What is social anxiety disorder?
It’s normal to feel nervous in some social situations. For example, going on a date or giving a presentation may cause that feeling of butterflies in your stomach. But in social anxiety disorder, also called social phobia, everyday interactions cause significant anxiety, fear, self-consciousness and embarrassment because you fear being scrutinized or judged by others.
Social anxiety disorder is a chronic mental health condition, but treatment such as psychological counseling, medication and learning coping skills can help you gain confidence and improve your ability to interact with others.
How common is social anxiety disorder?
Social anxiety disorder (social phobia) is the third largest mental health care problem in the world today.
The latest government epidemiological data show social anxiety affects about 7% of the population at any given time. The lifetime prevalence rate (i.e., the chances of developing social anxiety disorder at any time during the lifespan) stands slightly above 13%. Please discuss with your doctor for further information.
What are the symptoms of social anxiety disorder?
Feelings of shyness or discomfort in certain situations aren’t necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on the individual’s personality traits and life experiences. Some people are naturally reserved and others are more outgoing.
In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interferes with your daily routine, work, school or other activities.
Emotional and behavioral symptoms
Signs and symptoms of social anxiety disorder can include persistent:
- Fear of situations in which you may be judged
- Worrying about embarrassing or humiliating yourself
- Concern that you’ll offend someone
- Intense fear of interacting or talking with strangers
- Fear that others will notice that you look anxious
- Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice
- Avoiding doing things or speaking to people out of fear of embarrassment
- Avoiding situations where you might be the center of attention
- Having anxiety in anticipation of a feared activity or event
- Spending time after a social situation analyzing your performance and identifying flaws in your interactions
- Expecting the worst possible consequences from a negative experience during a social situation
For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.
Performance type of social anxiety disorder is when you experience intense fear and anxiety only during speaking or performing in public, but not in other types of social situations.
Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:
- Fast heartbeat
- Upset stomach or nausea
- Trouble catching your breath
- Dizziness or lightheadedness
- Confusion or feeling “out of body”
- Muscle tension
Avoiding normal social situations
Common, everyday experiences that may be hard to endure when you have social anxiety disorder include, for example:
- Using a public restroom
- Interacting with strangers
- Eating in front of others
- Making eye contact
- Initiating conversations
- Attending parties or social gatherings
- Going to work or school
- Entering a room in which people are already seated
- Returning items to a store
Social anxiety disorder symptoms can change over time. They may flare up if you’re facing a lot of stress or demands. Although avoiding anxiety-producing situations may make you feel better in the short term, your anxiety is likely to persist over the long term if you don’t get treatment.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
See your doctor or mental health provider if you fear and avoid normal social situations because they cause embarrassment, worry or panic. If this type of anxiety disrupts your life, causes severe stress and affects your daily activities, you may have social anxiety disorder or another mental health condition that requires treatment to get better. If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes social anxiety disorder?
Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of environment and genes. Possible causes include:
- Inherited traits. Anxiety disorders tend to run in families. However, it isn’t entirely clear how much of this may be due to genetics and how much is due to learned behavior.
- Brain structure. A structure in the brain called the amygdala may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.
- Environment. Social anxiety disorder may be a learned behavior. That is, you may develop the condition after witnessing the anxious behavior of others. In addition, there may be an association between social anxiety disorder and parents who are more controlling or protective of their children.
What increases my risk for social anxiety disorder?
There are many risk factors for social anxiety disorder, such as:
- Family history. You’re more likely to develop social anxiety disorder if your biological parents or siblings have the condition.
- Negative experiences. Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder. In addition, other negative events in life, such as family conflict or sexual abuse, may be associated with social anxiety disorder.
- Children who are shy, timid, withdrawn or restrained when facing new situations or people may be at greater risk.
- New social or work demands. Meeting new people, giving a speech in public or making an important work presentation may trigger social anxiety disorder symptoms for the first time. These symptoms usually have their roots in adolescence, however.
