What Is Social Anxiety Disorder?

Social anxiety disorder, sometimes called social phobia, is a chronic mental health condition. People with social anxiety disorder experience fear and anxiety in social situations and performance situations where they are surrounded by unfamiliar people and exposed to scrutiny by others. Affected individuals are excessively and persistently fearful of being embarrassed, humiliated, judged, or rejected by others.

Talk therapy, such as cognitive behavioral therapy (CBT) and antidepressant medications, can be used to treat social anxiety disorder and other mental health conditions.

Severity of Social Anxiety Disorders

Mild social anxiety is associated with physical and emotional symptoms in certain social situations while still being able to function in daily life and participate in social interactions.
Moderate social anxiety is associated with physical and emotional symptoms while continuing to participate in some social situations but avoiding others.
Extreme social anxiety is associated with intense anxiety, such as panic attacks, in all or most social situations, leading to avoidance behaviors.

Note: Many people with social anxiety disorder fluctuate between different levels of severity at different points in their life. Seeking timely care from a mental health care provider for mild social phobia may prevent it from becoming a more severe problem.

How Common Is Social Anxiety Disorder?

The National Institute of Mental Health estimates that about 12% of the adult U.S. population (more than 40 million Americans) have experienced social anxiety disorders at some point in their lives. This condition is more common in females than males, and 90% of diagnosed social anxiety disorders are made in young people under the age of 25. Social anxiety disorder is the third most common mental health condition (the two most common ones being substance abuse and major depression).

Symptoms: How Does Social Anxiety Feel Like?

Common Triggers and Anxiety-Inducing Situations

Some people with social anxiety disorder experience anxiety or fear in specific social situations, while others experience symptoms in all social situations. Examples of situations that can trigger social anxiety disorder symptoms include:

Performance situations such as public speaking
Meeting or talking to new people
Answering questions in front of other people
Answering the phone or making phone calls
Asking for help in public places like stores or restaurants
Eating in front of others
Using public restrooms
Going for job interviews
Dating

Emotional or Psychological Symptoms of Social Anxiety

Self-consciousness
Embarrassment
Awkwardness
Not knowing what to say
Mind going blank
Avoiding eye contact
Fearing being judged, humiliated, or rejected by others
Experiencing anxiety when around other people, especially strangers
Avoiding places where other people are present

Physical or Physiological Symptoms of Social Anxiety

Blushing
Sweating
Trembling or shaking
Racing heart
Dizziness or lightheadedness
Nausea
Stiff body posture

Symptoms of Social Anxiety Disorder in Children

In young children, social anxiety disorder can manifest as crying, tantrums, clinginess, freezing, shrinking, or refusing to speak in social situations. These symptoms are present not only when the child is among adults but also among peers.

Distinguishing Between Social Anxiety and Other Conditions

Social Anxiety Disorder vs Social Phobia

The terms social anxiety disorder and social phobia are often used interchangeably. However, social phobia is an older term that was used prior to 1994. Since then, the correct name for this mental disorder is “social anxiety disorder.” The definition has been expanded to include fear and anxiety of being judged by others in social situations, not just performance situations.

Social Anxiety Disorder vs Agoraphobia

As noted, social anxiety disorder is a fear of social situations, especially those involving unfamiliar people. People with this mental health condition worry about being judged, criticized, humiliated, or rejected by others. Social anxiety can cause a person to experience physical and emotional symptoms both.

Agoraphobia is a fear of situations from which escape might be difficult or help might not be available in case of a panic attack or other anxiety symptoms. People with agoraphobia fear being in public spaces, enclosed spaces, and crowded places.

How Is Social Anxiety Different From Shyness?

The key difference between social anxiety disorder vs shyness is that social anxiety causes intense fear and anxiety, interferes with daily functioning, and causes a person to avoid certain situations, while shyness does not.

