Social Anxiety Disorder

Social anxiety disorder (formerly known as social phobia) is a condition that causes you to have an intense and ongoing fear of others watching or judging you.

With this mental health condition, specific or several social situations trigger fear and anxiety, like:

• Answering a question in front of people
• Asking for help in a restaurant, store or other public place
• Dating
• Eating in front of people
• Meeting new people
• Performing in front of people
• Taking or making phone calls
• Using public restrooms

A core feature of social anxiety disorder is that you’re afraid of being judged, rejected and/or humiliated. It’s different from being shy or introverted. You may fear others seeing you have anxiety symptoms, like blushing or sweating. The disorder overwhelms your daily life.

Social anxiety disorder is a common anxiety disorder. It affects about 13% of people in the U.S. Symptoms often begin during childhood and adolescence.

Many people with this condition don’t try to get help because they think social anxiety is just part of their personality. Talk to a healthcare provider if you have intense symptoms when in social situations.

Symptoms of social anxiety disorder

With social anxiety disorder, your mind and body react intensely to social interactions. The underlying feelings are fear and worry. The fear is out of proportion to the actual threat the situation poses.

These feelings can lead to physical symptoms.

This condition ranges in severity. You may have these symptoms during specific types of social situations or most of them.

Emotional and behavioral symptoms

Thoughts and behaviors that can be signs of social anxiety disorder include:

• Avoiding places where there are people
• Fear or worry that other people will judge you negatively or reject you
• Feeling very self-conscious or embarrassed in front of people
• Finding it scary and hard to be around other people, especially strangers
• Your mind “going blank” and not knowing what to say

Physical symptoms

Physical symptoms in social situations can include:

• A stiff body posture
• Avoiding eye contact
• Blushing and sweating
• Intense nervousness to the point of nausea
• Shaking and a racing heartbeat
• Elevated blood pressure and/or “white coat syndrome”

Social anxiety disorder causes

Researchers don’t know the exact cause of social anxiety disorder. But they think many factors contribute to it, like:

• Growing up with overly controlling parents
• Childhood stress and trauma
• Brain changes, which may or may not be genetic

Complications of this condition

Without treatment, social anxiety disorder can greatly affect your life. It can lead to:

• Dropping out of school
• Declining job performance
• Relationship issues
• An overall decreased quality of life

It can also increase your risk of other anxiety disorders, mood disorders and substance use disorders.

The good news is that treatment can make a big difference. It may help prevent these complications.

How doctors diagnose this condition

Your healthcare provider will ask questions about your symptoms and history. They can diagnose social anxiety disorder based on the criteria for it in the DSM-5. The criteria include:

• Continuing, intense fear or anxiety about social situations because you believe others may judge you negatively or humiliate you
• Avoiding social settings that may cause you anxiety, or enduring them with intense fear or anxiety
• Intense anxiety that’s out of proportion to the situation
• Anxiety and/or distress from social situations that get in the way of your day-to-day life
• A physical condition, medication or substance use doesn’t better explain your symptoms

Typically, you must have symptoms for at least six months to get a diagnosis.

How is it treated?

Social anxiety disorder is highly treatable with cognitive behavioral therapy (CBT) and/or medication. Together, you and your healthcare provider will find the best treatment plan for you. You may find a support group helpful, as well.

Therapy

Cognitive behavioral therapy (CBT) is a form of talk therapy. It’s the go-to treatment for social anxiety disorder. A psychologist or therapist works with you to change thinking and behavior patterns that are unhelpful.

CBT usually takes place over a limited number of sessions. Using a question-and-answer format, your therapist helps you change how you look at things. As a result, you learn to respond better to social situations.

Medications

Specific medications for social anxiety disorder include:

• SSRIs orSNRIs: These are types of antidepressants. They’re the main medication for this disorder.
• Benzodiazepines: You use these pills for short periods of time. You may take them while waiting for the antidepressants to work or as needed for situations that trigger anxiety.
• Beta-blockers: Some beta-blockers treat or prevent physical symptoms of performance anxiety, like a fast heart rate. They’re also short-term medications.

Antidepressants can take weeks to start working. It might be hard to wait until you start feeling better. But it’s important to begin treatment and stick with it. Ask your provider about when you can expect to feel better after starting an antidepressant.

What can I expect if I have this condition?

Social anxiety disorder generally doesn’t go away on its own. Evidence shows that cognitive behavioral therapy (CBT) and medications like antidepressants are very successful in managing the condition.

One study found that CBT for social anxiety disorder reduces symptoms for 12 months or longer after therapy ends. It also helps with depressive symptoms a year or more after treatment.

It can take time to figure out the best treatment approach. But starting the process of managing this condition brings you one step closer to feeling better.

What is the difference between having social anxiety disorder and being shy?

Anyone can experience shyness from time to time. Having social anxiety disorder consistently gets in the way of or prevents you from doing everyday activities. This includes things like going to the grocery store or talking to other people. Because of this, social anxiety disorder can negatively affect your education, career and personal relationships. Being shy from time to time doesn’t affect these things.

Three main factors that set apart social anxiety from shyness are:

• How much it interferes with your day-to-day life
• How intense your fear and anxiety are
• How often you avoid certain situations