Social phobia is not shyness: performance exposure is torture

Various life circumstances can make us the focus of attention, such as in situations of exposure and social performance, bringing us initial discomfort that tends to improve over time.

Some routine examples are: school or university work that we need to present in front of the whole class, an explanation of the goals achieved at the end of the month in a work team meeting, a job interview or promotion, when we are introduced as the new member of a group of friends There are also those cases in which we are one more, such as parties, birthdays, restaurants or any other type of social event, including activities such as eating in a group or signing a document.

For those who suffer from Social Phobia or Social Anxiety Disorder (SAD), the two situations (being the center of attention or being in social interaction in a group) can be decoded as a threat followed by a feeling of shame, a feeling of inadequacy and being being monitored, watched, evaluated, judged or even rejected, and this type of anxiety is much more prevalent than one imagines.

Another issue worth mentioning is that initial anxiety is expected to normalize over time, leaving the person more comfortable in the situations exemplified above, but this does not happen with those who suffer from Social Anxiety, quite the contrary, because this it tends to intensify, causing somatic symptoms such as cold sweats and hand tremors, as well as behavioral symptoms characterized by avoidance of places and situations.

Thus, the person becomes more and more a prisoner of their fears: that of being evaluated and that of being ridiculed or rejected. This is one of the least known anxiety disorders, but it causes numerous damages in the functional life of those who suffer from it.

It is classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as Social Anxiety Disorder and by ICD-11 as Social Phobia, being the most common anxiety disorder, being prevalent in women, affecting approximately 9% of women and 7% of men, generally beginning in childhood and/or adolescence and characterized by an exacerbated fear of exposure and social performance for a period of at least 6 months.

Signs and characteristics of Social Anxiety Disorder (SAD)

From the threatening perception of being negatively evaluated by people, anticipatory anxiety is present and with it its characteristic symptoms of anxiety: dizziness, shortness of breath, facial flushing, nausea, tremors in hands and feet, excessive sweating (sweating), stomach ache, palpitation, headache, muscle tension, cold sweat, feeling of anguish and apprehension. 

In front of a presentation to the public, for example, the person babbles, the speech does not come out or is shaky, it seems that everything that was studied is not remembered, the body shudders and what is most desired is that this state of torture ends the day. As soon.

In fact, it is something that causes a lot of apprehension and suffering, since the person suffers before, during and after the event, anticipating catastrophic situations and ruminating invasive thoughts, the most common being the tormenting beliefs that it will not work, that the The person’s concept will fall before everyone’s evaluation, that he will be ridiculed, that he will be ashamed or that he will not be able to carry out the proposed task and from this point on, his entire career will be destroyed, catastrophizing the situation. There is, in this picture, an exacerbation of irrational fears and I will explain the causes below.

Social Anxiety Disorder (SAD) is not just about shyness

We all have our personality characteristics, our way of being and of relating to people. Some are more reserved and introspective, others more talkative and outgoing, but Social Phobia/SAD is not about introspection or just shyness.

As I previously reported, we display some level of anxiety in new or unexpected situations where we are the “center of attention.” However, this fear of exposure and social interaction tends to decrease, the person adapts and is expected to gradually develop mechanisms of social skills to deal with these events.

The same does not happen with those who suffer from Social Anxiety, since the person’s anxiety tends to increase to a critical point in which they decide to give up important things in their life, such as a profession, a relationship or friendships, avoiding any situation where you can be evaluated on your performance. Therefore, the person loses opportunities and becomes more and more cloistered in her fears. Therefore, Social Anxiety Disorder is highly disabling, bringing with it functional, personal, affective and psychosocial damage.

Other diagnostic criteria for Social Phobia or Social Anxiety Disorder (SAD) according to the DSM-V are the following clinical and behavioral aspects.


1- Persistent fear of being exposed in public and consequently of being judged, criticized and rejected.

2- Anticipatory anxiety, rumination and catastrophic thoughts, as well as typical anxiety symptoms before and during the exposure event.

3- Possible appearance of anxiety attacks in the most serious cases.

4- Behavioral avoidance and avoidance of social interaction or exposure to performance evaluation events.


Possible causes include genetic, neurophysiological and environmental factors. Family learners, overprotective and overly critical parents, as well as traumatic experiences during the child’s development period, such as exposure followed by teasing, punishment and humiliation in front of peers or others, which causes low self-esteem and fear of social interaction. The severity of the disorder will depend on the age, duration, intensity and suffering generated.

Disorders associated with social anxiety:

The main disorders associated with SAD are: Depression, Attention Deficit Hyperactivity Disorder (ADHD) and Alcoholism.


According to clinical evidence, the treatment that brings effective results is psychotherapy. However, in the most serious cases it is necessary to include medication, with selective serotonin receptor inhibitors (SSRIs) being the most commonly used.

In addition to the use of specific psychological techniques and instruments in the treatment of SAD, such as relaxation techniques, self-management, training in social skills and assertiveness, as well as systematic exposure and desensitization techniques, cognitive restructuring and dysfunctional beliefs are worked on. essential, these last two being the central points of Psychotherapy. This is because it is precisely the cognitive errors that lead to irrational beliefs, which translate into anxious symptoms and avoidance or avoidance behaviors that make it impossible, paralyze, and impair the person’s social skills.

As previously reported, all areas of life are compromised, from personal, academic, and work life. It is also necessary to verify, during the clinical history, whether traumas occurred in the patient’s life history, especially in childhood, involving experiences of humiliation, contempt, ridicule, and exclusion.