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. This condition will affect 12% of adults in America at some point in their lives.1
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 Disorder?
Social anxiety disorder is a type of anxiety disorder where a person has a phobia, or specific fear, of certain social situations and interactions. In some cases, people with social phobias fear specific types of social activities like dates, parties, or large crowds, while other people with the condition become anxious in almost all social interactions. For some people, even 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 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.
Social anxiety disorder is one of several types of anxiety disorders. While all anxiety disorders share a common symptom of excessive fear or worrying, people with this disorder only experience symptoms in response to social situations. These symptoms might occur before, during, or even after a social interaction or event, but are always related to social aspects. Specifically, social anxiety is driven by concerns about being judged, critiqued, or disliked by others.
Do I have Social Phobia or Am I Just Shy?
People who are introverted or shy may be more likely to experience social anxiety, but this doesn’t mean they have a social phobia. Experiencing anxiety in social situations is fairly normal, even for people who aren’t shy or introverted. The difference between a normal fear and a 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.
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: 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 certain public spaces and when untreated, can become an avoidance of virtually all public spaces.
- 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.
Triggers for Social Anxiety
Symptoms of a social phobia can be triggered by a variety of situations and circumstances, many of which are highly individualized.
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
This list of activities, interactions and social situations that can trigger social anxiety isn’t comprehensive. People with social phobias often experience anxiety in more than one social situation, but these are individualized and depend on the person, 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.
Social anxiety can occur at any time before, during, and even after a social activity or interaction. Some people find that their anxiety is much worse before an event than it is during it, or find that they become more comfortable once they are there, but this isn’t always the case. Some people become so anxious or uncomfortable during an event that they make an excuse to leave early. People who become anxious after a social event may repeat and replay interactions or conversations in their head because they worry they said something embarrassing.
Symptoms of Social Anxiety Disorder
All mental health and substance use disorders have a standardized set of symptoms that act as “criteria” that a person must meet in order to receive the diagnosis. The criteria for each mental health condition, including social anxiety disorder, can be found in the 5th edition of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-V). This manual is used by licensed professionals who have the qualifications to diagnose and treat these disorders. Each criteria outlines a set of symptoms and several symptoms that need to be met in order for the diagnosis to be given.
According to the DSM-V, the symptoms of social anxiety disorder are:2
- 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
- The anxiety/avoidance has been occurring for at least 6 months
Signs of Social Anxiety Disorder
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 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.
Thought Changes
Many people find that anxiety has a lot of cognitive involvement and that during times when they are anxious, their mind is very active. Overthinking or over-focusing on specific things that evoke anxiety is common.
In social anxiety disorder, the thoughts that people commonly get fixated on include:
- Personal flaws or insecurities
- Self-critical thoughts
- Beliefs that other people are looking or laughing at them
- Beliefs that other people are judging them or that their anxiety is obvious to others
- Beliefs that other people dislike them
- Replaying select interactions that “prove” people dislike them
- Replaying certain interactions that were awkward or embarrassing
- Imagining awkward, embarrassing or negative interactions that haven’t happened
- Inner “debates” between anxious thoughts and rational thoughts
Emotional Changes
The most obvious emotional change that occurs in people who have social anxiety is that they feel anxious. Aside from fear, there are sometimes other emotional changes that occur in people with social anxiety disorder.
These emotional changes include:
- Irritability that occurs because of feeling constantly nervous, uptight or on-edge
- Sadness or loneliness that occurs as a result of social avoidance and isolation
- Frustration or anger with themselves as a result of being so anxious or avoidant
- Shame that results from over-focusing on flaws, insecurities, and mistakes
- Guilt that arises when important relationships are damaged because of avoidance
Behavior Changes
Some people notice that their social anxiety results in specific changes to the way they act or communicate.
These behavior changes might include:
- Avoidance is the most common behavior seen in people with social anxiety disorder, and includes actively avoiding any situations or settings that trigger anxiety
- Nervous “tics” that a person does automatically without thinking when nervous like fidgeting, nail biting, or blinking excessively
- Misrepresenting, including any way of speaking, acting, or representing themselves differently in order to be liked or accepted
- Communication differently than normal, which could include a person who is quiet rambling on, a funny person becoming very serious, or an outspoken person being silent and withdrawn
- Losing track of conversations or not listening to what is being said because of being so distracted by thoughts and feelings of self-consciousness
What Causes Social Anxiety Disorder?
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. These include things 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.
