What to know about social anxiety disorder
Social anxiety disorder is a condition characterized by a fear of being watched or judged by others in social situations. It may occur due to a combination of genetic and environmental factors.
Social anxiety disorder is also known as social phobia. Anxiety is a fear that arises in anticipation of an event, and a phobia is an irrational fear of certain objects or situations.
The National Institute of Mental Health report that 12.1% of adults in the United States experience social anxiety disorder at some point in their lifetime. It is more common in females than in males.
However, social anxiety disorder is treatable. Talking therapy, cognitive behavioral therapy (CBT), and medications can help people overcome their symptoms.
This article provides an overview of social anxiety disorder, including its symptoms, causes, diagnosis, and treatment.
What is social anxiety disorder?
People with social anxiety disorder are fearful of or anxious about certain social situations due to a fear of negative judgment, embarrassment, or rejection.
Although some anxiety is usual in social situations, such as when giving a presentation or going on a date, social anxiety disorder refers to anxiety that is intense, affects work or personal life, and lasts for at least 6 months.
People with social anxiety disorder may feel worried about appearing anxious, such as blushing or trembling, or about others thinking that they are awkward or unintelligent. Many people also have strong physical symptoms, such as an increased heart rate, feeling sick, or sweating.
Although the person may acknowledge that their fear is excessive, the anxiety often feels overpowering and out of their control.
The triggers of social anxiety vary among people but might include:
- meeting unfamiliar people
- talking to people at work or school
- being called on to speak in class
- having to talk to a cashier in a store
- using a public restroom
- being seen when eating or drinking
- having to perform in front of others
Many people with this condition do not seek treatment, believing it is just a part of their personality. They may instead seek help for related issues, such as depression or substance use.
Social anxiety disorder has many effects on the body and mind, causing physical, emotional, and behavioral symptoms.
The symptoms tend to occur in certain social situations and may include:
- physical symptoms, such as blushing, sweating, trembling, nausea, an increased heart rate, and the mind “going blank”
- feelings of panic or panic attacks
- a fear of experiencing anxiety or of seeming anxious in front of others
- an intense fear of judgment from others
- feelings of fear or dread in situations with other people, especially strangers
- feeling very self-conscious, embarrassed, or awkward in front of others
- having difficulty speaking
- avoiding situations that might trigger anxiety
- a rigid body posture and a soft voice during social interactions
- difficulty making or maintaining eye contact
- sensitivity to criticism, low self-esteem, and negative self-talk
These symptoms can greatly disrupt daily life, such as school, work, and relationships. Without treatment, the person may not achieve their potential at school or work, as they may avoid participating in group tasks, speaking in front of groups, or receiving a promotion.
When severe or chronic, social anxiety can lead to the development of other conditions, such as depression or substance use disorders.
In children, the symptoms appear in interactions with both adults and peers. Their feelings of anxiety might appear as:
- throwing tantrums
- clinging to a parent or caregiver
- not speaking in social situations
Various treatment options can help people manage their symptoms, gain confidence, and overcome their anxiety.
Without treatment, however, social anxiety disorder may persist throughout life — though it may feel better or worse at certain times.
Healthcare professionals will usually recommend treatment with psychotherapy, medication, or both. The sections below will look at these options in more detail.
Psychotherapy, or talking therapy, helps people understand their experiences and develop effective coping methods.
There are many types of psychotherapy, including:
- interpersonal therapy
- psychodynamic therapy
- family therapy
CBT is a common treatment. It aims to help the person recognize and change negative thoughts or beliefs about social situations. It also aims to change people’s behaviors or reactions to situations that trigger anxiety.
CBT can help a person recognize that their own thoughts, not those of others, can determine how they react and behave.
Exposure therapy, or cognitive delivered exposure, can also help. With this approach, the person gradually works up to facing the situations they fear with a therapist and in a safe environment.
A range of medications can help people manage the symptoms of social anxiety disorder.
The three main types are antianxiety medications, antidepressants, and beta-blockers. The sections below will look at these options in more detail.
Selective serotonin reuptake inhibitors, which people mainly use as antidepressants, can also help with the symptoms of social anxiety disorder. They may take several weeks or months to take effect.
Some examples include:
- paroxetine (Paxil, Paxil CR)
- sertraline (Zoloft)
- fluoxetine (Prozac, Sarafem)
Serotonin-norepinephrine reuptake inhibitors, which are another class of antidepressant, can also help.
Some examples include:
- venlafaxine (Effexor, Effexor XR)
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
Antianxiety medications act quickly to reduce the symptoms of anxiety, but doctors will usually recommend them as a short-term solution, as they can create dependence.
