Social anxiety disorder: causes, symptoms & tips
Almost one in ten people in Switzerland experiences symptoms of social anxiety disorder. The fear of being scrutinised or judged can really interfere with daily life.
A handshake, a lecture, a department meeting – situations that are part of everyday life for many people can be torturous for others. Even thinking about moments like these triggers palpitations and anxiety in those affected.
Social anxiety disorder, also called social phobia, goes far beyond normal shyness and can have a significant impact on a person’s daily life.
What is social anxiety disorder?
Social anxiety disorder is a recognised mental health condition characterised by an intense, persistent fear of being judged or scrutinised in social situations. The anxiety is so severe that those affected avoid social situations.
This is also how it is described in the International Classification of Diseases, ICD-10. The ICD is a globally valid system that helps medical professionals and researchers to classify diseases.
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Shyness and social anxiety disorder: the difference
In contrast to shyness, which many people are familiar with, the fears associated with social phobia are much stronger. Those affected are not only afraid of appearing insecure, but are also panicky about embarrassing themselves or being rejected.
This fear is disproportionate to the situation and massively restricts everyday life, work and relationships.
The disorder often begins in adolescence. While normal insecurities subside over time during puberty, they persist and often intensify if a person suffers from social anxiety disorder.
Over the years, those affected become increasingly withdrawn – some to such an extent that they barely participate in social life.
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Frequency: How many people are affected?
Based on the findings of the Swiss Health Observatory 2023 report, almost 10% of the Swiss population suffer from symptoms of social phobia. Women (11.3%) are more frequently affected by social phobias than men (8.1%).
Almost a third of young women between the ages of 15 and 24 said they recognised signs of social anxiety disorder in themselves. In comparison, the figure for men of the same age was 17%.
In an international comparison, the figures are significantly higher than in Germany, for example, where only 1 to 3% of people admit to experiencing symptoms.
Symptoms: What are the signs of a social anxiety disorder?
People suffering from a social anxiety disorder fear situations in which they could be scrutinised or judged. They often know that their fear is exaggerated, but they are unable to control their behaviour. This not only causes great suffering, but also leads to avoidance behaviour.
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Physical symptoms of a social anxiety disorder
Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:
- Blushing or visible trembling
- Sweating or a shaky voice
- Nausea, dizziness or shortness of breath
- Palpitations or muscle tension
- Strong urge to go to the toilet
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Psychological symptoms of social phobia
In addition to the physical signs, the illness is characterised by intense thoughts and feelings:
- Fear of negative evaluation or rejection
- Constant worry about embarrassing or humiliating yourself
- Excessive rumination before, during and after social situations
- Expecting the worst possible outcome in everyday encounters
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Behavioural changes due to a social phobia
Behaviour is strongly determined by fear. Typical signs are:
- Cancelling appointments or invitations
- Avoiding presentations, exams or public appearances
- Withdrawal from groups or conversations
- Hardly any eye contact or withdrawal from everyday life
The disorder has a profound impact on everyday life and relationships. It can permeate all areas of life – from school and work to friendships and relationships.
Causes & risk factors: What triggers social anxiety disorder?
As with many mental illnesses, there is no single cause of social anxiety disorder. In fact, it results from an interplay of genetic, biological and social factors.
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Predisposition and biology
Anxiety disorders tend to run in families. In addition to genetic factors, the brain also plays a role: The amygdala, responsible for processing anxiety, often reacts hypersensitively in those affected.
Researchers at Uppsala University in Sweden have also discovered that an altered balance between the neurotransmitters serotonin and dopamine is linked to the development of social anxiety disorder.
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Childhood and youth
Experiences such as teasing, exclusion, conflict or even abuse can increase the risk. Children who are naturally shy or reserved are also considered more susceptible.
If no way is found to deal with the fears during this developmental phase, they can persist into adulthood.
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Personality and self-image
Low self-esteem or the urge for perfectionism increase the fear of being judged negatively. Those who set themselves particularly high standards fear mistakes or embarrassment all the more.
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Triggers in adulthood
New demands, such as a job interview, an important presentation or meeting new people, can trigger symptoms for the first time.
