When Hello Feels Like a Threat: Living with Social Anxiety Disorder

I’ve had the honor of sitting across from many brave people who’ve quietly carried the weight of social anxiety. It often starts with a whisper, maybe I’m just shy, until that whisper grows into a constant hum of self-doubt, discomfort, and the urge to disappear in moments that are supposed to feel ordinary.

For some, avoiding phone calls. For others, it’s overthinking a simple hello for days. I’ve spoken with clients who feel physically frozen in social settings, with their heart racing and their hands trembling, not because they’re unkind or antisocial, but because their brain has learned to see connection as a threat.

And they are not alone.

Social anxiety disorder, also known as social phobia, affects over 15 million adults in the U.S. alone. It’s one of the most common mental health conditions, yet it often hides in plain sight, under polite smiles, quiet nods, and “I’m just tired” responses.

Today, I, Dr. Susan Hollander, want to help you understand what social anxiety disorder really is, how to recognize its symptoms, and the kinds of support that can make a meaningful difference. If you or someone you love is struggling, there are options and hope.

What is social anxiety disorder?

Social anxiety disorder is not just being shy or introverted; it’s a deeply rooted fear that shows up in social situations and feels, quite literally, like danger. Even when a person knows there’s no real threat, their body and mind react as if something is deeply unsafe. That reaction is very real, and it’s exhausting.

People living with social anxiety often describe a fear of being judged, rejected, or humiliated. It makes everyday interactions, like speaking up in a meeting, making eye contact, or even eating in front of others, feel impossible. This isn’t a flaw or a personality quirk; it’s a well-documented mental health condition, and you’re not making it up.

Clinically, social anxiety disorder is recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as one of the primary anxiety disorders, along with panic disorder and generalized anxiety disorder. But as a therapist, I see it through a more human lens, something that affects not just your social life but your sense of confidence, safety, and self-worth.

And no, it’s not just “in your head.” Researchers believe that social anxiety disorder often develops from a mix of inherited traits, early experiences, and brain chemistry. Supported by the Mayo Clinic, certain people have an overactive amygdala, the part of the brain that helps control fear, which heightens the sense of threat in social settings. 

For others, growing up with overly critical or controlling caregivers or experiencing bullying, rejection, or humiliation increases vulnerability. These aren’t personal failings; they’re human reactions to both biology and lived experience. Knowing where it comes from is often the first step toward healing it.

You didn’t choose this, but you will find relief from it.

What are the symptoms of social anxiety disorder?

Social anxiety disorder shows up as a deep, persistent fear in social situations, often accompanied by physical sensations like a racing heart, shaky hands, or a flushed face. You may notice yourself avoiding people, places, or conversations, not because you don’t care, but because the experience feels intense. These responses aren’t flaws. They’re signs that your nervous system is working overtime to protect you, even when you’re not in danger.

Let’s break it down:

Physical symptoms:

• Sweating (even if it’s not hot)
• Trembling or shaking
• Rapid heart rate
• Dizziness or lightheadedness
• Nausea or stomach discomfort
• Difficulty breathing or tight chest
• Blushing uncontrollably

One symptom that causes a lot of confusion is shortness of breath. Many people worry it means something is physically wrong when it’s actually a common response to anxiety. If that sounds familiar, you may want to read How to Tell If Shortness of Breath Is from Anxiety.

Emotional and behavioral symptoms:

• Extreme fear of being judged negatively
• Worrying for days or weeks before an event
• Avoiding social situations, especially unfamiliar ones
• Needing a “safe person” to accompany you
• Feeling self-conscious even when alone in public
• Struggling to make eye contact
• Speaking softly or not at all
• Replaying and criticizing social interactions afterward

I’ve worked with clients who’ve skipped weddings, baby showers, or work events, not because they didn’t want to celebrate or connect, but because the thought of small talk or group settings felt too intense. Often, they’d say they had a headache or just weren’t feeling up to it, but underneath, there was a deep fear of being judged or feeling out of place.

How is social anxiety disorder diagnosed?

Social anxiety disorder is typically identified through a thoughtful conversation with a licensed mental health professional. They’ll ask questions about what situations trigger your anxiety, how long it’s been happening, and how much it affects your daily life, relationships, work, school, or even simple errands. The goal isn’t to judge, but to better understand the full picture so you can receive the care and support that best fits you.

When someone begins to wonder if what they’re feeling might be more than just nerves, the next step is often a gentle evaluation with a licensed mental health professional. This process is collaborative, never rushed, and never cold. It’s about getting a fuller picture of your experience so we can understand what’s going on beneath the surface.

