Social anxiety disorder is a mental health condition characterized by excessive fear of certain social situations and specific concerns of being negatively judged by others. Often, social anxiety leads to avoidance of these situations, impairing a person’s ability to function and affecting their quality of life.
Social anxiety disorder, also called social phobia, is highly treatable. Treatment for social anxiety may include medication or therapy, or a combination of the two. Therapy is often the first treatment for social anxiety, as it carries fewer risks than certain anxiety medications. The most common and proven form of therapy for social anxiety disorder is cognitive behavioral therapy, or CBT.
What Is Social Anxiety?
Social anxiety disorder is a type of anxiety disorder where a person has a phobia, or specific fear, of social situations. In some cases, people with social phobias fear specific types of social activities like dates, parties, or large crowds, while other people become anxious in almost all social interactions. For some people, talking on the phone, attending classes, or just seeing friends can trigger social anxiety.
People who have social anxiety worry that others will judge them for being socially awkward or think badly of them, or that they will embarrass themselves. While most people worry about what others think of them, people with social phobias become excessively worried and stressed out about this. This often causes them to become very anxious before a social event or activity, and sometimes to change or cancel their plans at the last minute.
How Common Is Social Anxiety Disorder?
Social anxiety disorder is one of the most common mental health conditions in the U.S, affecting about 7.1% of the adult population. It is estimated that social anxiety disorder will affect 12% of adults in America at some point in their lives.1 However, a 2020 scientific journal looking at SAD across different countries including the U.S. suggested that social anxiety cases may be higher than the current estimates. This is because there is a large portion of the population who may go undiagnosed. The same journal revealed that social anxiety appears to be growing exponentially worldwide, specifically among young people between the ages of 18–24.2
It is also reported that women may be more affected by the disorder, particularly young adult women and teenage girls. In clinical settings, however, gender rates are equally if not slightly higher for men who seek help—often driven by gender role related stress.3
Social Anxiety Disorder vs. Generalized Anxiety Disorder
The main difference between social anxiety disorder and generalized anxiety disorder is that social anxiety disorder occurs only in response to specific social interactions and situations. People with generalized anxiety disorder experience anxiety in response to several different situations, and sometimes even when there is no identifiable trigger.
Social Anxiety Vs. Shyness
People who are introverted or shy may be more likely to experience social anxiety, but this doesn’t mean they have a diagnosable social phobia. Experiencing anxiety in social situations is fairly normal, even for people who aren’t shy or introverted. The difference between normal shyness versus social phobia is that phobias cause excessive anxiety that involve a lot of distress, and they often lead to avoidant behavior that interferes with a person’s ability to function.
Social Anxiety Symptoms
The key symptom of social anxiety is fear or avoidance when facing a social situation that has lasted for at least six months, but the exact manifestations of the condition can look a bit different for everyone.
Emotional & Behavioral Symptoms
Emotional and behavioral symptoms of social anxiety disorder include:3
- Significant fear of one or more social situations in which the person is exposed to possible scrutiny by others
- Fear or embarrassment that other people will notice symptoms of anxiety
- Exposure to social situations almost always causes intense anxiety, which may escalate into a panic attack
- A recognition that the fear is irrational or excessive
- Avoidance of the feared situations or extreme distress when they are not avoided
- The anxiety and/or resulting avoidance leads to an interference in normal routine, functioning, social activities or relationships, or leads to marked distress
Physical Symptoms
Physical symptoms of social anxiety include:3
- Shortness of breath
- Blushing
- Feeling dizzy
- Sweating profusely/sweaty palms
- Heart palpitations
- Rigid body posture/muscle tension
- Nausea or feeling a knot in the stomach
- Zoning out or having a blank stare
- Speaking with a very low voice or stumbling over one’s words
Avoidance Symptoms
Avoidance symptoms of social anxiety include:3
- Refusing to go to school or missing work
- Not attending a social gathering or party
- Staying away from places where there are a lot of people
- Reluctant to meet new people or initiate a conversation
- Avoiding eye contact in conversations
- Diverting attention from themselves to others
- Avoid using public bathrooms when others may be present
- Not eating, drinking, writing, or pointing in public (from fear of trembling hands)
- Not shaking a person’s hand or eating spicy foods (because of fear of sweating)
- Averse to places with bright lights or discussing intimate topics (because of fear of blushing)
What Triggers Social Anxiety?
People with social phobias often experience anxiety in more than one social situation, but someone’s anxiety triggers depend on their unique experiences, their routine, and even negative or embarrassing experiences they may have had in the past. Social anxiety can also vary from day to day, with certain surroundings, circumstances, or other stressors influencing the level of social anxiety.