Benzodiazepines are a common class of antianxiety drug. Some examples of these include alprazolam (Xanax) and clonazepam (Klonopin).
In 2020, the Food and Drug Administration (FDA) strengthened their warning about benzodiazepines. Using these drugs can lead to physical dependence, and withdrawal can be life-threatening. Combining them with alcohol, opioids, and other substances can result in death. It is essential to follow the doctor’s instructions when using these drugs.
Beta-blockers help block the physical effects of anxiety, such as sweating, tremors, and a rapid heartbeat. They do this by blocking the stimulating effects of adrenaline.
Doctors usually prescribe these drugs for specific situations, such as having to give a presentation, but not for ongoing treatment.
Tips for overcoming anxiety
Social anxiety is a highly individual experience. The tips that help one person may be less helpful for another. For this reason, it can be useful to try various methods to find out what works best.
The following tips may help people overcome anxiety in social situations.
Increase social situations gradually
People with social anxiety disorder often avoid social situations where they may trigger their feelings of anxiety. Although this reduces anxiety in the short-term, avoidance can make anxiety much worse in the long-term.
If possible — and with the help of a therapist, if necessary — the person can gradually increase their exposure to the situations they fear. This creates space for them to have a positive experience with the situation.
Having positive social experiences can boost a person’s confidence and reduce their anxiety or reassure them that they can overcome it.
Take time to relax
Engaging in mood-boosting activities releases feel-good chemicals in the brain, which can relieve stress and make a person feel better about their feelings of anxiety.
Before going into a social situation that feels scary, try doing something relaxing or enjoyable, such as listening to music, reading, playing a video game, or meditating.
Reframe your thoughts
If a person holds onto the idea that they are shy, it will reinforce current anxiety about talking to people or being in public. Thoughts fuel behavior patterns.
A technique tied to CBT involves guiding people through the reframing process. Writing down these thought processes can help.
For example, “I am a shy person” can become “I acted like a shy person at the gathering.” It may help the person to know that they can change how they perceive themselves and how they feel that others see them.
Avoid relying on alcohol
Using alcohol and other substances may reduce anxiety in the short-term, but it can make anxiety worse over time and lead to dependence or substance use disorders.
Learn about tips for overcoming social anxiety here.
A doctor may ask questions about the person’s medical history and carry out a physical exam to rule out any physical causes of their symptoms. They may then refer the person to a mental health professional.
A mental health professional will ask the person about their symptoms, including when they occur, how often they occur, and when they started.
Clinicians use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to diagnose mental health conditions, including social anxiety disorder.
The diagnostic criteria for this condition include:
- having a persistent fear about one or more social situations that might involve scrutiny from others (such as conversations, social interactions, being observed, or performing in front of others)
- having a fear of acting in a way that others will judge negatively or that might lead to rejection or offense (such as a fear of seeming anxious or of doing something embarrassing)
- avoiding situations that might cause feelings of anxiety
- experiencing symptoms that persist for 6 months or longer, cause significant distress, or impair the person’s work, social life, or other key areas
Causes and risk factors
The causes of social anxiety disorder are complex. They are likely to involve a combination of genetic and environmental factors.
Social anxiety disorder typically starts early in life, during a person’s adolescence or teenage years, but it can affect people of all ages. The condition is more common in females than males.
Possible causes and risk factors include:
- Genetics: Anxiety disorders can run in families, so there may be a genetic component at play.
- Adverse life events: Stressful or traumatic events — such as abuse, violence, the death of a loved one, or a prolonged illness — may increase the risk of an anxiety disorder. Previous bullying, humiliation, or rejection can also increase the risk.
- Parenting styles: Some sources suggest that overprotective parenting can increase a child’s risk of social anxiety.
Social anxiety disorder is treatable. Without treatment, however, it can be debilitating.
The symptoms of social anxiety disorder can significantly disrupt the person’s work and social life and may result in a lack of social support, low achievement at work and in other areas, a reduced quality of relationships, and a reduced quality of life.
Social anxiety disorder is associated with other mental health concerns, including low self-esteem, depression, substance misuse, and suicidal ideation.
With appropriate treatment, it is possible to reduce the symptoms of social anxiety disorder, which can greatly improve quality of life.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Find more links and local resources.
Social anxiety disorder is a relatively common mental health condition. Symptoms include an intense fear of certain social situations, a fear of ridicule, and a strong desire to avoid social situations.
When severe or without treatment, the condition can be debilitating. However, with effective intervention — which might include talking therapies, medications, or both — people can greatly improve their quality of life.