You walk into a job interview and break into a cold sweat. You have to give a speech, and your stomach won’t stop flipping. You walk into a party alone and feel your heart race.
This kind of nervousness in certain social situations is actually pretty typical.
But for people with social anxiety disorder, also called social phobia, everyday social interactions — such as chatting with strangers at a party — do more than cause temporary nervousness: They cause significant distress. The Anxiety & Depression Association of America defines social anxiety disorder as an intense fear of being judged negatively by others or rejected in social situations. These fears cause those with the disorder to avoid social situations — making work, school and other social activities extremely difficult.
According to the National Institute of Mental Health, around 12% of adults in the U.S. experience social anxiety disorder at some time in their lives. Left untreated, it can impact educational goals, occupational performance, relationships and overall quality of life.
But social anxiety disorder is treatable. Psychotherapy and medication can help people with social anxiety disorder gain confidence and improve their ability to manage their symptoms and interact with others more comfortably.
If you think you or someone you love might have social anxiety, you may be worried or confused about what’s happening. Below are answers to common questions about the disorder.
Is social anxiety the same as being shy?
No. Shyness and social anxiety disorder are different. Shyness is a personality trait, not a disorder. Shy people are naturally reserved and sometimes take time to adjust to new situations — for example, they might spend time observing a group activity before joining in. They don’t have the encompassing anxiousness, worry and negative emotions associated with social anxiety disorder. Shy people can participate in work, school and other social activities without major issues.
What triggers social anxiety?
The triggers for social anxiety disorder depend on the individual. Many people with social anxiety disorder experience anxiety in most social situations. Others have specific triggers, such as talking to strangers or speaking in front of an audience.
Some common examples of social anxiety triggers include:
- Interacting with unfamiliar people or strangers.
- Attending parties or social gatherings.
- Entering a room in which people are already seated.
- Going to work or school.
- Starting conversations.
- Making eye contact.
- Going on a date.
- Asking for help.
- Returning items to a store.
- Eating in front of others.
- Using a public restroom.
What are signs of social anxiety disorder?
Social anxiety can manifest with emotional, behavioral and physical symptoms.
Emotional or behavioral signs of social anxiety
When someone has social anxiety disorder, it can impact the person’s ability to function in areas that are important to them.
For example, they generally:
- Have significant fear or anxiety in one or many social situations.
- Worry they will act in a way that will be judged negatively by others.
- Assume they can’t cope with being rejected by others.
- Are concerned about coming across as nervous, dumb, shy or awkward.
- Display fear or anxiety that’s disproportionate to the situation.
- Avoid social situations that provoke fear or anxiety.
To be diagnosed with social anxiety disorder, you must display one or more of these behaviors for six months or longer and struggle to function in important areas of your life.
Some people with social anxiety disorder also have depressive disorders or alcohol use disorders. People often discover that they have social anxiety disorder after seeking care for depression or substance use. A person may turn to substance use to try to cope with their social anxiety, such as drinking to dampen worries about being judged. Depression might arise from the growing problems that come with facing anxiety in multiple life areas.
Physical signs of social anxiety
When people with social anxiety disorder are faced with a social situation that makes them anxious, they can experience physical symptoms, such as:
- Blushing.
- Fast heartbeat.
- Trembling.
- Sweating.
- Upset stomach or nausea.
- Trouble catching their breath.
- Dizziness or lightheadedness.
- Muscle tension.
Is social anxiety different in men and women?
When it comes to anxiety, there are some notable differences between women and men, for example:
- Men are more likely to seek treatment for social anxiety disorder.
- Women who are diagnosed with an anxiety disorder are more likely than men to be diagnosed with other conditions, such as bulimia nervosa or major depressive disorder.
- Women with anxiety disorders are more affected by their illnesses than men, leading to higher rates of disability for women with anxiety disorders.
- Women often deal with their anxiety by avoiding uncomfortable situations, while men are more likely to turn to substance use.
- One study showed that women with higher levels of social anxiety may be better at identifying emotions from facial expressions than men or women without social anxiety disorder.
What causes social anxiety?
No one knows for sure what causes social anxiety disorder, but experts have some ideas. For example, there is evidence that:
- Social anxiety disorder may run in families.
- Brain structuremay play a role in controlling responses to fear.
- Stressful, embarrassing or traumatic experiences, including bullying, increase the risk of social anxiety disorder.
- Conditions that draw attention, such as Parkinson’s or facial disfigurement, can make people more self-conscious.
- New social or work demands, such as changing jobs or giving a speech, can trigger social anxiety disorder.
How is social anxiety treated?
Wondering how to overcome social anxiety? Luckily, when people are diagnosed with social anxiety disorder, there are several proven treatment options. Most people get the biggest relief by combining therapy, medication and lifestyle changes.
Therapy
Therapy is one of the most tried-and-true treatments for social anxiety disorder. Two of the most prominent therapies are:
- Cognitive behavioral therapy (CBT) is a common treatment that works by gradually exposing individuals to the social situations that trigger their anxieties — allowing them to gain confidence and build the social skills necessary to overcome social anxiety disorder. They also may learn skills to directly challenge their worries.
- Acceptance and commitment therapy (ACT) uses mindfulness strategies, such as identifying troubling situations, looking at thoughts objectively, and accepting negative thoughts and difficult feelings while staying engaged with important activities.
Another option may be support groups. Support groups, often led by a health care professional, area safe place for people with social anxiety disorder to find out how other people cope with social anxiety.
Medication
There are several kinds of medication used to treat social anxiety disorder:
- Antidepressants can help alleviate the symptoms of depression and anxiety.
- Beta-blockers can be used to treat physical symptoms such as an accelerated heart rate, sweating, and a shaking voice or limbs. They are typically used in brief performance situations, like giving a speech.
- Benzodiazepines are anti-anxiety drugs that can bring anxiety levels down quickly. They are generally used for a short amount of time because some people may develop a dependency on benzodiazepines.
What does social anxiety look like in teens and children?
Experts estimate that 11.2% of adolescent girls and 7.0% of boys have social anxiety disorder. The average onset for social anxiety disorder is around ages 13 to 19, though it can sometimes start in younger children. In children, symptoms of anxiety may include crying, having temper tantrums, clinging to parents or refusing to speak in social situations.
The signs of social anxiety disorder in children and teens are similar to adults. They include:
- Extreme shyness.
- Apprehension to try new things.
- Physical/health problems that are noticeable to others, such as a skin condition or physical deformity.
- Speech problems, such as speech impediments.
- Being bullied or abused, in person or online.
Additionally, some studies show that overprotective parenting styles are correlated to anxiety and other behavior issues in children.
Do I have social anxiety?
If you’ve felt socially anxious for six months or more, it’s time to get help. Contact your health care provider to learn how to deal with social anxiety disorder and enjoy more of what life has to offer.
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