Prevalence, Causes, Symptoms, and Treatment for Social Anxiety
Facts Abouth Social Anxiety
If you’re looking for reliable facts about social anxiety disorder, you’re in the right place. Social media is often full of myths. Even support forums, while sometimes helpful, can spread misinformation or focus only on worst-case scenarios. That’s why I put this guide together.
Here you’ll find clear, research-based information on what social anxiety is, how common it is, where it comes from, how it connects with other conditions, and most importantly – what you can do about it!
Prevalence of Social Anxiety Disorder
Social Anxiety Disorder (SAD) is the third largest mental health care problem in the world today (after depression and alcohol dependence), affecting 7% to 8% of the population at any given time, with a lifetime prevalence of about 13%. An estimated 19.2 million Americans have social anxiety disorder. That’s a lot of people! SAD is more common in women than in men (though men are more likely to seek help), and more common in younger people.
Social anxiety usually begins in adolescence, often between ages 10 and 15. Onset after 25 is rare, though it can appear in early childhood.
Over one-third of people with social anxiety struggle for more than 10 years before seeking help. The majority (about 70%) have another mental health concern.
Causes of Social Anxiety
The exact cause of social anxiety disorder is still unclear. Research suggests it develops through a mix of genetic, biological, psychological, and environmental factors.
There are several subtypes of SAD, and causes and risk factors vary for each. Possible causes of SAD include:
Biological Factors
Anxiety disorders tend to run in families, suggesting a genetic component. Overactivity in certain brain structures, such as the amygdala may cause a heightened fear/anxiety response in social situations for people with social anxiety
Psychological Factors
Cognitive distortions and biases in thinking are major causes of social anxiety. Low self-esteem is also frequently a factor.
Environmental Factors
However, SAD may also be a learned behavior. This can refer to parental/family interactions, other negative life events, and experiences in other environments
Some researchers have suggested that SAD may play an adaptive role when considered in an evolutionary framework
Why do I have social anxiety? Here is what many people commonly say:
- Having biological parents or siblings with the disorder
- Parental style, especially having parents who are overly controlling or protective, distant, or rejecting
- Some individuals with SAD perceive their parents as having isolated them from social experiences and as being more avoidant of social situations themselves
- Having a childhood temperament that is shy, timid, or withdrawn. Behavioral inhibition, defined as a temperamental style characterized by the tendency for children to display fear, avoidance, or quiet restraint in unfamiliar situations, is associated with SAD
- Having a health condition that draws attention and increases self-consciousness
- Witnessing the anxious behavior of others, especially one’s parents (SAD may be a learned behavior)
- Facing increased demands at work or in social situations (e.g., giving a speech or making a presentation)
- Experiencing a socially traumatic event involving rejection or humiliation, bullying or teasing; being criticized or humiliated in front of the class; making a presentation; blushing
- Someone whose parents didn’t have many friends and didn’t socialize (lack of role model)
- Some people have been shy all their lives and don’t remember a time when they were comfortable around strangers or even loved ones
- Emotional or physical abuse
- Having a family that criticizes or condemns your ideas, or your right to have ideas
- Lack of acceptance by your family
Diagnosing Social Anxiety Disorder
If everyday social situations cause intense fear, embarrassment, or panic, you may have social anxiety disorder or another condition that requires treatment.
When seeking help, we recommend looking for a doctor or mental health professional who specializes in social anxiety and who understands the problem and how to treat it.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM – 5), published in May 2013 by the The American Psychiatric Association, Social Anxiety Disorders can be diagnosed with the following criteria:
Criteria for Diagnosis of Social Anxiety Disorder
- Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation), being observed (e.g., eating or drinking), or performing in front of others (e.g., giving a speech).
- The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (e.g., be humiliated, embarrassed, or rejected) or will offend others.
- The social situation(s) almost always provoke fear or anxiety. (Note: in children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failure to speak in social situations.)
- The social situation(s) are actively avoided or endured with marked fear or anxiety.
- The fear or anxiety is out of proportion to the actual threat posed by the social situation. (Note: “Out of proportion” refers to the sociocultural context.)
- The fear, anxiety, or avoidance is persistent, typically lasting six or more months
- The fear, anxiety, and avoidance cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not attributable to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
- The disturbance is not better accounted for by another mental disorder (e.g., anxiety about having Panic Attacks in Panic Disorder, agoraphobia situations in Agoraphobia, separation from attachment figures in Separation Anxiety Disorder, public exposure to perceived physical flaws in Body Dysmorphic Disorder, or social communication problems in Autism Spectrum Disorder. Failure to speak is not better accounted for by stuttering or expressive language problems in Communication Disorders, or refusal to speak due to opposition in Oppositional-Defiant Disorder.
- If another medical condition (e.g., stuttering, Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is unrelated or is out of proportion to it.
Other Information on Diagnosis
There is a performance-only specifier “if the fear is restricted to speaking or performing in public” and “Individuals with performance-only social anxiety disorder do not fear or avoid non-performance social situations”.
You can see a table comparing the diagnostic criteria from DSM-V (above) with the previous DSM-IV here.
