Social anxiety disorder — sometimes known as social phobia — is a type of anxiety disorder that causes anxiety or fear in social settings.
Someone with this disorder has trouble talking with people, meeting new people, and attending social gatherings. They may feel anxious about others judging or scrutinizing them.
They may understand their fears are irrational but feel powerless to overcome them.
Social anxiety is different from shyness. Shyness can make socializing, school, and work difficult, but it doesn’t disrupt life to the same extent as social anxiety. Social anxiety is persistent and overwhelming and may affect everyday activities, such as shopping for groceries.
According to the Anxiety and Depression Association of America (ADAA), around 15 million American adults have social anxiety disorder. It often starts during the teenage years.
For a person with social anxiety disorder, social interaction may lead to:
- trembling or shaking
- a rigid body stance
- difficulty speaking
- feeling as if their mind goes blank
- dizziness or lightheadedness
- rapid heart rate
Psychological symptoms may include:
- intense worry before, during, and after a social situation
- avoiding social situations or trying to blend into the background if you must attend
- self-consciousness and fear of doing something embarrassing
- concerns that others will notice you’re stressed or nervous
- feeling a need to consume alcohol to help face a social situation
- missing school or work because of anxiety
Everyone feels anxious at times, but people with social anxiety have a constant fear of being judged by others or humiliated in front of them.
They may avoid all social situations, including:
- asking a question
- job interviews
- using public restrooms
- talking on the phone
- eating in public
Some people have limited or selective anxiety. For example, they may only be anxious when eating in front of others or talking with strangers. People with severe symptoms may avoid all social settings.
The exact cause of social anxiety disorder is unknown, but it
Physical, biological, and genetic factors likely play a role, according to scientists. Problems with neurotransmitter systems may lead to imbalances in the hormones serotonin, dopamine, and glutamate. These brain chemicals help regulate mood.
Environmental factors may contribute, but only as part of a complex interaction that also involves biological and genetic features, some experts say.
Factors that may contribute include a history of:
- emotional, physical, or other kinds of abuse
- negative interactions with peers
- overcontrolling parenting styles
- having an insecure attachment style
Negative experiences may lead to a type of post-traumatic stress disorder (PTSD), where social anxiety is a symptom.
Anxiety disorders can run in families, but it’s unclear whether this is due to genetic or environmental factors.
There’s no medical test to check for social anxiety disorder, but a doctor will likely use criteria from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) to establish if social anxiety disorder is likely.
They will likely ask about:
- your symptoms
- your family history
- other health conditions
The criteria for assessing social anxiety disorder, according to the DSM-5, are:
- a fear of one or more social situations that could involve scrutiny from others
- having a fear of acting in a way that will lead to a negative evaluation by others, or upset or offend others
- a specific situation nearly always provokes fear or anxiety
- the person either avoids the situation or attends with intense anxiety or fear
- fear is out of proportion to the threat
- fear or anxiety is persistent, usually lasting 6 months or more
- fear and anxiety disrupt daily living
- other symptoms or health conditions cannot explain the fear and anxiety the person feels
They may also wish to rule out other conditions, such as:
- a substance-related issue
- a personality disorder
- concerns about a health issue, obesity, or a physical characteristic, such as a facial burn
Several treatment options can help with social anxiety disorder. How well a therapy works will vary between individuals. Some people only need one type of treatment, but others may need a combination.
A primary care doctor may prescribe treatment, or they may refer you to a psychologist or other mental health specialist.
Options include the following:
Cognitive behavioral therapy (CBT): CBT helps you learn new ways to manage anxiety, for example, how to replace negative thoughts with positive ones.
Acceptance and commitment therapy (ACT): In ACT people learn to use mindfulness, acceptance, and behavioral strategies to be more present and figure out how to live a value-based life despite negative feelings.
Group therapy or a support group: This helps you learn social skills and techniques to interact with people in social settings. Working in a group will help you see that you’re not alone and enable role play of practical solutions.
Exposure therapy: In this type of therapy, a healthcare professional will help you gradually face social situations rather than avoiding them.
Medications can help improve your symptoms and help you function in your daily life.
Medications that can treat social anxiety disorder
- selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) and Sertraline (Zoloft)
- selective norepinephrine reuptake inhibitors (SNRIs), for example, venlafaxine (Effexor)
SSRIs and SNRIs can take
You may start with a low dose and gradually increase your prescription to avoid side effects. If you’re unhappy with one medication, the doctor may offer an alternative.
The doctor will explain the benefits and risks and help you decide which treatment is right for you.
Home and natural remedies can support the treatment recommended by your doctor.
Tips to address stress and anxiety include:
- breathing exercises
- mindfulness and meditation
- exercises, such as yoga and tai chi, to help manage stress
- avoiding caffeine and other stimulants
- establishing a regular sleep routine
- learning about anxiety and its effects
- finding a trusted person to talk with honestly, such as a friend, therapist, or family member
- knowing the signs and when to seek help
- getting regular exercise and eating a balanced diet to boost your overall sense of well-being
According to the ADAA, over one-third of people with social anxiety don’t seek help until they have had symptoms for at least 10 years. People may not see their discomfort as a mental health issue, and they may not realize that help is available.
Without treatment, social phobia
- achievement at work and in studies
- social interaction
- quality of life
Counseling therapy, lifestyle changes, and medication can help many people cope with social anxiety and other mental health issues.
Help is out there
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call the 988 Suicide and Crisis Lifeline at 988.
- Text HOME to the Crisis Textline at 741741.
- Not in the United States? Find a helpline in your country with Befrienders Worldwide.
- Call 911 or your local emergency services number if you feel safe to do so.
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you are not in the same household, stay on the phone with them until help arrives.
What are the symptoms of social anxiety?
People with social anxiety either avoid or feel very anxious in social settings. They may blush, sweat, tremble, avoid people, stand rigidly, avoid eye contact, or find it hard to talk. They may not know why they feel anxious, but it’s usually due to a fear of being judged or offending another person.
What is the main cause of social anxiety?
Experts don’t know exactly why it happens, but an imbalance in brain chemicals may play a role. Life events may contribute, such as a history of abuse or growing up in a household with a controlling parenting style. But, these are unlikely to be the only factors, according to experts.
How can I overcome social anxiety?
It’s important to seek medical help as soon as possible, as other complications may arise if a person lives with social anxiety disorder for a long time. Counseling, medication, and lifestyle remedies are all options. Social anxiety disorder seems to
People with social anxiety disorder feel fearful or anxious in social situations. The feeling may be so overwhelming that they avoid socializing and may avoid school, work, shopping, and other places where interaction may occur.
The person fears that someone will judge them or that they will offend someone or somehow humiliate themselves, but the threat is unlikely to be real.
Medication, counseling, and lifestyle remedies can help people manage symptoms and improve their quality of life.