Severe Social Anxiety: A Debilitating Condition

Social anxiety disorder, particularly in its more severe form, can significantly impair an individual’s ability to function in daily life and go far beyond shyness or occasional nervousness in social situations. For those with severe social anxiety, the prospect of any social interaction including leaving home and attending work or school can trigger intense fear, panic, and a range of physical symptoms that can be overwhelming and disruptive.

A person with severe social anxiety may experience particularly difficult forms of physical, emotional and cognitive symptoms such as blushing • feeling hot or sweating • trembling or shaking • disjointed speech • racing heart • tension in head, neck, or shoulders • nausea or butterflies • mind going blank • disabling negative thoughts about themselves or how they are perceived by others.

Some individuals may experience panic attacks.  Please see our page on panic attacks.

Severe social anxiety may sometimes be related to other conditions such as selective mutism. This condition is characterised by a consistent inability to speak in specific social situations. See https://www.selectivemutism.org.uk/ and https://www.selectivemutism.org/

A common and visible symptom of severe social anxiety can be blushing. Extreme blushing can cause significant distress in itself and further exacerbate other symptoms (see our page blushing and social anxiety).

Another hallmark of severe social anxiety is the tendency to avoid leaving one’s accommodation. This avoidance behaviour can lead to what is essentially self-imposed isolation. For these individuals, the thought of encountering others, even if just shopping or leaving the house can trigger extreme anxiety. This avoidance can have far-reaching consequences, potentially impacting employment, earning capacity, housing, medical care, education and personal relationships.

Speeches, interviews, group work, presentations
For some with social anxiety, overt performance scenarios – a speech, interview, group work, presentation etc – may make social anxiety symptoms even stronger. In such situations it can be harder to hide or mask symptoms – knowing that others may see you struggle, can often make the social anxiety much worse. For some – especially when they feel they have no support or escape – it can lead to severe or tragic outcomes. It is essential you seek help immediately if your social anxiety is reaching a crisis point – see our page https://socialanxietyalliance.org.uk/getting-help-in-a-crisis/

Impact on Daily Life

The effects of severe social anxiety can permeate every aspect of an individual’s life. For those able to work it may mean taking jobs that are not suitable or appropriate to their skills. For those in professional settings it may manifest as a reluctance to speak up in meetings, difficulty presenting to groups, or challenges in networking and career advancement. For some it can result in difficulties working in any capacity. This in turn can have a severe impact on financial stability and housing.

In educational contexts, students of all ages may struggle with class participation, friendships, group activities, or regular attendance.  In some instances, social anxiety can result in people completely dropping out of school, college or university.

Personal relationships can also suffer. Individuals with severe social anxiety may find it challenging to initiate conversations, make friends, or pursue romantic relationships. Even maintaining existing relationships can be difficult, as the person may frequently cancel plans or avoid social gatherings.  The lack of self-esteem which is often associated with social anxiety disorder can also mean that sufferers are more vulnerable to abuse.

In many aspects of ordinary life social anxiety disorder can result in people accepting second best and not speaking up e.g. to access public or healthcare resources, make a complaint, or to stand up for their rights.

The digital age has introduced new challenges for those with social anxiety. While online communication might seem easier than face-to-face alternatives, many individuals may still experience severe anxiety when engaging in calls, chats, posts or interacting on social media platforms.

Long-term Consequences and comorbidities

If left untreated, severe social anxiety can lead to a range of secondary issues including depression, social isolation and loneliness alongside an increased risk of developing other anxiety disorders. NICE social anxiety guidance for professionals states there is a significant degree of comorbidity between social anxiety disorder and other mental health problems. This is why it is so important to find help especially if you feel you are struggling.

Treatment
Whilst severe social anxiety can be debilitating there is evidence-based research that it still responds to therapy in the same ways as less severe forms of social anxiety. See our pages on what the NHS offers, how to make progress, self-help books, support groups and forums, courses-and-practical-help, finding a private therapist.

It is essential you seek help immediately if your social anxiety is reaching a crisis point. See our page https://socialanxietyalliance.org.uk/getting-help-in-a-crisis/