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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. This disorder goes far beyond mere 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.
Severe social anxiety has the potential to significantly impair everyday communication and, in some cases, can lead to other anxiety-related conditions such as selective mutism. This condition is characterised by a consistent inability to speak in specific social situations, despite being able to speak more comfortably at other times. In this context an individual experiences an overwhelming anxiety that effectively “freezes” the individual’s ability to communicate verbally. The silence is often accompanied by other signs of social anxiety, such as avoidance of eye contact, physical rigidity, or withdrawal from social interactions.
One of the most common and visible symptoms of severe social anxiety can be blushing (see our page blushing and social anxiety). This involuntary reddening of the face, neck, and ears often occurs in situations where an individual feels self-conscious or believes that they are the centre of attention. For someone with severe social anxiety, blushing can feel like more than just minor embarrassment – it can cause significant distress and further exacerbate their anxiety in social situations.
A person with severe social anxiety may also experience other severe physical symptoms as a result. For these individuals in social contexts, they may experience panic attacks. A panic attack is characterised by a severe episode of fear that leads to significant physical symptoms, such as shortness of breath and sweating. Others may not have panic attacks but may feel nauseous to the point of feeling sick, have a racing heart, be sweating profusely and/or feel significantly dizzy. These symptoms can make social situations, understandably, even more fearful. Please see our page on panic attacks.
Another hallmark of severe social anxiety is the tendency to avoid leaving one’s house or one’s room in a shared flat/house. This avoidance behaviour stems from an intense fear of social situations and 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 (people based, rather than agoraphobia) can have far-reaching consequences, potentially impacting employment, earning capacity, housing, medical care, education and personal relationships.
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 might struggle with class participation, group projects, or even attending classes regularly. In some instances, social anxiety can result in people completely dropping out of school, college or university. In many aspects of life social anxiety can result in people accepting second best and not speaking up, for instance to make a complaint or to stand up for their rights.
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.
The digital age has introduced new challenges for those with social anxiety. While online communication might seem like a far safer alternative, many individuals still experience anxiety when engaging in video calls, sending emails, 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 and an increased risk of developing other anxiety disorders. The “context” section of the NICE social anxiety guidance for professionals states there is a significant degree of comorbidity between social anxiety disorder and other mental health problems, most notably depression (19%), substance-use disorder (17%), GAD (5%), panic disorder (6%), and PTSD (3%).
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.
Please see our pages on what is CBT?, self-help books, what the NHS offers, finding a private therapist.
If you need more immediate help, please see our pages on getting help in a crisis.