Some situations and circumstances that can trigger social anxiety include:
- Large social gatherings, events or parties
- Being the center of attention
- Introductions or meeting others for the first time
- Interacting with authority figures
- Physical signs of embarrassment like blushing or shaking
- Having to speak or perform in front of others
- Having to eat or drink in front of others
- Dating and intimate or romantic interactions
- Receiving compliments or praise
- Being asked questions
- Having to engage in small talk
- Basic interactions like making an appointment or placing an order
- Giving or receiving constructive feedback
- Confrontation or difficult conversations
Do I Have Social Anxiety?
Humans are social creatures, and it is normal to experience a degree of social anxiety. Having anxiety in social situations, even when it is intense, does not necessarily mean that a person is struggling with a diagnosable social anxiety disorder. For the diagnosis to be made, the anxiety must cause significant distress, disruptions, or impairments for a person over a long period of time.
Signs of social anxiety in yourself or someone else might include:
- Actively avoiding any situations or settings that trigger anxiety
- Nervous “tics” that you do automatically without thinking like fidgeting, nail biting, or blinking excessively
- Having a different way of speaking, acting, or representing yourself in social situations in order to be liked or accepted
- Losing track of conversations or not listening to what is being said because you’re self-consciousness
- Believing that other people are looking at you, laughing at you, or judging you
- Replaying select interactions in your head that “prove” people dislike you
- Replaying certain interactions that were awkward or embarrassing
- Imagining awkward, embarrassing or negative interactions that haven’t happened
- Inner “debates” between your anxious thoughts and rational thoughts
What Does Severe Social Anxiety Look Like?
Depending on the person and how they cope with the condition, social anxiety can look very different. One person could venture out of their home regularly while seeming distracted, stressed, anxious, and jumpy. Another person with more severe social anxiety could choose isolation and reclusively over being around people. This person could seem calm and relaxed on the outside, but it is only because they are never challenging the source of their anxiety.
Types of Social Anxiety Disorder
People with social anxiety disorder may fear different types of interactions and situations. Some people develop anxiety in any social situation, including when they are with people they know well. Others might only experience social anxiety around people they do not know well or when in large groups of people. Others may experience social anxiety that is setting-specific, like people who are afraid of party settings, work settings, or of being in crowded places.
The four types of social anxiety are:
- Performance Anxiety or Stage Fright: Performance anxiety can occur in any situation where a person must speak, talk, or complete a task (even a small, easy task) in front of others. Having to perform a task while being observed leads many people to become uncomfortable, but for people with social anxiety disorder it is debilitating.
- Glossophobia: Glossophobia is one of the most common phobias – a fear of public speaking. While performance anxiety might be related to any task a person has to do in front of others, glossophobia is a specific fear of public speaking.
- Agoraphobia: Again considered a separate disorder, agoraphobia is also related to social anxiety. Agoraphobia means having a specific fear of being in certain public places. Agoraphobia often results in avoidance of being in those public spaces, and when untreated, can become an avoidance of virtually all public spaces and a fear of people in general.
- Panic Disorder: Many, but not all, people with social anxiety disorder also experience panic attacks. When panic attacks are regular, sometimes people develop a separate anxiety disorder known as panic disorder, where they develop an intense fear of having another panic attack.
What Causes Social Anxiety?
A combination of environmental, biological, and psychological factors place some people at higher risk than others for developing social anxiety disorder. Certain factors are known to increase risk for almost any mental health condition, like having a family history of mental illness, experiencing early trauma, lacking a social support system, or having an existing mental health or substance use disorder.
Risk factors for developing social anxiety could include:
Growing Up Isolated
People who grew up in homes where they were overly sheltered or controlled are at higher risk, as are those raised by detached, neglectful, overly critical or anxious parents. Growing up socially isolated also increases the risk of developing social anxiety disorder, as does having parents who were overly concerned with the opinions of others.
Adverse Childhood Experiences
Specific adverse events are more closely linked to an increased risk for developing social anxiety disorder. These include having a parent separate, divorce or leave the home, or having a new stepparent join the family.
Being Bullied
Children and teens who experience bullying are more likely to develop social anxiety disorder.
Being Female
Women are more likely to develop social anxiety disorder than men, although this disparity is not clearly understood.4
Having a Parent With a Mental Illness
Being raised by a parent or caregiver with a mental illness or substance use disorder is also a risk factor, as anxiety has a genetic component.4
How Can Social Anxiety Affect Someone’s Life?
