Social Anxiety Disorder (Social Phobia)
What is social anxiety disorder (social phobia)?
Social anxiety disorder (formerly known as social phobia) is a mental health condition where you experience intense and ongoing fear of being judged negatively and/or watched by others.
Social anxiety disorder is a common anxiety disorder.
If you have social anxiety disorder, you have anxiety or fear in specific or all social situations, including:
- Meeting new people.
- Performing in front of people.
- Taking or making phone calls.
- Using public restrooms.
- Asking for help in a restaurant, store or other public place.
- Answering a question in front of people.
- Eating in front of people.
- Participating in an interview.
A core feature of social anxiety disorder is that you’re afraid of being judged, rejected and/or humiliated.
Who does social anxiety affect?
Social anxiety disorder is a common mental health condition that can affect anyone. Most people who have social anxiety disorder experience symptoms before they’re 20 years old. Women and people designated female at birth (DFAB) experience higher rates of social anxiety than men or people designated male at birth (DMAB).
How common is social anxiety disorder?
Social anxiety disorder isn’t uncommon. Approximately 5% to 10% of people across the world have social anxiety disorder. It’s the third most common mental health condition behind substance use disorder and depression.
Are there different types of social anxiety?
A person with social anxiety disorder can have a mild, moderate or extreme form of it. Some people with social anxiety only experience symptoms with one type of situation, like eating in front of others or performing in front of others, while other people with social anxiety experience symptoms in several or all forms of social interaction. In general, the different levels of social anxiety include:
- Mild social anxiety: A person with mild social anxiety may experience the physical and psychological symptoms of social anxiety but still participate in, or endure, social situations. They may also only experience symptoms in certain social situations.
- Moderate social anxiety: A person with mild social anxiety may experience physical and psychological symptoms of social anxiety but still participate in some social situations while avoiding other types of social situations.
- Extreme social anxiety: A person with extreme social anxiety may experience more intense symptoms of social anxiety, such as a panic attack, in social situations. Because of this, people with extreme social anxiety usually avoid social situations at all costs. A person with extreme social anxiety likely has symptoms in all or many types of social situations.
It’s very common to have anticipatory anxiety when facing these situations. It’s possible to fluctuate between different levels of social anxiety throughout your life. No matter which type of social anxiety you have, it’s important to seek treatment because this type of anxiety affects your quality of life.
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 interferes with or prevents you from doing everyday activities such as 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.
In general, the three main factors that distinguish social anxiety from shyness are:
- How much it interferes with your day-to-day life.
- How intense your fear and anxiety are.
- How much you avoid certain situations.
Many people with social anxiety disorder don’t try to get help or seek treatment because they think social anxiety is just part of their personality. It’s important to reach out to your healthcare professional if you’re experiencing ongoing and intense symptoms when in social situations.
Symptoms and Causes
What causes social anxiety disorder?
Researchers and healthcare professionals are still trying to figure out the cause of social anxiety disorder. Social anxiety disorder can sometimes run in families, but researchers aren’t sure why some family members get it and others don’t. Many parts of your brain are involved with fear and anxiety, so social anxiety disorder is a complex condition to study. Researchers are also looking into how stress and environmental factors could contribute to social anxiety.
What are the signs and symptoms of social anxiety disorder?
When people with social anxiety have to perform in front of or be around other people, they tend to experience certain symptoms, behaviors and thoughts. A person with social anxiety disorder can have these symptoms during specific types of social situations or they can have them in several or all social interactions.
Physical and physiological symptoms of social anxiety disorder can include:
- Blushing, sweating, shaking or feeling your heart race in social situations.
- Feeling very nervous to the point of feeling nauseated in social situations.
- Not making much eye contact when interacting with others.
- Having a stiff body posture when you’re around other people.
Thoughts and behaviors that can be signs of social anxiety disorder include:
- Being very self-conscious in front of other people.
- Feeling embarrassed or awkward in front of other people.
- Feeling your mind “go blank” and not knowing what to say to other people.
- Feeling very afraid or worried that other people will judge you negatively or reject you.
- Finding it scary and hard to be around other people, especially strangers.
- Avoiding places where there are people.
Diagnosis and Tests
How is social anxiety disorder diagnosed?
A healthcare provider such as a clinician, psychologist, psychiatrist or therapist can diagnose a person with social anxiety disorder based on the criteria for social anxiety disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. The criteria for social anxiety disorder under the DSM-5 includes:
- Experiencing continuing, intense fear or anxiety about social situations because you believe you may be judged negatively or humiliated by others.
- Avoiding social situations that may cause you anxiety, or enduring them with intense fear or anxiety.
- Experiencing intense anxiety that's out of proportion to the situation.
- Experiencing anxiety and/or distress from social situations that interfere with your day-to-day life.
- Experiencing fear or anxiety in social situations that aren’t better explained by a medical condition, medication or substance abuse.