During this process, we’ll likely talk about:

• How long has anxiety been showing up in your life? Typically, we look for patterns lasting six months or more
• The kinds of situations that bring up fear or discomfort, and how often they lead to avoidance
• Whether there might be other factors at play, like depression, trauma, or physical health conditions
• Any use of substances like alcohol or marijuana, especially if they’re being used to cope with social situations

Sometimes, a physical checkup is also recommended just to rule out things like thyroid issues or other medical concerns that mimic anxiety symptoms.

It’s important to remember that social anxiety isn’t about feeling nervous once in a while. It’s about a fear that feels so intense and persistent that it gets in the way of your everyday life, at work, in school, in relationships, or even when doing something as simple as returning an item at a store. If that sounds familiar, please know that you’re not alone and that support is available.

What causes someone to develop social anxiety disorder?

There isn’t one single reason someone develops social anxiety; it’s usually a combination of experiences, traits, and biology. And if you’re wondering, why me? That’s such a common and valid question. The truth is that social anxiety disorder often begins in childhood or adolescence and slowly shapes how someone feels about connection, safety, and being seen.

Here are some of the most common contributors I see in my work:

• Family patterns: Anxiety can run in families, though it’s not always clear if that’s due to genetics, learned behavior, or both.
• Temperament: Children who are naturally quieter, sensitive, or slow to warm up may be more likely to develop social anxiety as they grow.
• Early social experiences: Bullying, teasing, or repeated embarrassment in school or at home can make social situations feel threatening later in life.
• Fear response in the brain: Research suggests the amygdala, the part of the brain that helps process fear, is more reactive in people with social anxiety, leading to a heightened sense of threat in everyday situations.
• Parenting styles: Being raised in an overly critical or controlling environment can make a child feel like they’re constantly being evaluated or judged.
• Unstable environments: Moving frequently, family conflict, or a lack of social connection in early years can also contribute to feelings of social vulnerability.

According to a review referenced by Healthline, about 50–70% of individuals with social anxiety disorder also experience another mental health condition, such as depression or another anxiety-related disorder. This overlap is incredibly common and treatable.

So, if this resonates with you or someone you care about, please know: You didn’t choose this. But together, we can choose what healing looks like.

If you’re starting to connect the dots between your early experiences, relationships, and the way anxiety shows up for you now, you’re not alone. Many people I work with feel a deep sense of frustration or even shame for not “growing out of” certain fears. 

If you’ve ever wondered how anxiety might be affecting your closest connections, you might find this article helpful: My Anxiety Is Ruining My Relationship.

How does social anxiety differ from just being shy?

Shyness is a personality trait, something many people experience from time to time. Social anxiety disorder, on the other hand, is a mental health condition that can deeply affect a person’s daily life, relationships, and sense of self.

A shy person might feel nervous at first, but gradually feel more comfortable with time or familiarity. Someone with social anxiety may feel intense dread long before a social event, experience physical symptoms like a racing heart or nausea during the interaction, and then replay the moment in their mind for days afterward, focusing on every perceived flaw.

The difference lies in how much it disrupts life. Social anxiety creates patterns of avoidance, not because someone doesn’t want a connection, but because their body and mind perceive it as unsafe. That kind of fear isn’t just uncomfortable; it’s exhausting. And it deserves support, not shame.

What support options are available for social anxiety disorder?

Social anxiety disorder is highly treatable, and meaningful progress is possible with the right kind of support. Therapy is often the most effective approach, especially when it focuses on understanding the roots of anxiety, not just managing symptoms. In my work, I use a blend of compassionate techniques tailored to each individual’s needs, helping clients feel both seen and safe.

Here are some of the ways we can work together:

• Identifying family history: Sometimes the fear we carry isn’t just ours; it’s something we’ve learned or inherited. Understanding your family’s emotional patterns can provide clarity and ease some of the shame that often surrounds anxiety.
• Recognizing fear patterns: Together, we notice where the fear shows up, how it builds, and what it’s trying to protect you from. When you see the pattern, you can begin to shift it gently.
• Relaxation techniques: Simple, body-based practices like breathwork or grounding exercises help regulate the nervous system, making social moments feel more manageable.
• Problem-solving techniques: When social anxiety occurs in specific situations, such as work meetings or social gatherings, we can develop realistic and supportive steps to help you feel more confident and prepared.
• Psychodynamic psychotherapy: This deeper form of therapy looks at the unconscious roots of your anxiety. Often, fears about being judged or rejected began long ago and are tied to earlier experiences that still shape how you feel today. Healing those early wounds changes how you experience the present.
• Learning to self-affirm: Many people with social anxiety struggle with self-criticism. I help clients develop a kinder inner voice, one that feels steady, calming, and true. Replacing harsh self-talk with self-affirmation can shift your entire sense of self in social situations.