- Having a health condition that draws attention. Facial disfigurement, stuttering, Parkinson’s disease and other health conditions can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is social anxiety disorder diagnosed?
Social anxiety disorder is diagnosed based on your medical history, physical exam, and sometimes a mental health assessment, which is an evaluation of psychological symptoms. You may be asked to answer questions about your anxiety and what makes it better or worse.
Blood or urine tests may also be done to rule out other medical conditions that can cause similar symptoms (such as hyperthyroidism).
How is social anxiety disorder treated?
The two most common types of treatment for social anxiety disorder are medications and psychotherapy. These two approaches may be used in combination.
Psychological counseling (psychotherapy) improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations.
Cognitive behavioral therapy is the most common type of counseling for anxiety. In exposure-based cognitive behavioral therapy, you gradually work up to facing the situations you fear most. This therapy can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others.
First choices in medications
Several types of medications are used to treat social anxiety disorder. However, selective serotonin reuptake inhibitors (SSRIs) are often the first type of medication tried for persistent symptoms of social anxiety. Your doctor may prescribe Paroxetine (Paxil) or Sertraline (Zoloft).
The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety disorder.
To reduce the risk of side effects, your doctor may start you at a low dose of medication and gradually increase your prescription to a full dose. It may take several weeks to several months of treatment for your symptoms to noticeably improve.
Your doctor or mental health provider may also prescribe other medications for symptoms of social anxiety, such as:
- Other antidepressants. You may have to try several different antidepressants to find one that’s the most effective for you with the fewest side effects.
- Anti-anxiety medications. Benzodiazepines may reduce your level of anxiety. Although they often work quickly, they can be habit-forming and sedating, so they’re typically prescribed for only short-term use. If your doctor prescribes anti-anxiety medications, try taking them before you’re in a social situation so you know how they’ll affect you.
- Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice and limbs. Because of that, they may work best when used infrequently to control symptoms for a particular situation, such as giving a speech. They’re not recommended for general treatment of social anxiety disorder. As with anti-anxiety medications, try taking them before you need them to see how they affect you.
Stick with it
Don’t give up if treatment doesn’t work quickly. You can continue to make strides in psychotherapy over several weeks or months. And finding the right medication for your situation can take some trial and error.
For some people, the symptoms of social anxiety disorder may fade over time, and medication can be discontinued. Others may need to take medication for years to prevent a relapse.
To make the most of treatment, keep your medical or therapy appointments, take medications as directed, and talk to your doctor about any changes in your condition.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage social anxiety disorder?
The following lifestyles and home remedies might help you cope with social anxiety disorder:
- Get regular exercise. Start slowly so that you don’t overdo it. Build up your exercise program bit by bit, and aim for at least 2½ hours a week of moderate exercise. It’s fine to be active in blocks of 10 minutes or more throughout your day and week.1
- Get enough sleep by going to bed at nearly the same time every night. Also, keep your room quiet and dark. This may reduce distractions and may help you get a good night’s rest.
- Eat a balanced diet by choosing foods low in fat and high in fiber.
- Avoid foods and beverages that contain caffeine, such as chocolate and coffee, since they may increase your anxiety.
- Try some relaxation exercises. Certain breathing exercises and muscle relaxation exercises help reduce anxiety.
- Change how you think. Positive thinking can change how you feel and can reduce your anxiety.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Social Anxiety Disorder – Topic Overview. http://www.webmd.com/anxiety-panic/tc/social-anxiety-disorder-topic-overview#1. Accessed July 5, 2017.
Social Anxiety Fact Sheet: What is Social Anxiety Disorder? Symptoms, Treatment, Prevalence, Medications, Insight, Prognosis. http://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis. Accessed July 5, 2017.
Social anxiety disorder (social phobia). http://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/basics/definition/con-20032524. Accessed July 5, 2017.
Review Date: July 7, 2017 | Last Modified: July 7, 2017