Visible characteristics, such as stuttering, trembling or physical anomalies, can also contribute to those affected avoiding social situations even more.
Effects on life
If left untreated, social anxiety disorder dominates everyday life and blocks many opportunities for those affected.
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Effects of a social phobia on work and career
Many sufferers avoid situations in which they could be the centre of attention. They forego presentations, postpone job interviews or keep a low profile at meetings. The costs them career opportunities. This often leads to the feeling of not being good enough or not meeting requirements.
Social phobia also influences study and career choices. Some consciously choose paths that require less contact or pressure to perform, which limits development opportunities and has a long-term impact on income and career.
A study by Mettu University in Ethiopia confirms these correlations: Students with social anxiety disorder achieved significantly poorer exam results, avoided oral presentations and reported a noticeable decline in their quality of life.
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Effects of social phobia on friendships and relationships
Anyone who turns down invitations or avoids conversations quickly loses touch socially. This leads to loneliness and makes it difficult to make new contacts.
Anxiety also causes problems in partnerships. Many are afraid to address personal needs or boundaries. Conflicts remain unresolved, and closeness and intimacy suffer. Over time, those affected miss out on opportunities to deepen friendships or build a relationship.
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Health consequences of social anxiety disorder
The constant tension also has an effect on the body. People who are constantly on alert often suffer from sleep disorders, headaches or stomach problems. Constant stress weakens the immune system and increases the risk of cardiovascular disease.
The connection with depression is particularly clear. A European study from 2009 with almost 19,000 participants showed that 19.5% of people with social anxiety disorder also suffered from severe depression.
The risk of developing depression within two years of the onset of social anxiety disorder is more than five times higher than in the rest of the population, according to the study authors Maurice M. Ohayon and Alan F. Schatzberg.
Diagnosis: How is social anxiety disorder recognised?
Specialists and psychotherapists use clear criteria to determine whether someone is actually suffering from social anxiety disorder. A diagnosis is made when the fears
- have existed for at least six months,
- almost always occur in the same situations,
- are associated with the fear of negative judgement,
- put a heavy strain on everyday life,
- are disproportionate to the actual risk.
A physical examination is usually carried out first to rule out other causes such as medication or physical illnesses. Doctors then discuss the symptoms and have those affected fill out standardised questionnaires and interviews . These help to classify the severity and type of phobia more precisely.
“A differentiated diagnosis makes it possible to detect the disorder at an early stage and treat it in a targeted manner,” writes Dr Torsten Berghändler. It is also important to differentiate it from other illnesses, such as panic disorder or depression, which can cause similar symptoms.
Self-test: Do I have a social anxiety disorder?
A short self-test can help you to get an initial feeling for whether or not you have a social phobia. If several statements apply, it is worth seeking professional clarification:
- I’m very afraid of speaking in public.
- I avoid situations where I could be the centre of attention.
- I feel uncomfortable when I have to join a group.
- I’m afraid that people will see me blushing, trembling or sweating.
- I cancel meetings or appointments because I’m afraid of negative feedback.
Important: A self-test can never replace a medical diagnosis. If you suspect that you suffer from a social anxiety disorder, it is essential that you seek professional help.
Treatment options: How is social anxiety disorder treated?
Social anxiety disorder rarely goes away on its own. The good news, however, is that client-centered therapy – supplemented by medication if necessary – can significantly alleviate anxiety and make everyday life easier.
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Psychotherapy for social anxiety disorder
Cognitive behavioural therapy, in which those affected learn to question their anxious thoughts and gradually confront feared situations, works best. This way, the fear subsides over time.
However, researchers at the University of California in the USA have shown that this is not enough for everyone: “We see that many people fall back into old patterns after treatment. That’s why we are working on adjusting the therapy more closely to the everyday lives of individuals,” they write.
Digital channels are also gaining in importance. Particularly exciting: exercises in virtual reality. For example, those affected practise speaking in front of an audience in a computer-generated environment.
Researchers at Monash University in Australia report: “Virtual reality can be just as effective as real training situations and can be more low-threshold.”
