Social anxiety disorder: symptoms explained (DSM-5-TR)

Social anxiety disorder (also known as social phobia) is an anxiety disorder characterized by a persistent fear of being judged, embarrassed, or negatively evaluated in social situations.

People with social anxiety often experience a combination of emotional, cognitive, behavioral, and physical symptoms. These symptoms can vary in intensity, but they typically involve fear of social interaction, increased self-consciousness, and avoidance of situations where attention may be focused on them.

According to the DSM-5-TR, a diagnosis of social anxiety disorder requires that symptoms are persistent (typically lasting 6 months or longer), cause significant distress, and interfere with daily functioning such as work, relationships, or social life.

It is important to distinguish social anxiety disorder from normal nervousness or shyness. Many people feel uncomfortable in certain social situations, but social phobia involves a more intense and persistent pattern of fear, avoidance, and distress.

On this page, you will find a structured overview of the most common social anxiety symptoms, including emotional, physical, and behavioral patterns, as well as safety behaviours that often maintain the anxiety.

Emotional and behavioral symptoms of social anxiety

Social anxiety disorder is primarily characterized by a persistent fear of social situations in which a person may be evaluated by others. This fear is often driven by concerns about being judged, embarrassed, or negatively perceived.

These symptoms typically involve a combination of anxious thoughts, self-focused attention, and avoidance patterns. For example, a person may become highly aware of their own behaviour, appearance, or physical sensations, while simultaneously assuming that others are noticing and judging them.

According to the DSM-5-TR, these symptoms must be persistent (typically lasting at least 6 months), cause significant distress, and interfere with daily functioning such as work, school, relationships, or social activities.

Below is an overview of common emotional and behavioral symptoms seen in social anxiety disorder:

• Fear of embarrassment or humiliation in social situations
• Fear of being judged or negatively evaluated by others
• Avoidance of situations where attention may be focused on you
• Intense fear of social interaction (e.g., conversations, meetings)
• Excessive self-consciousness during everyday situations
• Fear of showing anxiety symptoms (e.g., blushing, sweating)
• Worry before social situations (anticipatory anxiety)
• Negative automatic thoughts (e.g., “I will mess this up”)
• Post-event rumination (replaying situations and focusing on perceived mistakes)
• Selective attention to negative signals while ignoring neutral or positive feedback
• Expecting worst-case outcomes in social situations

These symptoms often reinforce each other. For example, negative thoughts increase anxiety, which heightens self-awareness and physical symptoms, which in turn strengthens the belief that something is wrong. This interaction plays a central role in maintaining social anxiety over time.

Some individuals experience symptoms mainly in performance situations (such as public speaking), which is referred to as the performance-only specifier.

Physical symptoms of social anxiety

In addition to emotional and cognitive symptoms, social anxiety disorder often involves strong physical reactions. These symptoms are part of the body’s natural fight-or-flight response, which is activated when a situation is perceived as threatening.

In social anxiety, this response is triggered by situations involving potential evaluation by others. Even when there is no real danger, the body reacts as if there is, leading to intense physical sensations that can feel overwhelming or difficult to control.

Common physical symptoms include:

• Racing or pounding heart, often experienced as sudden awareness of the heartbeat
• Blushing, especially in situations where attention is focused on the person
• Sweating, including visible sweating of the face or hands
• Muscle tension, particularly in the shoulders, neck, or jaw
• Trembling or shaking, which may be noticeable to others
• Shortness of breath or feeling unable to breathe deeply
• Dizziness or light-headedness, sometimes accompanied by feeling faint
• Nausea or stomach discomfort, including “butterflies” or urgency
• Shaky or unsteady voice during conversations
• Feeling detached or “out of body” (derealization or depersonalization)

These physical symptoms can be very distressing, especially when a person fears that others will notice them. As a result, attention often shifts inward, increasing self-consciousness and amplifying the perception of these symptoms.

In some cases, the intensity of these reactions can resemble a panic attack, which can further increase fear and avoidance of social situations.

Over time, the fear of experiencing these physical symptoms can become just as important as the social situation itself. This contributes to patterns such as avoidance and safety behaviours, which may reduce anxiety in the short term but maintain it in the long term.

Avoidance in social anxiety

Avoidance is one of the central processes that maintains social anxiety disorder. People may avoid feared situations completely, or remain in them while experiencing intense discomfort.

Avoidance often develops as a natural attempt to reduce anxiety. By staying away from situations that trigger fear, anxiety decreases in the short term. However, this relief reinforces the belief that the situation is dangerous, making it more difficult to face similar situations in the future.

Commonly avoided situations include:

• Attending social events or gatherings
• Speaking in groups or meetings
• Starting conversations or making small talk
• Meeting new people
• Eating or drinking in public
• Making eye contact
• Entering a room where others are already present
• Being the center of attention
• Using public restrooms
• Being observed while performing tasks

Over time, avoidance can expand to more situations, leading to increasing restrictions in daily life, reduced confidence, and stronger anxiety responses.

Because avoidance prevents people from learning that feared outcomes often do not occur, it plays a key role in keeping social anxiety in place.

Safety behaviours in social anxiety

In addition to avoidance, many people with social anxiety rely on safety behaviours to cope with feared situations. These are strategies used to reduce anxiety, prevent embarrassment, or minimize the chance of negative evaluation.

Unlike avoidance, safety behaviours allow someone to remain in a situation, but in a controlled or protective way. For example, a person may stay quiet, avoid eye contact, or mentally rehearse what to say.

Although these strategies can reduce anxiety in the short term, they often have unintended long-term effects. Because the person attributes their “success” to the safety behaviour rather than to their actual ability to cope, the underlying fear remains unchanged.

Common safety behaviours include:

• Bringing a friend for reassurance
• Avoiding eye contact
• Staying quiet or speaking as little as possible
• Rehearsing conversations in advance
• Focusing attention on others to avoid being noticed
• Using a phone to avoid interaction
• Choosing positions that attract less attention
• Wearing clothing to hide signs of anxiety (e.g., blushing)
• Checking appearance repeatedly
• Pretending to be uninterested or distant

Both avoidance and safety behaviours prevent new learning. In evidence-based treatments such as cognitive behavioral therapy (CBT), reducing these behaviours is an important step in breaking the cycle of social anxiety