The Link Between Social Anxiety and PTSD, and Ways to Cope

Text written by: Mirjana Ostojić, CBT psychotherapist

Post-traumatic stress disorder (PTSD) is usually associated with life-threatening experiences, but social trauma, such as rejection or humiliation in social situations, can also cause symptoms similar to PTSD. Social trauma (peer bullying, mockery, humiliation, rejection by others, negative childhood experiences) can lead to the development of social anxiety, because we learn to associate social interactions with danger, which leads to avoidant behaviors. Thus, PTSD can be caused by social trauma. Social trauma may also be involved in the development of other disorders, such as obsessive-compulsive disorder (OCD).

PTSD (post-traumatic stress disorder) and social anxiety disorder are significantly similar - individuals with both conditions often have symptoms such as fear of negative evaluation, avoidance of social situations, and intrusive memories that cause intense distress. The connection between these two disorders lies in shared emotional and cognitive processes that cause excessive arousal (hyperarousal), negative self-perception, and avoidant behaviors.

In addition to their similarities, PTSD and social anxiety are essentially different disorders. PTSD is characterized by unique symptoms such as heightened attentional vigilance, emotional numbness, nightmares and dissociative reactions (e.g., flashbacks), which are usually not observed in social anxiety. This indicates that PTSD may involve more pronounced or severe emotional dysregulation, likely related to the severity and nature of the traumatic event itself. On the other hand, social anxiety disorder may primarily manifest as fear of negative evaluation by others, without the same traumatic memories and physiological responses seen in PTSD.

Do social anxiety and PTSD often occur at the same time?

Experiencing social trauma can increase the likelihood of PTSD and social anxiety occurring simultaneously. Approximately one third of people diagnosed with social anxiety meet all the criteria for PTSD or suffer from clinically significant PTSD symptoms in response to social trauma.​

The coexistence of both disorders can be attributed to social withdrawal, heightened arousal and avoidant behaviors that are often present in people with PTSD, which may manifest as social anxiety symptoms such as fear of negative evaluation by others and shame, humiliation. Although the exact percentage varies depending on the research, it is generally estimated that about 30% to 40% of those with a primary diagnosis of PTSD also experience symptoms of social anxiety. In contrast, the percentage of individuals with social anxiety who simultaneously experience PTSD symptoms is smaller, which underlines the need to consider trauma history when addressing social anxiety. This complex relationship highlights the importance of comprehensive assessment and treatment strategies for effectively treating both conditions.

​Coping skills for social anxiety and PTSD

Neuroscience research has shown that one of the most effective ways we can change how we feel is to become aware of our inner experiences. If we pause for a moment and consciously focus on what we are experiencing, with an attitude of acceptance, openness and curiosity, we can begin to understand our reactions and what they are trying to tell us. Once we reach some understanding, we can assess our reactions and decide to what extent they are appropriate to the situation or are just messages from the past. Instead of suppressing, fighting or denying unpleasant feelings, try to accept them. By allowing and accepting these feelings, we create space for them to pass naturally through our body.

How can you ease the symptoms of social anxiety and PTSD?

Although it is important to explore and resolve the underlying wounds of PTSD and social anxiety, there are things you can do at any moment to ease or tolerate the intense feelings associated with these diagnoses. Recovering from PTSD and social anxiety does not mean you never feel discomfort or symptoms, but rather that you change your relationship to these reactions so that they do not control your behavior.

Some methods that can help you cope with symptoms of PTSD and social anxiety:

Naming sensations and feelings: Consciously focus on what you are experiencing without judgment! Simply notice, observe and name the sensations you are experiencing. E.g. "I notice that I feel nauseous because of a sense of fear and tension."

Practicing breathing techniques: Breathe in deeply, hold for a moment and slowly exhale. An extended exhale activates our parasympathetic nervous system, which is responsible for relaxation and rest.

Changing temperature: A sudden change in your body temperature can alter the sensations and emotions you experience. Next time you feel a surge of emotion, take an ice cube and hold it in your palm. The cold will make your brain redirect attention from your emotions to the ice cube.

Use your imagination: Close your eyes and imagine your safe place while describing what you see, hear, smell and feel. E.g. "I imagine a forest, I see bushes, I hear birds chirping and I feel the wind on my skin."

Practice making decisions based on inner wisdom (integrating awareness of your emotions with the facts of the situation): Recognize and accept your feelings while also reminding yourself of activities you can do so that unpleasant symptoms do not interfere with your everyday functioning. Tell yourself "I can be anxious and spend time with my friend."

Self-compassion: Show yourself the kindness and patience that you need from others. It's okay not to be okay.

Also, developing a lifestyle that includes healthy habits and routines can ease the intensity of some symptoms of PTSD and social anxiety. Changes in daily habits that can have a significant impact in relieving symptoms of PTSD and social anxiety include regular physical activity, healthy eating, enough sleep, spending time in nature, drinking enough water, spending time with people who have a positive influence on you, enjoyable activities, caring for a pet, and learning about symptoms and diagnoses.

Treatment Options for PTSD and Social Anxiety

PTSD and social anxiety can cause very exhausting symptoms that often require intervention. Engaging in psychotherapy can provide relief from symptoms through psychoeducation, improving coping skills and strengthening your support system.

In some cases, medication may be recommended, especially if symptoms are severe or significantly affect daily functioning. Medications can help ease the difficulties associated with PTSD and social anxiety. A combination of psychotherapy and medication can provide a comprehensive approach to addressing these intertwined conditions, offering the best opportunity to significantly reduce symptoms and improve quality of life.

When to Seek Professional Help for PTSD and Social Anxiety

If your PTSD or social anxiety symptoms significantly interfere with your daily life, relationships, or overall well-being, it is advisable to seek professional help. Experiencing PTSD and social anxiety symptoms can become overwhelming and greatly diminish daily functioning, especially if you do not have a consistent and safe support system.

Our emotional pain is often caused by other people, so our nervous system learns to associate people with threat or danger. Our brain struggles to recognize the nuances of a situation and instead generalizes associations formed in the past. Psychotherapy allows you to form a safe relationship, enabling your nervous system and mind to experience something that calls into question the narrative that "all people are dangerous / no one can be trusted."

Although people are often the cause of trauma, we can only recover in relationship with other people, never in isolation.

References

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3. Williamson, J. B., Jaffee, M. S., & Jorge, R. E. (2021). Posttraumatic Stress Disorder and Anxiety-Related Conditions. Continuum (Minneapolis, Minn.), 27(6), 1738–1763.

4. Etkin, A., & Wager, T. D. (2007). Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. The American Journal of Psychiatry, 164(10), 1476–1488.