Your healthcare provider or another clinician will likely see if the DSM-5 criteria match your experience by asking questions about your symptoms and history. They may also ask you questions about your medications and do a physical exam to make sure your medication or a medical condition isn’t causing your symptoms.
A person typically has to have had symptoms of social anxiety disorder for at least six months in order to be diagnosed.
Is there a test to diagnose social anxiety disorder?
Healthcare professionals and psychologists can use certain tools or tests — usually a series of questions — to learn more about what you’re experiencing to gauge whether or not you could have social anxiety disorder.
Based on the responses, your healthcare provider can then make a social anxiety disorder diagnosis.
Management and Treatment
Is social anxiety disorder treatable?
Social anxiety disorder is highly treatable with cognitive behavioral therapy (CBT) and/or medication such as antidepressants (typically selective serotonin reuptake inhibitors also known as SSRIs or beta-blockers).
What is cognitive behavioral therapy (CBT)?
Cognitive behavioral therapy (CBT) is a form of psychological treatment. Your psychologist or therapist works with you to change your thinking and behavioral patterns that are harmful or unhelpful.
CBT usually takes place over multiple sessions. Through talking and asking questions, your therapist or psychologist helps you gain a different perspective. As a result, you learn to respond better to and cope with stress, anxiety and difficult situations.
What medications are used to treat social anxiety disorder?
Antidepressants are effective for depression and anxiety disorders and are a frontline form of treatment for social anxiety disorders. Anti-anxiety medications are typically used for shorter periods of time. Blood pressure medication known as beta-blockers can be used for symptoms of social anxiety disorder as well. Specific medications that are used to treat social anxiety disorder include:
- SSRIs (selective serotonin reuptake inhibitors): SSRIs are a type of antidepressant. Common SSRIs used to treat social anxiety disorder include fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine, citalopram and escitalopram.
- SNRIs (serotonin-norepinephrine reuptake inhibitors): SNRIs are another type of antidepressant. Venlafaxine or duloxetine (Cymbalta®) are common SNRIs used to treat social anxiety disorder.
- Benzodiazepines: These medications are used for short periods of time, either while the antidepressants start to work or used on-demand in situations that provoke anxiety. They aren’t intended to be used for long periods. Lorazepam or alprazolam are examples of benzodiazepines.
- Beta-blockers: Some beta-blockers are used to treat or prevent physical symptoms of anxiety, such as a fast heart rate. Propranolol or metoprolol are examples of beta-blockers.
It could take time to figure out the best dosage and type of medication for you. Know that starting the process of treating your social anxiety disorder brings you one step closer to feeling better.
Are there side effects to medication used to treat social anxiety?
Yes, there can be side effects from the antidepressants, anti-anxiety medication and beta-blockers used to treat social anxiety disorder. The type of side effects depends on the medication and how your body responds to it. Ask your healthcare provider or psychiatrist about what you can expect after you’ve started a medication.
How long does social anxiety medication take to work?
Antidepressants (SSRIs and SNRIs) can take weeks to start working. Although it might be difficult to have to wait until you start feeling better, it’s important to begin treatment if you have social anxiety disorder, and to stick with it. Ask your healthcare provider or psychiatrist when you can expect to feel better after starting an antidepressant.
Anti-anxiety medications usually take effect quickly. They’re usually not taken for long periods of time because people can build up a tolerance to them. Over time, higher and higher doses are needed to get the same effect. Anti-anxiety medications can be prescribed for short periods while the antidepressant starts to work.
Beta-blockers also work quickly to help with specific symptoms of anxiety, such as tremors or feeling like your heart is racing. However, like the anti-anxiety medications, they can’t treat depressive symptoms that may coexist with social anxiety disorder.
What are the risk factors for developing social anxiety?
Healthcare professionals and researchers are still trying to figure out the cause of social anxiety disorder. So far, they’ve found that the risk factors for developing social anxiety disorder can include:
- Genetic, when social anxiety disorder runs in your family.
- If you experienced parenting that’s overly controlling or invasive as a child.
- If you experienced stressful of fearful events in your life.
Outlook / Prognosis
What is the prognosis (outlook) for social anxiety disorder?
People with social anxiety disorder respond very well to treatment, whether that’s in the form of cognitive behavioral therapy (CBT), medication or both. Some people who have social anxiety disorder may have to take medication for the rest of their life to manage their social anxiety. Others may only need to take medication or be in psychological therapy for a certain amount of time.
If left untreated, social anxiety disorder can be debilitating and can result in poor education outcomes, declining job performance, lower-quality relationships and an overall decreased quality of life. A large percentage of people who have social anxiety disorder and don’t get treatment can develop major depression and/or alcohol use disorder. Because of this, it’s very important to contact your healthcare provider and seek treatment if you have symptoms of social anxiety.
