Social anxiety

No more fear of social contact

Being shy in certain situations is quite normal behaviour. However, social fears (social anxiety) can develop from it. The fear of being the centre of attention in certain situations and acting in an embarrassing or shameful manner can even remain for a lifetime.

At Schoen Clinic, we specialise in anxiety disorders. Based on a precise diagnosis, we offer you professional help to overcome your shyness.

Causes & symptoms

Shy = socially anxious?

Shyness is a widespread and normal character trait that disappears by itself if you have contact with the same people more often. If you only speak to strangers in an absolute emergency, that is an expression of severe shyness. 
With social phobia, the fear is so great, however, that social contact is completely avoided or can only be withstood with great anxiety or with aids such as medicine.
A pronounced and long-lasting fear of situations in which a confrontation with unknown people or a performance assessment could take place is characteristic. Those affected fear that they may display humiliating or embarrassing behaviour (e.g. blushing or stuttering) or be judged negatively by others. To prevent this, they often try to avoid the situations or hide their fears.
Social anxiety often occurs at a very early stage – mostly as early as puberty.

Social anxiety: Causes of this condition

There is no single cause for the development of social anxiety. Instead, several circumstances come together that contribute to the emergence of social anxiety, but do not automatically cause it.

Predisposition

Studies show that genetic predisposition also plays a role. People with this predisposition show a kind of ‘natural restraint or inhibition’ in social situations in order to be better accepted by their environment or a group. The children of sociophobic parents have an increased risk of experiencing fear in social situations.

Personality

Those affected are often inhibited and shy from early childhood onwards. This part of their personality is particularly apparent in new situations or in contact with strangers. They avoid social activities or intensive contact, even out of a fear of rejection or criticism.

Upbringing

Children who are constantly criticised by their parents, receive little love or feel like they are disturbing them can develop low self-esteem. This can lead to insecurity and can subsequently be transferred to other areas of life. The children of overprotective parents, however, may not learn to deal with negative experiences and mistakes. Parents who tend to have little social contact and place very high value on the opinions of outsiders can be a further factor.

Learning and life experiences

Often dramatic or socially stressful experiences in childhood or adolescence also play a role. For example, when children are teased, rejected or laughed at. The feeling of having said something wrong in school can also lead to significant insecurity, self-doubt and thus to fears. Divorce, family conflicts or a parent’s mental illness are also negative experiences that can increase the likelihood of illness.

Children who, for example, have been teased for years because of their appearance can later feel inferior as adults and experience fear when in contact with other people. In the event of a migration background, the prejudices of adults can also be transferred to children. Those affected could be treated with hostility, teased, regarded as inferior and excluded and/or a feeling of exclusion could develop.

Symptoms: Signs of social anxiety

Those affected often avoid interpersonal contact because they are afraid of being embarrassed or rejected. Small talk is just as horrible to them as a visit to a restaurant because they fear being judged or observed negatively. Other socially anxious people are afraid to eat, drink or write in public because they might tremble. Some, for example, turn their backs on others when they are drinking and thus attract even more attention. Those affected often also avoid making telephone calls to the authorities, exchanging goods or obtaining information from strangers, e.g. asking for directions. 

Social anxiety can be limited to certain situations or affect all social situations. Social anxiety also includes exam nerves or the fear of blushing.

Warning signals

  • Fear of scrutiny by other people 
  • Fear of eating in public
  • Fear of public speaking
  • Fear of meeting the opposite sex
  • Blushing
  • Avoiding eye contact
  • Trembling
  • Rapid heartbeat
  • Diarrhoea
  • Nausea
  • Increased urge to urinate
  • Blacking out
  • Low self-esteem
  • Fear of criticism
  • Pronounced avoidance behaviour, social isolation
  • Panic attacks

Diagnostics

Diagnosis: How social anxiety is diagnosed

We generally conduct a clinical examination for you, backed up by structured interviews and questionnaires. We also carry out differential diagnostic examinations, such as the exclusion of agoraphobia (claustrophobia) or panic disorder with agoraphobia. 

Diagnostic criteria: 
  • The pronounced fear of attention and performance situations, in which you could embarrass yourself, exists for more than six months. 
  • Being confronted with a situation in which you are in the public eye or in which a performance is demanded triggers an anxiety reaction or panic attack in you.
  • You recognise that your behaviour is excessive.
  • You avoid certain situations or only withstand them under great pressure and anxiety.
  • Clear restriction of your quality of life
  • Social anxiety is not caused by medication, drugs, other mental disorders or physical illnesses.