The Unseen Tension: A Narrative Review of Long-Term Outcomes of Social Anxiety Disorder

Social anxiety disorder (SAD) is a highly prevalent and disabling condition marked by persistent fear of social or performance situations. Cultural norms can sometimes reinforce socially anxious behaviors, contributing to underdiagnosis. This “neglected disorder” has significant long-term consequences. This narrative review aims to explore the long-term impacts of SAD on various life domains, identify common comorbidities, and examine contributing environmental and genetic factors. A review of existing literature was conducted, synthesizing findings on the long- term functional, relational, and health consequences of SAD, with a focus on comorbidity, patterns, and treatment approaches. Findings indicate that SAD often remains undiagnosed, rooted in a combination of environmental influences and genetic predispositions. Over time, it can lead to difficulties in forming close relationships, reduced opportunities for realizing one’s potential, and a heightened risk of comorbid psychiatric conditions, alongside a strained and often critical relationship with the self. The widespread use of social media adds a complex layer as it can serve as a form of distraction or protection for individuals with SAD, it may also become an avenue for avoidance, identity exploration, and even dependency. Genetic factors may, in some cases, contribute to reduced responsiveness to cognitive-behavioral therapy alone, with better outcomes observed when pharmacological and psychotherapeutic interventions are combined. SAD can profoundly affect life trajectory, from self-perception to academic and occupational progression and relational satisfaction. Given its cultural reinforcement, underdiagnosis, and potential for lifelong impact, a multifaceted approach that addresses both environmental and genetic factors is essential for effective management and prevention of long-term disability.