According to the American Psychiatric Association, shyness is a personality trait in many people. It can cause a person to be awkward, quiet, passive, nervous, tense, or self-conscious during social interactions. Shyness may even cause physical symptoms like blushing, sweating, or a fast heartbeat. However, shyness is not a mental health condition. It is similar to a natural response, such as butterflies in your stomach on a first date. People can grow out of shyness and overcome poor social skills without medical interventions.

Social anxiety disorder is a mental health condition. People with social anxiety disorder experience persistent, intense fear and anxiety in social situations, to the point that it disrupts their ability to function and affects their quality of life. Severe social phobia and the fear of being judged negatively can cause a person to avoid situations that require interactions with unfamiliar people, for example, job interviews or parties. These avoidant and safety behaviors can affect career and personal relationships. For this reason, it is important to have social anxiety disorder treated by a mental health specialist.

Causes And Risk Factors: What Can Cause Social Anxiety?

Researchers are not sure of the exact cause of social anxiety disorder but believe it is a combination of genetic and environmental factors. Many parts of the brain are involved in fear and anxiety, and it is a complex mental health condition that isn’t fully understood.

Genetic Factors

Social anxiety disorders may run in families, which points to a genetic link. In other words, having a family member with this condition may increase your risk of developing social anxiety disorder. However, not everyone with a family history of social phobia will develop social anxiety disorder.

Environmental Factors

Social anxiety disorder may be linked to environmental factors such as a history of abuse, bullying, or teasing. It can also be triggered by health conditions that draw attention to your appearance or voice. Children with overbearing, controlling, or overprotective parents may be more likely to develop social phobia.

Temperamental Factors

Children who are shy, timid, reserved, or withdrawn may be at an increased risk of developing social anxiety disorder.

When To Talk To A Mental Health Professional

Talk to a mental health professional if fear and anxiety in social situations are leading to negative consequences in your day-to-day life—such as avoiding work and social engagements and affecting personal relationships with family members, friends, and colleagues.

Learn more: Psychiatrist vs Therapist: Understanding the Difference.

How is Social Anxiety Disorder Diagnosed?

Mental health professionals diagnose social anxiety disorder based on a guidebook called the Diagnostic and Statistical Manual of Mental Disorders (DSM-V or DSM-5) by the American Psychiatric Association. DSM-V defines social anxiety disorder as:

“A marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions, such as having a conversation or meeting unfamiliar people; being observed, such as eating or drinking; and performing in front of others, such as giving a speech.”

Features of social anxiety disorder include:

“The individual fears that they will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
The social situations almost always provoke fear or anxiety.
The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
The social situations are avoided or endured with intense fear or anxiety.
The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
The fear, anxiety, or avoidance is not better explained by the symptoms of other anxiety disorders or mental disorders, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
If another health condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.”

If you match the DSM-5 criteria for social anxiety disorder, your healthcare provider will obtain a medical history, ask questions about your symptoms, obtain a medication list, perform a physical exam, and order further testing to make sure your symptoms are not stemming from some other medical condition or mental disorder.

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Treatment Options: How Do Doctors Treat Social Anxiety?

Psychotherapy for Treating Social Anxiety Disorder

Cognitive behavioral therapy (CBT) is a type of psychotherapy (talk therapy or psychological counseling) that is one of the most effective treatments for social anxiety disorder and other psychiatric disorders.

It involves working with a psychologist or therapist to change negative thoughts and behavior patterns that are harmful. CBT takes place over multiple therapy sessions, either in-person or online, individually or in groups. You gain a different perspective on your social fears and anxieties, learn healthy ways to manage difficult situations, and gain confidence and self-esteem in social situations.

Exposure therapy is a type of cognitive behavioral therapy (CBT) in which you are gradually exposed to anxiety and fear-inducing situations. It may involve role-playing to help you develop confidence, coping skills, and social skills.

Learn more about the types of therapy available to support mental well-being.