Medication and support groups are also helpful for some individuals. If that’s something you’re considering, we’ll talk about it together to make sure it aligns with your goals and comfort level. Look for local meetups or check resources like the Anxiety and Depression Association of America (ADAA). Healing doesn’t have to start with a prescription; it can start with a conversation.

You don’t have to be uncomfortable to “fix” anything. We work at a safe, respectful, and sustainable pace because healing isn’t about forcing change. It’s about gently creating space for it.

What lifestyle changes can help manage social anxiety?

There are small, meaningful shifts you can make in your daily routine that help calm an overactive nervous system and build a sense of safety in your body. These aren’t quick fixes, but they are gentle ways to support your healing over time.

Here are some supportive habits I recommend to my clients:

• Move your body regularly: A simple daily walk, even for 10–15 minutes, will help regulate stress hormones and increase your sense of calm.
• Limit caffeine and alcohol: Both can intensify anxious feelings. Try noticing how you feel after coffee or a glass of wine, and permit yourself to adjust if needed.
• Practice mindfulness in short, doable ways: Even just a few quiet minutes of breathing or grounding can begin to rewire how your brain responds to stress.
• Keep a simple journal: Writing down what triggers your anxiety and how you respond can help you spot patterns and, eventually, new options.
• Try social rehearsal: practice common social scenarios in a safe space, even if it’s just in your head. This can help build confidence before the real moment arrives.

The goal isn’t perfection. It’s presence. And it’s okay if that presence takes time to build. Exploring how anxiety interacts with how we treat ourselves, our self-esteem, our self-talk, and our worth is an important part of healing. If that resonates, I’ve written more about it here: Self-Dislike and Self-Esteem.

When should you seek treatment for social anxiety disorder?

If social situations have become something you dread, avoid, or recover from for days, it might be time to talk to someone about it.

You don’t need to hit a crisis point before asking for help. If anxiety is keeping you from friendships, career growth, connection, or joy, that’s reason enough. Whether you’re skipping events, hesitating to speak up at work, or feeling a quiet sense of panic when you walk into a room, you deserve support that meets you with care, not pressure.

Healing begins not when things get “bad enough” but when you feel ready to feel better. If you’re looking for gentle, effective support, I invite you to learn more about my Anxiety Therapy and how we can begin working together.

Can social anxiety disorder get better?

Yes, social anxiety can improve with the right support. It doesn’t happen overnight, but with time, care, and consistency, you can achieve meaningful relief.

Every person’s journey looks different. Some find their footing through talk therapy. Others may benefit from additional tools, such as medication or a supportive community environment. But one thing remains true across the board: you don’t have to live with this forever.

According to the 2022 National Healthcare Quality and Disparities Report, nearly 20% of children and teens in the U.S. are currently living with a mental, emotional, or behavioral disorder. In just five years, the number of youth diagnosed with depression grew by 27%, and mental health challenges remain the leading cause of disability in this age group. These numbers may feel heavy, but they also reflect a growing awareness and demand for care that works.

The good news is that people are getting better. The more we understand about anxiety and its roots, the more effective therapy becomes. And when we approach healing with compassion and steadiness, the results can be lasting.

You are not broken. Your nervous system is just trying to protect you in ways that no longer serve you. Therapy can help you learn new ways to feel safe and live more freely.

You are not alone

If you’ve been quietly carrying the fear of social interaction, please hear this: you’re not broken, and you’re not the only one who feels this way.

In my practice, I’ve seen how isolating social anxiety can feel, and I’ve also seen how resilient people become when they start to understand the why behind their fear. That fear may feel powerful, but it is not permanent. And you don’t have to face it alone.

Whether you’re reaching out for the first time, returning to therapy, or simply reflecting on your experience, I’m glad you’re here. That first step? It’s never small. It’s incredibly brave.

And you are worth that step.

Ready to Take the First Step Toward Relief?

If you’re feeling anxious about social situations or simply tired of carrying that quiet worry day after day, I want you to know that support is here, and healing is possible. You don’t have to navigate this alone.

You can learn more about what to expect in therapy, or if you’re ready, reach out today to schedule a consultation. I offer a safe, welcoming space where we move at a pace that feels right for you.

Whenever you’re ready, I’m here to help you begin.
Visit susanlhollanderphd.com to get started.