Having a social anxiety disorder can be very debilitating especially when it spreads to a variety of life areas. In turn, this causes the sufferer to avoid doing even the most basic, everyday things. Although everyone’s thoughts, feelings, and reactions to social anxiety are different, if left untreated the condition can worsen and deprive people from leading healthy and productive lives.5
Here are just some examples on how social anxiety can affect people:5
- Educational consequences: Dropping out of school and having less qualifications
- Vocational issues: Being less productive at work, taking too many days off, having lower paying jobs and higher rates of unemployment particularly among women
- Financial troubles and lower household income
- Being single, unmarried, or divorced and not having children especially among men
- Having fewer friends, minimal social support, and inability to form close relationships
- Increased risk for suicidal thoughts and suicide attempts
- Risk for developing a co-occurring mental condition like depression
- Self-medicating via substance/alcohol to endure social situations, which can lead to a substance/alcohol use disorder
- Lower overall quality of life with inability to perform ordinary life tasks like going to the grocery store, getting a haircut, making a phone call, etc.
Social Anxiety and Depression
Studies have shown links between social anxiety and depression, indicating that people with SAD are more prone to experience depressive symptoms and have poor quality of life. Social anxiety typically impairs someone’s personal and social functioning, generating feelings of inadequacy and helplessness that can often mirror or trigger depression. Conversely, a person who struggles with depression can feel unworthy and unlikable which can make them avoid social situations and interactions with other people. When these two disorders co-occur it can make treatment and recovery more challenging.
Can Social Anxiety Be Prevented?
There isn’t conclusive data indicating that social anxiety can be prevented. However, like most other psychiatric conditions, early detection and appropriate treatment can significantly improve someone’s symptoms. As such, entering an evidence-based treatment sooner rather than later and working on therapy goals can lend great benefits and help people feel less anxious in social situations.
When Is Social Anxiety Disorder Diagnosed?
Social anxiety disorder is only diagnosed when all of the criteria for the condition are met and the condition triggers an impairment in the person’s life. If someone cannot work, go to school, maintain healthy relationships, or care for themselves, a professional could diagnose them with social anxiety disorder.
The majority of people will note some distress and anxiety when entering new or different social situations. These symptoms could mean that they have social anxiety, but it may not mean they have enough symptoms to have a diagnosable condition.
Social Anxiety Treatment
Social anxiety disorder is highly treatable. Treatment for social anxiety might include medication, therapy, or a combination of the two. Therapy is considered a frontline treatment for social anxiety, as it carries fewer risks than certain anxiety medications. Anxiety therapy also helps people learn skills to manage symptoms and reduce avoidant behaviors, improving their overall level of functioning.
Social Anxiety Therapy
Social phobia is treatable, and many people with the disorder respond well to therapy.
Common kinds of therapy for social anxiety include:
- Cognitive behavioral therapy (CBT): CBT is often provided in individual counseling sessions and involves helping people notice, interrupt, and change unhelpful thoughts that feed into their anxiety.6
- Exposure therapy: Exposure therapy is a specific kind of CBT that can also help people struggling with social phobias, and involves “exposures” where a person gradually faces feared social situations, resulting in desensitization, less avoidance, and more confidence.
- Acceptance and commitment therapy (ACT): ACT can also be effective in treating social phobias, and involves the use of mindfulness skills to help people accept and respond differently to their anxiety and to make choices based on their values, rather than their emotions.7
- Group therapy: Led by a licensed professional, group therapy provides a structured and safe setting for people to process their experiences with one another, build social skills, and gain coping strategies. CBT groups for social anxiety have shown to decrease negative beliefs about oneself and being overly self-conscious.
Social Anxiety Medication
Anti-anxiety medication is also sometimes recommended to certain patients, normally in addition to counseling. The most common forms of anti-anxiety medications prescribed are Benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), and selective-norepinephrine reuptake inhibitors (SNRIs). Medication can be prescribed by doctors, psychiatrists, and sometimes nurse practitioners or physician assistants. Some medications are prescribed as PRN, or as-needed, while others are recommended to be taken daily.
Support Groups
Support groups are a great way to complement and extend professional treatments, but people with social anxiety may choose to stay away from group settings. Entering a support group could be part of someone’s treatment plan that they could graduate to as symptoms are managed. The Anxiety and Depression Association of America offers a comprehensive list of support groups.
How to Get Help for Social Anxiety Disorders
Many people start their search for treatment by using an online therapist directory, conducting a google search, or going through their insurance company to find an in-network therapist or psychiatrist. When finding a therapist, it is important to do research and find someone who is experienced in treating social anxiety, and also someone who you feel you can open up and relate to. Most therapists offer consultations to help people in this decision making process, often at no cost.
Social phobias can be very difficult to cope with, and can get in the way of functioning and having meaningful interactions and relationships with other people. Most people with social anxiety want to have close relationships with people and even enjoy time they spend with others when they are able to relax. Finding the right therapist (sometimes in addition to medication) can help people reach this goal, becoming more comfortable, confident, and relaxed in social situations.
