Airports, concerts, picnics, stores, festivals…it takes me days to recover from a social event…and this recover is living in solitude, unengaged, basically living as a hermit. Which of course friends,family and my daughter don’t understand.

Lea August 15, 2013 - 1:29 pm

After reading thing, I kind of understand a little more about why I act the way I do in some situations. I didn’t even make the relation between the anxiety & those actions!

sara July 12, 2013 - 8:08 pm

Wow, this is incredible!
I do face social anxiety sometimes, not to the extreme, but enough to make me feel uncomfortable to the point where I sometimes don’t even make sense.
Having read this makes me feel more hope in getting through this.
Thank you 🙂

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