How long will I have social anxiety disorder?
If left untreated, a person with social anxiety disorder could have it for the rest of their life. People who are on medication and/or participate in psychological therapy for their social anxiety are often able to drastically lessen or overcome their symptoms and anxiety. They learn how to live with the social anxiety but not let it overwhelm them.
How can I overcome social anxiety?
It’s almost impossible to overcome social anxiety without treatment. Social anxiety disorder is a medical condition. Like all other medical conditions, it requires treatment. Evidence has shown that cognitive behavioral therapy (CBT) and medications like antidepressants are very successful in treating and managing social anxiety disorder. Treatment can help you drastically lessen or overcome your symptoms and anxiety in social situations.
What can I do if I have social anxiety?
It can be uncomfortable and scary, but it’s important to tell your healthcare provider if you’re experiencing signs and symptoms of social anxiety disorder.
If you’ve already been diagnosed with social anxiety disorder, there are some things you can do to manage your symptoms and feel well, including:
- Get enough sleep and exercise.
- Don’t use alcohol or recreational drugs.
- If you take medication for your social anxiety, be sure to take it regularly and don’t miss doses.
- If you participate in talk therapy, be sure to see your therapist regularly.
- Reach out to family and friends for support.
- Consider joining a support group for people who have social anxiety.
- See your healthcare provider regularly.
When should I see my healthcare provider?
If you’re experiencing signs or symptoms of social anxiety disorder, be sure to talk to your healthcare provider. Getting treatment for social anxiety is crucial to feeling better and reaching your full potential.
If you’ve already been diagnosed with social anxiety disorder, be sure to see your healthcare provider regularly. If you’re experiencing worsening or concerning symptoms, or think your treatment isn’t working, contact your healthcare provider as soon as possible. Don’t discontinue medications on your own without discussing it with your healthcare provider first.
What questions should I ask my doctor?
Asking for help or talking about your mental health can be uncomfortable. But your mental health is just as important as your physical health, so it’s important to talk to your healthcare provider about your symptoms. Some questions that may be helpful to ask your healthcare provider if you have or think you might have social anxiety disorder include:
- Should I see a therapist, psychologist and/or psychiatrist?
- Do you have any recommendations for psychologists, psychiatrists or therapists that I could see?
- Is there medication I can take for social anxiety disorder?
- Do you know of any support groups for social anxiety disorder?
- Do you know of any books I could read about social anxiety disorder?
- What are the next steps after I’ve been diagnosed with social anxiety disorder?
Frequently Asked Questions
What is the difference between social anxiety disorder and agoraphobia?
While social anxiety disorder and agoraphobia both involve anxiety and public places, they’re different mental health conditions.
Social anxiety disorder is an anxiety disorder where you have intense and ongoing fear or anxiety that you’ll be judged, watched or humiliated by other people in social situations.
A person with agoraphobia experiences feelings of panic or helplessness when they’re in certain places or in certain situations, not necessarily because of other people. They fear situations where escape might be difficult if something were to go wrong. Agoraphobia is an anxiety disorder that typically develops after one or more panic attacks.
What is the difference between social anxiety and social phobia?
There isn’t a significant difference between social anxiety disorder and social phobia. Social anxiety disorder used to be called social phobia. Prior to 1994, a diagnosis of social phobia meant you experienced fear and anxiety when performing in front of people. In 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM) changed the name to “social anxiety disorder” and expanded the criteria for diagnosis. It was changed to include the fear and anxiety of being judged or watched by others in social situations, not just when performing.
How can I help someone with social anxiety?
There are multiple things you can do to help and support someone with social anxiety, including:
- Learn about social anxiety disorder: Educate yourself about social anxiety disorder to better understand what they’re going through. Don’t assume you know what they’re experiencing.
- Be empathetic: Don’t downplay or dismiss their feelings and experiences. Let them know that you’re there to listen and support them. Try putting yourself in their shoes.
- Encourage them to seek help and/or treatment: While having an understanding and supportive friend or family member is helpful to a person with social anxiety, social anxiety disorder is a medical condition. Because of this, people with social anxiety disorder need cognitive behavioral therapy (CBT) and/or medication to treat and manage their social anxiety. Encourage them to talk to their healthcare provider if they’re experiencing signs and symptoms of social anxiety.
- Be patient: It can take a while for someone with social anxiety disorder to get better once they’ve started treatment. Know that it’s a long and complex process and that their symptoms and behaviors will eventually improve.
A note from Cleveland Clinic
Social anxiety disorder is a common condition that affects people all over the world. If you experience signs of social anxiety disorder or have been diagnosed, know that you’re not alone. While experiencing social anxiety can be scary, the good news is that it’s treatable. Your mental health is just as important as your physical health, so be sure to talk to your healthcare provider about what you’re experiencing. The sooner you get help and treatment, the sooner you’ll feel better.
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