Self-Help Tips for How to Overcome Social Anxiety
In addition to seeking counseling or other forms of treatment, there are some self-help strategies that people struggling with a social phobia can do on their own to improve their symptoms and calm their anxiety.
Here are five tips for how to deal with social anxiety:
1. Face Fears Instead of Avoiding Them
Avoidance tends to worsen anxiety. Each time a person with social anxiety disorder cancels or changes their plans to avoid a social situation they are worried about, their fear is reinforced and they become less confident in themselves. This can be avoided by facing fears and following through with social plans and commitments, even when they are anxious.
2. Open Up Around Those You Trust
Often, people with social anxiety tend to hold back in conversations with other people because of the fear they will say something wrong, embarrass themselves, or reveal something that would make the other person think poorly of them. This makes it harder for people to feel comfortable around them, and can keep them from deepening their relationships with other people.
3. Be Authentic Instead of Worrying What People Think
Because people with social phobias tend to worry excessively about what other people think, they sometimes try to portray themselves differently than they are. They might exaggerate stories, pretend to be interested in something the other person likes, or try too hard to appear outgoing. Being inauthentic tends to make them feel more nervous, less confident, and keeps other people from getting to know the real version of them.
4. Tell Someone About Your Anxiety in the Moment
Ironically, sometimes admitting to another person that you are anxious can help you feel a little better. It can help another person understand why they might be acting stand-offish or why they left early, and also makes the person who is anxious feel less pressure to “pretend.”
5. Practice Mindfulness
Mindfulness is the mental practice of bringing full attention and awareness to the here and now. Mindfulness can be practiced by focusing on one or more of the five senses, focusing on what they can hear, feel, touch, taste, or smell. This practice can provide a two-fold benefit to people who feel anxious, helping to take attention away from anxious thoughts while also helping them feel more centered and calm.
Outward Signs of Social Anxiety in Different Ages
Signs and symptoms of social anxiety can vary based on many different factors, including age. Children, teens, and adults may experience social anxiety in different situations, and may also present very differently.
How Social Anxiety Presents in Children
While it is normal for a child to experience some shyness, a social anxiety disorder could be suspected if this anxiety is severe, persistent, and leads to avoidance of social situations. Children sometimes lack the ability to identify and talk about their emotions and it is not uncommon that children instead complain about physical ailments like a stomach ache or headache.
Children tend to be more anxious in unfamiliar settings or with people they don’t know, especially adults, and these patterns sometimes also emerge in children with social anxiety. Children who have social anxiety in new situations may also struggle with separation anxiety, which is more common in younger children. Social phobias may also develop in children during times of stress, transition, or after having experienced something difficult or traumatic.
How Social Anxiety Presents in Teens
In teens, social phobias can be difficult to detect because a normal part of development for teens is to be more focused on approval from their peers. A more serious problem may be suspected if the teen becomes so anxious that they often cancel plans or refuse to participate in activities, or if their anxiety causes them a lot of distress (like having panic attacks).
Teens who are anxious may be more snappy, irritable, and on-edge or might even act out at school to get out of social situations. Teens with social anxiety may be more likely to be heavy social media users, as this can be a less anxiety-provoking way to connect with their peers. Watching for changes in eating and sleeping patterns is also important, as these can be indicators of a mental health issue.
How Social Anxiety Presents in Adults
In adults, social anxiety may occur in a broad variety of social settings or might be localized to specific settings. A social anxiety disorder diagnosis can sometimes result in overt forms of avoidance, like a person who often cancels plans because of anxiety, but is sometimes less obvious. Some people might have orchestrated their lives carefully so that their social anxiety is not triggered until they find themselves in a new or unfamiliar social situation. For this reason, social anxiety may peak during times of stress or transition.
How Social Anxiety Present in Older Adults
In older adults, social anxiety can be difficult to detect, especially because older adults tend to be more isolated, leave their homes less, and have fewer social activities. Sometimes, social anxiety can develop in response to periods of being less social. For example, an older adult who has been home more because of an illness or injury might become anxious when they resume their old routines. Social phobias and other anxiety disorders often co-occur in older adults with other medical and psychological conditions.
Final Thoughts on Social Anxiety Disorder
People who have a social phobia can experience a lot of anxiety when they are in certain social situations, and this can keep them from living their lives fully, doing things they enjoy, and connecting with others in meaningful ways. Because social relationships are central to both physical and mental health, seeking counseling or other treatment for social anxiety can do more than reduce anxiety, but also can make people healthier and happier.
Social Anxiety Infographics
