What is Social Anxiety Disorder and How is it Defined

Shame is almost always a key component of social anxiety, and one that needs to be treated in therapy. Many people with social anxiety also believe they are not acceptable and lovable or that they are ONLY acceptable if they handle things perfectly. Perfectionism and social anxiety often go hand in hand. Developing self compassion is a good way to address this. 

This page will describe the definition of social anxiety disorder, and all the different manifestations of it. People often don't recognize when they have it. One of the best way to define social anxiety disorder is to look at the diagnostic criteria

Social anxiety is different for each person and may manifest in different ways. Below is the diagnostic criteria.

1. The person has fear or anxiety about social situations where they may be negatively judged. Including social interactions( having a conversion), being observed( eating) or performing(giving a presentation).


2. The person is  fearful of acting in a way that will cause them to be negatively judged or showing their anxiety in a way that will cause them to be negatively judged resulting in being embarrassed, rejected and /or offending others. 

For children, this must occur in peer settings

3. The social situations almost always cause fear and anxiety.

In children they may show this by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

4. The anxiety is disproportionate to the social situation 

5. The social situations are avoided or endured with great distress

6. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or at least one area of functioning

7. The anxiety isn’t due to drug use, a medication side effect, or a medical disorder or another mental health disorder.

8. If another medical condition is present, the anxiety is not due to that condition or is disproportionate.

9. The anxiety is persistent typically lasting six months or longer.

It's important to note that a moment of social anxiety, feeling anxious about interacting socially is normal. It's not the same as social anxiety disorder, which is something that is pervasive and consistent and interferes in a major life domain. 

In the past it was required that the person with anxiety recognize that it is out of proportion to the triggering event, but with the most recent diagnostic change, only the clinician needs to see this.

Social Anxiety Disorder Definition: Interactional and Performance Anxiety

Many different experiences you may have never thought of can be categorized as types of social anxiety.

Social anxiety disorder can be divided into two main types.  Interactional and performance anxiety.

Interactional  Social Anxiety

Interactional social anxiety is anxiety about situations that may require you to talk, listen, and react. Interactional experiences are those that are considered the  most socially demanding.  For example, starting a conversation at a party is a form of interaction that  can have anxiety associated with it.

  • Dating Anxiety.  

If you are single dating anxiety can be pretty impairing! Dating anxiety is fear and discomfort with possible romantic partners. What fuels most anxiety, this one being no exception, is avoidance. Unfortunately this creates a life of loneliness for people with dating anxiety. Some studies show that the internet has provided some relief for these people. 

The ability to blush likely emerges when  children acquire self-awareness – a sense of public self that appears around the second year of life.  At the age of  3 or 4  children also begin to compare and therefore other  emotions  such as embarrassment, shyness, and shame come into play. This is when they  may start to fear judgment.  

  • Fear of Interacting with People in Authority

This is a fear of interacting with bosses, supervisors, teachers, police officers, etc. How would this affect your ability to respond when taking directions from your boss? Often people with this form of anxiety will tell me their boss or supervisor has challenged their behavior as defiant or asked them about their demeanor when in fact they are just anxious. I have heard similar stories from children who have this experience with teachers.

  • Fear of Ordering Food.

 Yes, this is real! These people will often go to great lengths to avoid ordering food from restaurants or fast food places. Imagine if you were with a group of people and you went to lunch. How would you order, what would you do to avoid having to order? This can lead to isolation due to the avoidance of all of the possible social situations where food ordering would be necessary.

  • Fear of Asking Questions or Seeking Help.

We are all familiar with the jokes about men who won’t ask for directions, but this can develop further into a real problem. If you are in the workplace and don’t understand your assignment, directions, or something that was communicated, this fear can cause you to avoid seeking the information you need!  Coaching and exposure (dealing with the feared experience) are often the treatments of choice for these issues. 

Watch a brief video about this here

Performance Anxiety

Performance anxiety can be about anything that requires you to perform something in front of others in a rehearsed way.  It may not even require a response from you at all. It is usually something learned or studied and then demonstrated. Interestingly, most people are more anxious about the second of the types of social anxiety, performance anxiety.

