Social anxiety symptoms, clinically termed Social Anxiety Disorder (SAD), encompass a triad of psychological, physiological, and behavioural manifestations arising from a persistent fear of scrutiny or negative evaluation. To meet DSM-5 criteria, this intense fear must persist for ≥6 months, be disproportionate to the actual threat, and cause clinically significant impairment. Lifetime prevalence reaches 12%, with females affected more frequently.
Core Psychological Symptoms include anticipatory anxiety (worrying for days or weeks before events), fear of scrutiny (dread of humiliation or rejection), and cognitive distortions (catastrophizing, overestimating threats, interpreting neutral cues as negative). Post-event rumination—replaying perceived flaws—is also characteristic.
Physiological Symptoms involve autonomic arousal: palpitations, blushing (erythema), sweating (hyperhidrosis), trembling, nausea, dry mouth, choking sensation, dizziness, and feeling of “mind going blank.” These somatic manifestations often reinforce the fear of public embarrassment.
Behavioural Symptoms include overt avoidance (skipping gatherings, avoiding eye contact, isolation) and safety behaviours (speaking softly, using phones as a distraction, excessive rehearsal). Children may express anxiety via tantrums, crying, or somatic complaints (stomachaches) to avoid school.
Diagnostic Threshold & Subtypes
- Duration: ≥6 months
- Impairment: Significant functional disability (work, relationships, school)
- Subtypes: Performance-only (public speaking) vs Generalised (most social situations)
- Insight: Adults recognise fear as excessive; children may not
Recognising this symptom triad is vital for differential diagnosis from shyness, as the sheer intensity and life-impairing nature of social anxiety necessitate evidence-based interventions like CBT or SSRIs.