Aside from general risk factors for mental illness, there are some specific to social anxiety disorder. 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. Finally, being raised by a parent or caregiver with a mental illness or substance use disorder is also a risk factor.3
Adverse life events, especially those occurring in childhood, are a known risk factor for a variety of mental health issues. Specific adverse events, however, 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 become involved. In addition, children and teens who experience bullying are more likely to develop social anxiety disorder. Women are more likely to develop social anxiety disorder than men, although this disparity is not clearly understood.3
Treatment of Social Anxiety Disorder
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. Therapy also helps people learn skills to manage symptoms and reduce avoidant behaviors, improving their overall level of functioning.
Therapy Options for Social Anxiety Disorder
Social phobia is treatable, and many people with the disorder respond well to therapy. The type of therapy with the most demonstrated evidence in treating social anxiety is Cognitive Behavioral Therapy, or CBT.4 CBT is often provided in individual counseling sessions and involves helping people notice, interrupt, and change unhelpful thoughts that feed into their anxiety.
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) also can 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.5
Medication
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.
How to Get Help for Social Anxiety Disorders
Many people start their search for treatment online, 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.
What Social Phobia Looks Like in Different Populations
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.
Social Anxiety Disorder Statistics
Anxiety disorders are the most common type of mental illness in America, affecting almost one in three people at some point in their lives. Social anxiety disorder is one of the most common forms of anxiety disorders affecting Americans.
According to the National Institute of Mental Health, statistics show:1
- Social anxiety disorder has affected 7.1% of Americans adults in the past year
- Social anxiety disorder affected more adult women (8%) than men (6.1%) in the past year
- Social anxiety severity varies; 29.9% of adults report serious impairment, 38.8% report moderate impairment, and 31.3% report mild impairment
- Social anxiety disorder affected an estimated 9.1% of teens in the past year
- Female adolescents were affected (11.2%) at higher rates than males (7%) in the past year
- In the course of their lifetime, 12.1% of Americans will experience social anxiety disorder
5 Ways to Cope With Social Phobia
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.
Five ways to cope with social anxiety disorder include:
- Facing 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.
- Opening 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.
- Being 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.
- Admitting to anxiety: Ironically, sometimes admitting to another person that they are anxious can help people 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.”
- Practicing 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.
Social Anxiety Disorder vs. Other Anxiety Disorders
Due to similarities in symptoms, such as high levels of anxiety and isolation, it is often easy to confuse social anxiety disorder with other types of anxiety or mental health disorders. While other mental health issues may manifest in similar ways, the key difference is that social anxiety is always tied to anxiety that arises from social situations, and not any other triggers.
Social Anxiety Disorder vs. Generalized Anxiety Disorder
These disorders are somewhat similar in their symptoms, both featuring excessive nervousness and worry. Both also may lead to avoidance of situations and triggers for anxiety, and both tend to negatively impact people’s lives and routines. 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 Disorder vs. Major Depressive Disorder
Sometimes symptoms of social anxiety disorder can look like major depressive disorder. Both disorders often result in people isolating themselves and giving up activities that matter to them. The difference is that in social anxiety disorder, the avoidance is driven by nervousness and worry about being judged by others. In depression, social avoidance and isolation is usually driven by sadness and a lack of interest, energy, or motivation that is characteristic of the disorder.
Social Anxiety Disorder & Other Mental Health Disorders
Social anxiety disorder can co-occur with other mental health or substance use disorders. It is possible, for instance, to be diagnosed with social anxiety disorder and major depressive disorder. It is even possible to be diagnosed with social anxiety disorder and another anxiety disorder like OCD, PTSD, or Panic Disorder. It is also not uncommon for social anxiety disorder to co-occur with substance or alcohol use disorders, as these substances are sometimes used by anxious people to self-medicate their symptoms.
Social Anxiety Disorder Tests & Self-Assessment Tools
Like all mental health conditions, social anxiety disorder cannot be self-diagnosed. Only a licensed professional counselor, psychologist, or other licensed professional can confirm a diagnosis. There are many different standardized assessment tools that a professional may use to aid in the diagnosis of social anxiety disorder. Some of the more common ones include the Social Phobia Inventory, the Social Anxiety Interaction Scale, and the Social Phobia Scale.6 While these scales have been validated and deemed reliable, they are not for public use and cannot be used to self-diagnose social anxiety disorder.
Still, many people may be interested in taking a screening to help determine whether they have some of the symptoms of social anxiety disorder. The Anxiety and Depression Association of America developed a Social Anxiety Screening Tool, which may be a useful place to start. Keep in mind that social anxiety disorder, like other mental health disorders, is not diagnosed solely based on a checklist of symptoms. Careful consideration is also given to a person’s environment and any current stressors or recent transitions.
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.