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Medication for social anxiety disorder
If the anxiety is very severe, medication can help. Doctors often use certain antidepressants to dampen feelings of anxiety. Medication takes a few weeks to work. Beta blockers can alleviate palpitations or trembling before a lecture.
Tranquillizers work quickly, but are only suitable in the short term because they can be addictive. In any case, those affected should consult experts and only take medication on their recommendation.
Therapy takes time and energy. If you take small steps and keep at it, you can make great progress. According to the researchers from Los Angeles: “It isn’t talking about the fear, but the repeated experience that brings about change”.
Tips for daily life
Therapy is important, but applying strategies in daily life can also help to get anxiety under control step by step.
Take small steps and set realistic goals: Overcome fear in small portions. Seek out challenges that are slightly outside your comfort zone and focus on building skills incrementally. Even small successes will boost your self-confidence.
Question your thoughts: make a note of what scares you. Ask yourself: How realistic is that? What is the worst that could happen – and how likely is it? This is how fears lose their power.
Stay alert: In company, consciously focus on the activity you are doing – such as talking or eating – rather than on yourself.
Relaxation and exercise: Regular exercise, breathing exercises or relaxation methods such as yoga, progressive muscle relaxation or autogenic training help to calm the body down. Even taking short breaks, listening to music or taking a walk can often work wonders.
Maintain healthy routines: Getting enough sleep, eating a balanced diet and following calming rituals, such as drinking a cup of tea with lavender or lemon balm, give you strength to handle stressful moments.
Record your progress: Keep a diary. Make a note of small successes and triggers that you have mastered. This will show you how much you’ve already achieved.
Use digital support: Mental health apps or online coaching can accompany and motivate exercises, even if you don’t have an appointment with a specialist.
Mini exercises – immediate help with the onset of an anxiety attack
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Calm your breathing
Breathe in for four seconds, breathe out for six seconds. Repeat five times.
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Ice water trick
Run cold water over your wrists or let an ice cube melt in your hand. The cold stimulus clams the body down immediately.
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5-4-3-2-1 method
Acknowledge five things you can see around you, four things you can touch, three things you can hear, two things you can smell and one thing you can taste. This is how you direct the focus outwards.
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Feel your body
Clench your fists tightly for five seconds and let go. Repeat this with your shoulders and legs.
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Practice making eye contact
Hold a person’s gaze briefly, smile and look away again. Mini-exercises like these strengthen confidence in dealing with others step by step.
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Positive sentence
Say a reassuring phrase to yourself, for example “The fear will pass in a moment”or “I’ve done this before”.
Finding support – how health insurance can help
Anyone who suffers from social anxiety disorder should seek help early on.
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Psychotherapy for social phobia
If anxiety is severely affecting your life, psychotherapy is a good idea. Basic insurance covers the cost for up to 30 sessions, minus the deductible and copayment. Prerequisite:
- A doctor with appropriate further training issues the prescription.
- The psychotherapist is recognised by the basic insurance and has a cantonal professional license.
An additional commitment to cover costs is required for longer therapy. A specialist will assess whether the treatment can be extended.
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Who should I contact?
- Psychiatrists are doctors who are also authorised to prescribe medication for anxiety disorders.
- Psychotherapists work with conversations and behavioural therapy methods.
- Psychologists without additional training are not allowed to treat illnesses.
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Supplementary insurance for more options
Sanitas also covers non-medical psychotherapy through its Vital Smart or Vital Premium supplementary insurance plans.
There are also contributions for digital offers, such as online coaching or prevention programmes. People with social anxiety disorder can use these as a supplement – for example to practise dealing with stress or learn relaxation techniques.
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Practical help
Sanitas Cover Check
Medical hotline (24/7): 0844 124 365
Emergencies (24/7): +41 44 446 47 47
Conclusion: Social anxiety disorder doesn’t have to rule your life
Social anxiety disorder can severely restrict your life – but it is treatable. With the right therapy, everyday strategies and the right help, anxiety can be reduced step by step. No one has to remain alone with this burden.