Types of  Performance Anxiety

  • Public Speaking.

 Fear of Public speaking is actually ranked as number one of the types of social anxiety! This fear can prevent people from successfully advancing in school and work. 

In one study the most common age of onset of paruresis, the fear of urinating in public is reported is between  12 and 15 years (Malouff and Lanyon, 1985).

  • Paraurisis.

This is a fear of not being able to urinate in public bathrooms or where others may hear you urinate. Although this may sound funny, it is not. People who have parauresis report they  often avoid drinking liquids, dating, social events, and sporting events, for fear that they will be trapped in a situation where they have to urinate in public. People with parauresis even report choosing a job based on this. For example, someone may choose a job closer to home so they can leave and go home to urinate. It is a very shameful and embarrassing condition. Research shows that most people suffering from this condition also have other anxieties and mental health conditions.

  • Test Anxiety. 

Test anxiety is a form of social anxiety that consists of anxious thoughts and feelings as well as physiological responses. Test anxiety can cause one to be unable to remember previously learned information and also can cause issues with comprehending what is being asked and formulating clear thoughts. Sometimes test anxiety can be treated without a therapist. The steps are outlined below

  1. Become aware of the self-talk statements you make ( the things you tell yourself).
  2. Focus on replacing those statements with more positive ones, self coach yourself.
  3. Practice deep breathing and other body relaxation techniques throughout the  time leading up to the test-taking situation.    
  • Sports Performance Anxiety. 

Sports performance is an area that coaches and trainers often must have a lot of knowledge in. Athletes may become anxious and overwhelmed and choke in a way that’s similar to what happens with a student who has test anxiety. Trainers and coaches will use visualization, breathing and relaxation techniques, self-talk and psychoeducation to assist athletes who are experiencing this. Some therapists specialize in sports psychology who may assist in this area. One recent study cited in psychology today demonstrated that in some cases of performance anxiety people who created the belief that their nervousness will improve their performance were able to decrease their anxiety and overcome the impact on their performance!

  • Writers Block and Stage Fright.

 Both of these terms may refer to a form of social anxiety. Writers who have writers' block frequently have an array of symptoms consistent with anxiety. Thoughts and fears that they cannot come up with something to write, a feeling of panic and dread, and the experience of being unable to write because of their symptoms of anxiety. Stage fright is a similar concept.

Social anxiety disorder has an early onset with an average age of 10–13 years.

Looking for more help?

The national social anxiety center has listings of clinics all over the country and great resources. I've gotten much of my training from their staff. 

·       For information on social anxiety click the links below.


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Sources for Definition of Social Anxiety


American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

, B. (2000). Self-Directed Treatment for Test Anxiety: Sometimes a Little Is Enough. Guidance & Counseling, 15(4), 2. Retrieved from Academic Search Premier database.

Madu, C. (2010, Jan/Feb). Tell yourself nervousness will improve your performance and it will. Psychology today , pp. 12-14.
Malouff JM, Lanyon RI. 1985. Avoidant paruresis: An exploratory study. Behav Modif 9: 225-234.

 Nikolić, M., Majdandžić, M., Colonnesi, C., de Vente, W., Möller, E., & Bögels, S. (2020). The unique contribution of blushing to the development of social anxiety disorder symptoms: Results from a longitudinal study. Journal of Child Psychology and Psychiatryn/a(n/a). https://doi.org/10.1111/jcpp.13221


Vythilingum, B., Stein, D., & Soifer, S. (2002). Is “shy bladder syndrome” a subtype of social anxiety disorder? A survey of people with paruresis. Depression & Anxiety (1091-4269), 16(2), 84-87. doi:10.1002/da.10061.


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Self-help Blog | Self Compassion And Mindfulness | United States

This page is about how self-compassion and mindfulness and skills such as forgiveness, kindness and compassion can help us with depression and anxiety.

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