What It's Like to Have Social Anxiety Disorder

Social anxiety disorder (SAD), or social phobia, is a chronic condition in which people have an intense fear of being embarrassed, humiliated, watched, judged, or offending others. For those with SAD, everyday social situations can give rise to extreme and irrational anxiety. In America alone, approximately 15 million adults wrestle with SAD—and it has been exacerbated as we have come out of the pandemic and returned to normal levels of face-to-face social interactions.

What is it like to have SAD? This was the central question of a study led by psychologist Aslak Hjeltnes of the University of Bergen in Norway. In order to pursue this inquiry, Hjeltnes and his research team recruited participants between the ages of 19 and 25 who were seeking treatment for SAD at the university. The researchers interviewed them about their experiences with social anxiety and then analyzed their narratives for themes.

What did Hjeltnes and his collaborators find? The analysis yielded five major themes, which are summarized below.

1. From Being Shy to Interpreting Anxiety as a Mental Health Problem

All of the participants reported long-term struggles with shyness and fear in social situations, going back as far as they could recall. Moreover, these challenges were present prior to understanding their reactions as a mental health issue. Many study participants could even point to specific experiences that marked the shift from understanding themselves as being “shy” to dealing with a mental health condition that was compromising their lives. Moreover, some said that they used to function "normally" before their anxiety took hold and their self-awareness in adolescence and young adulthood increased. Then, their sense of self and safety began to erode.

One participant admitted:

It was very hard in the beginning. It was very humiliating. I felt that it was very visible to others, because I would blush and those kinds of things. I think I kind of lost... I worked a lot, and I tried to kind of forget it. I guess I really tried not to think too much about it. But it was there, all the time. I guess it really was a hard time, in the beginning. And another year went by. Then I figured I should talk with my doctor about it. Because then it had lasted quite a while.

2. Experiencing Emotions as Threatening and Uncontrollable

Participants had great difficulty regulating their emotions across various situations in day-to-day life and often experienced their feelings as threatening and uncontrollable. In particular, the participants were afraid of the overpowering physical sensations associated with SAD, including heightened muscle tension, heart palpitations, sweating, blushing, and trembling.

One participant remarked:

I get angry and frustrated with myself. But when it becomes overwhelming, I cannot sort of think clearly. Then I cannot think rationally that I should focus on my breathing, even if I ought to do this. Because I know that if I manage to breathe, it passes. But when it comes so strongly, then I cannot think about that. Then I feel that everything falls apart, and it feels like I’m terrified inside and unable to focus on anything else.

^{3. Encountering Loneliness as Relationships Fall Away}

The young adults in this study expressed feeling burdened by loneliness. They reported that as the years passed, they stopped socializing and described a deepening estrangement from the lives and emotional interiors of other people. Most participants coped with their anxiety by using avoidance and withdrawal from social situations. This strategy proved helpful in reducing anxiety in the short term but had long-term consequences as it led to even greater emotional isolation over time.

One participant recounted:

It’s not that common that I get invited to things anymore. Because I’ve always said no to social gatherings and things, I do not get invited anymore. It gets pretty lonely then. Much isolation, and it’s hard to break that circle, because I feel [that] I cannot expose myself to these social things either, because I kind of... when I do not expose myself, then I do not get any practice, no improvement. And then it just gets worse and worse to get back into it.

4. Hiding the Vulnerable Self From Others

These young adults were beset by vulnerability. They experienced themselves as flawed, weak, and unworthy. They were also plagued by shame, inferiority, and self-criticism, and being assertive or having self-compassion was immensely difficult. They tried to hide their vulnerabilities from the world, felt utterly alone in their maelstrom of anxiety, and ultimately felt different and separate from others.

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A participant reflected:

At least among those I know, I believe there’s no one who struggles with the exact same as me. That everyone can have something they struggle with, but there’s no one who is so... wrong as that. Or that everyone can be liked, in spite of the things they [have]. No one is perfect, but I somehow feel that other people’s stuff, what they have, are the kinds of stuff that one can appreciate people for anyway, but I feel somehow that it makes me not quite worthy as a human being. With what I, with who I am, and what I struggle with.

5. Deciding to Face Social Fears in the Future

For years, many of the participants had suffered and felt held back because of their anxiety. They believed that their social withdrawal limited their life experience, both ordinary and remarkable. They also realized that if they wanted more meaningful relationships and a fuller life going forward, they would likely have to choose between continuing to avoid and withdraw from others and confronting their fears—that is, actively forcing change even if they were scared.

A participant shared:

It was something that I had thought about for a long time, really. That I struggle with certain things when I get anxious, and that it affects my life in a very negative way. And it just came to a point where I had to do something about it, because the longer you wait, the worse it gets, and I have already waited long enough.

While it was difficult for the participants to conceptualize their experiences as a psychological condition or mental illness, the authors note that doing so helped them have a framework and language to understand their pain—and find ways to move forward.