Medications for Treating Social Anxiety Disorder

Antidepressant drugs, which are commonly prescribed to treat depression, are also effective in treating social anxiety disorder. In addition, short-term treatment of social anxiety disorder may involve the use of other medications, such as anti-anxiety medications and beta-blockers (blood pressure medications), to manage some of the symptoms of social anxiety disorder. Some of the medications prescribed to treat social anxiety disorder include:

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). SSRIs are often the first go-to’s used for those with more severe social anxiety.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor).
Anti-anxiety medications called benzodiazepines for short-term treatment of social anxiety disorder symptoms until antidepressants kick in. Examples of a benzodiazepine include alprazolam (Xanax) and lorazepam (Ativan).
Beta-blockers can help to relieve or prevent some of the physical symptoms of social anxiety disorder, such as a racing heart. An example of a beta-blocker is propranolol.

While anti-anxiety medications and beta blockers start working quickly, it can take several weeks for the effects of antidepressant drugs to kick in and help you feel more like yourself again. You may need to work with your mental health professional to find the medicine(s) that work best to manage your social anxiety disorder without causing intolerable side effects.

Remember, your healthcare provider is there to support you. Clear, prompt communication with them is essential to ensure the safety and efficacy of your treatment. Let your provider know of any thought of harming yourself or overall worsening of your depressive symptoms during the first few weeks of starting antidepressants; this risk is higher in children and young adults.

Find out: What Are the Most Common Antidepressant Side Effects?

Combination Therapies

Studies have found that using a combination of CBT and antidepressants to treat social anxiety disorder has a better response rate than monotherapy with CBT or antidepressant medications. One large-scale randomized trial revealed that combined fluoxetine and cognitive behavioral therapy (CBT) for social anxiety disorder had a treatment response rate of about 54.2% compared to around 51.7% for CBT alone and about 50.8% for fluoxetine alone.

Is Social Anxiety Curable?

Social anxiety disorder is a chronic mental health condition that can last for years, even lifelong. While it is treatable with talk therapy and antidepressants, it may not be curable. This means you may need to continue having social anxiety disorder treated long-term to keep the symptoms under control.

Medications such as antidepressants and beta blockers can treat social anxiety disorder and alleviate its physical symptoms. At the same time, therapy and a healthy lifestyle are essential in preventing relapse.

It's important to note that while social anxiety may not be completely "curable," the good news is that both drug and non-drug approaches are effective in controlling the symptoms, thus improving the quality of life.

How Do I Cope With Social Anxiety?

Self-Help Strategies and Lifestyle Changes

Eating a healthy diet is important for overall physical and mental health. Adding more omega-3 fatty acids to your diet can support brain health.
Engaging in regular physical activity can help relieve anxiety-related symptoms.
Getting enough sleep can improve anxiety symptoms.
Practicing stress management techniques such as deep breathing, meditation, and relaxation exercises can help with anxiety-related symptoms.
Avoiding alcohol and recreational drugs is important. These substances are unhealthy ways of coping with social phobia and other anxiety disorders.
Avoiding caffeine and stimulants is recommended for people with symptoms of social anxiety disorder. These substances can disrupt the sleep cycle and cause restlessness and jitteriness on withdrawal.

Tips For Management: How To Help A Loved One

Learn about social anxiety disorder. Educating yourself can help you better understand what a loved one is going through.
Be patient. Social anxiety disorder is a chronic mental health condition that takes time to treat.
Be empathetic. Don't dismiss the feelings or experiences of a loved one with social anxiety disorder.
Encourage treatment. Support a friend or family member seeking treatment for social anxiety disorder.
Attend family therapy sessions. This will help you remain positive, help your loved one reframe their thinking and behavior patterns, and avoid enabling behaviors.

Available Resources and Support Groups

Hey Peers
Anxiety and Depression Association of America (ADAA)
Mental Health America (MHA)
7 Cups
The Tribe

Haldol

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