Preventing Social Anxiety Disorder
Unfortunately, at this time there is no known way to prevent SAD. However, being aware of the risk factors and symptoms, and seeking help as soon as the symptoms appear, can help you to minimize the impact of this disorder. Like so many other conditions, early detection leads to improved treatment effectiveness.
Prognosis for Social Anxiety Disorder
Left untreated, remission rate is low.
Social anxiety disorder can be debilitating, disrupting work, school, relationships, and quality of life. In severe cases, people may drop out of school, quit work, lose friendships, or confine themselves to their home.
With treatment, the outcome for social anxiety disorder is generally good. Many people improve significantly and enjoy more productive lives.
Comorbidities in Social Anxiety Disorder: It’s More Than Shyness!
People with SAD commonly have many comorbidities. These include:
- Depression. Major Depressive Disorder has been found in anywhere from 19.5% to over 58% of people with SAD. By contrast, the prevalence (12-month) in the general population is 6.6% (16% lifetime).
- Other Anxiety Disorders. Co-occurrence of other anxiety disorders is also high, about 38%, and increases when Major Depressive Disorder is present to 65.2%.
- By contrast, the rate of having other anxiety disorders is about 7% for the general population.
- Other Phobias. The presence of another phobia in people with SAD has been found to be 27% to 59%.
- It is 5-12% in the general population.
- Personality Disorders. SAD is highly correlated with personality disorders, especially Avoidant Personality Disorder.
- Alcohol Abuse. Alcohol abuse is very high in people with SAD, about 20% – 28%. It’s 4.65% in the general population. Those will SAD are 2-3 times more likely to develop an alcohol disorder than those without SAD. Those with an alcohol disorder are 10 times more likely to have SAD than those without.
- Suicide. Anxiety disorders in general are highly associated with suicide attempts. Among different anxiety disorders, people with SAD, in particular, are more likely to engage in self-harm, and do it multiple times, with at least one of the times being a true suicide attempt.
People with SAD are a high risk for suicidal ideation or actual suicide attempt. The table below shows the number of people with SAD who’ve had suicidal thoughts or made suicidal attempts.
| Study 1 | Study 2 | |
| Suicidal Ideation | 172/1140 (15%) | 550/1751 (31%) |
| Suicide Attempt | 403/1140 (35%) | 214/1751 (12%) |
Even though these people may have also had other disorders, the researchers showed that the risk for suicidal thought or action was high for SAD independent of the other factors.
In the general population (a sample of all people, with or without any disorders or illness), the numbers are as follows:
| Suicidal Ideation: | 3.7% |
| Suicide Attempt: | 0.5% |
These statistics show very clearly that people with SAD represent a very high proportion of people at risk for suicide. Of note, suicide risk in general is significantly higher in young adults aged 18-29 and in females.
- Unemployment. In one study, people with SAD had a 19.2% unemployment rate, while the general population had a 7.5% unemployment rate. They were less likely to be in managerial positions (1.6% vs. 7.1%) and more likely to have left a job for mental or emotional reasons (24% vs. 5%). They were twice as likely to be in the lowest income category. People with SAD are 2.25 times as likely to be unemployed as those with other anxiety disorders.
Treatment for Social Anxiety
Most common treatments for social anxiety
The two best-known therapies that have been proven effective by numerous research studies are Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT).
Cognitive Behavioral Therapy (CBT)
CBT is the most common type of counseling for SAD (and for anxiety disorders, in general). Hundreds of research studies indicate that, after the completion of social anxiety-specific CBT, people with social anxiety disorder report a changed life. CBT treatment works in both individual and group settings.
CBT teaches you how to recognize and change negative thoughts about yourself. It’s based on the premise that our feelings and behaviors are caused by our thoughts, not by external things like people, situations and events. Therefore, by changing “how we think”, we can change our feelings and behaviors, even if our situations remain the same. This is empowering because even if an unwanted situation won’t change, you can change the way you think and behave.
Acceptance and Commitment Therapy (ACT)
ACT is another therapy that has been shown to be effective in overcoming social anxiety. ACT is similar to traditional CBT in some respects, but also has several key differences. In particular, rather than trying to teach people to better control their thoughts and feelings, ACT teaches to “just notice, accept, and embrace” their private events, especially previously unwanted ones. The ultimate goal of ACT therapy is to help the individual to live a more meaningful and fulfilling life by increasing their ability to choose their actions and behaviors based on their values.
Other Treatments for Social Anxiety
But they are not the whole story!
Depending on your situation other types of therapy may be more helpful. These include psychodynamic therapy, metacognitive therapy, internal family systems and more!
Aside from formal therapy, self-help in the form of groups or books can be very effective. Medication, meditation, journaling and faith-based perspectives can also be helpful.
If you’ve tried one approach and it didn’t work, don’t give up! There are many other effective options.
Final Thought About Social Anxiety
Social anxiety is more than shyness (the inspiration for my book!). It can derail your whole life if left untreated. But it CAN be treated! You can not only manage it, you can thrive and have a full and meaningful life.
I’ve personally worked with hundreds of people in my social anxiety self-help groups that have succeeded.
I hope you’ve found these facts about social anxiety to be helpful. You can read more on my social anxiety resources page. You can also read about my personal story here.
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