Mental Health Anxiety Disorders Social Anxiety Disorder Guide Social Anxiety Disorder Guide Overview Diagnosis Treatment What Is Social Anxiety? By Michelle Pugle Michelle Pugle Facebook LinkedIn Twitter Michelle Pugle is an expert health writer with nearly a decade of experience contributing accurate and accessible health information to authority publications. Learn about our editorial process Updated on February 22, 2021 Medically reviewed by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD, is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Types of Social Anxiety Symptoms Diagnosis Causes and Risk Factors Treatment Coping Next in Social Anxiety Disorder Guide How Social Anxiety Disorder Is Diagnosed Social anxiety, also known as social anxiety disorder (SAD) or social phobia, is a mental health condition characterized by intense, and disabling fear of social situations. These feelings are experienced on emotional, physical, and cognitive levels, causing severe discomfort that can lead to social avoidance. People with SAD are afraid of being negatively judged by others, which can generate feelings of embarrassment, self-consciousness, and even depression. While it's normal to experience social anxieties in new or unfamiliar situations, when these fears persist, cause significant distress, and limit your life, you may be experiencing SAD. It typically presents during youth in people who are very shy. SAD can affect work, school, and other day-to-day activities, and can even make it hard to make and keep friends. The consequences can be isolation and loneliness, as well as a breakdown of relationships, including those with family, coworkers, and friends. Social anxiety is the second most commonly diagnosed anxiety disorder, affecting approximately 15 million American adults. About 7% of the general population in the U.S. will experience some form of social anxiety disorder in a 12-month period, and some estimates show the lifetime prevalence rate for developing SAD is 13% to 14%. Theresa Chiechi / Verywell Types of Social Anxiety There are two types of social anxiety: specific and general. A specific or performance-only social anxiety example would be the fear of speaking in front of groups, while people with generalized social anxiety are anxious, nervous, and uncomfortable in a variety of social situations. It is much more common for people with social anxiety to have a generalized type of this disorder. When anticipatory anxiety, worry, indecision, depression, embarrassment, feelings of inferiority, and self-blame are involved across most life situations, a generalized form of social anxiety may be the cause. Symptoms Experiencing symptoms of social anxiety does not necessarily mean someone has an anxiety disorder. However, if these symptoms result in persistent emotional distress or are disrupting everyday routines, that could be a sign of social anxiety disorder. Physical Physical symptoms can arise when a person with SAD is confronted with social situations like giving a speech, playing a sport, or performing in a recital. This happens because their fight-or-flight stress response has been activated into overdrive by the perceived threat of the social situation. People with SAD may experience the following when having to perform in front of or be around others: BlushingSweatingTrembling Nausea A rapid heart rateRigid body posture, making little eye contact, or speaking with an overly soft voice Psychological The psychological symptoms of SAD may be largely invisible to others, but they are serious and have the ability to derail someone’s life. These symptoms include: Avoiding social situationsExtreme and irrational anxietySevere fear of judgement and rejectionIntense feelings of self-consciousness Wanting to talk to others, but experiencing difficulty and fear Complications Without treatment, these symptoms can fester into significant problems. Difficulties communicating and connecting with others can mean lost opportunities. Examples of complications arising from SAD may include: Fear of interviewing can hinder professional growthAnxiety about meeting new people can lead to isolationAvoidance of social situations can result in someone confining themselves at home all the timeAlcohol and other substances may be used to self-medicate, creating further mental health and relationship issuesDepression and self-harm or suicidality can result Diagnosis Your healthcare provider will ask you questions about your symptoms and to describe your experience. The next common step is for your practitioner to order lab tests to rule out underlying conditions that could be causing your symptoms like tumors, hormonal imbalances, and infectious diseases like Lyme disease. Once they determine that your symptoms are not caused by a physical illness, your healthcare provider will then refer you to a psychiatrist or other mental health professional who will use the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to gauge whether you have social anxiety disorder. Diagnostic factors include: Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutinyThe individual fears acting in a way or showing anxiety symptoms that will be negatively evaluatedSocial situations almost always provoke fear or anxietyThe fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural contextSocial situations are avoided or endured with intense fear or anxietyThe fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioningThe fear, anxiety, or avoidance is persistent, typically lasting for six months or moreThe fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse) or another medical conditionThe fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorderIf another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessiveSpecify if the fear is restricted to speaking or performing in public SAD is sometimes confused with panic disorder. The key differences are that people with panic disorder experience unexpected panic attacks, rather than anxiety symptoms specifically related to social situations. Causes and Risk Factors It's unclear what exactly causes SAD, but many factors influence a person’s likelihood of developing social anxiety: Biological markers: Increased blood flow to the amygdala (a part of the limbic system responsible for fear) has been shown in brain images of people with SAD. Other parts of the brain involved in anxiety include the brain stem (controls heart rate and breathing), the prefrontal cortex (helps appraise risk and danger), and the motor cortex (controls your muscles).Genetic factors: As with all anxiety disorders, there is a significant genetic predisposition to developing social anxiety disorder.Environment: Unhealthy coping mechanisms (like conflict avoidance) and anxious responses or behaviors can be learned by way of observation of authority figures and peer groups.Physical appearance: Certain physical characteristics that stand out as unusual to the surrounding social norm can underlie social anxiety.Temperament: Exhibiting excessive inhibitions of new activities, people, places, or things can be an early sign of SAD. This is usually shown through extreme shyness or crying when meeting new people.New job or social situations: Any major life changes, whether positive or negative, may be an underlying trigger for SAD. The Anatomy of the Brain Subtypes The National Social Anxiety Center recognizes several subtypes of social anxiety disorder: Paruresis or shy bladder syndrome is centered on what others would think about them if they were unable to initiate the flow of urine. Conversational anxiety involves experiencing distorted and negative thoughts about what strangers and acquaintances think when talking with them. Male sexual performance anxiety is a vicious cycle that occurs when feeling anxious about performing sexual activities turns to excessive self-monitoring and self-evaluating during sexual relations that can then prevent erection or orgasm. Public speaking anxiety, or glossophobia, is one of the most common phobias, affecting about 73% of the population. LGBTQ anxiety can occur both from internalized social stigmas about the community and from being bullied or ostracized. Treatment Treatment options can include helping a person develop healthier thought patterns and coping mechanisms and other psychosocial improvements. They can also be used to help manage and reduce the associated symptoms of social anxiety disorder. Psychotherapy Many research studies have shown that anxiety-specific cognitive behavior therapy (CBT), a type of psychotherapy that teaches healthier ways of thinking, behaving, and reacting to situations, can actually effect positive changes in brain structures involved in processing and regulating emotion. Medication Medications can be effective in the short term at managing symptoms of social anxiety. But if they are not used in conjunction with an active, structured CBT program, medications alone will have no long-term benefits for people with SAD. Medications that may be used to manage SAD include: Anti-anxiety medications: They work quickly, and include benzodiazepines such as Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), and Ativan (lorazepam) Antidepressants: Namely selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). It takes several weeks for these medications to begin working, but studies have found that 50% to 80% of patients with the general form of social anxiety disorder respond after taking venlafaxine or an SSRI for eight to 12 week Beta-blockers: They are used to help reduce the physical symptoms of anxiety, most commonly performance-type social anxieties. Fewer than 5% of people with SAD will seek treatment within a year following the initial onset of the disorder, and more than a third of people report experiencing symptoms for 10 or more years before getting help. Coping There are additional ways to help improve quality of life and reduce symptoms of anxiety when living with SAD: Join a support group to find support and a safe place to learn and begin to understand that your thoughts about judgment and rejection are not true or are distorted.Challenge negative thinking patterns that involve trying to foreshadow events and thinking about worst-case scenarios. For example, can you really know what that person is thinking about you?Focus outward to help prevent hyper-focusing on your bodily sensations and physical reactions or appearance.Take time to breathe deeply and fully, giving your nervous system a chance to calm down.Avoid caffeine, including hidden sources of caffeine in chocolate and sodas, which can aggravate anxiety.Add omega-3 fatty acids to your diet (think fatty fish and nuts) to support your overall mood and anxiety.Practice patience with yourself and others. Don’t expect perfection in social situations, and use the skills you’ve learned to stay or get calm. Omega-3s, Fish, and Mercury in the Diet 18 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute of Mental Health. Social Anxiety Disorder: More Than Just Shyness. Anxiety and Depression Association of America. Social Anxiety Disorder. Social Anxiety Institute. What is Social Anxiety? Health Essentials from the Cleveland Clinic. Is a Hidden Medical Condition Causing Your Anxiety? Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 16, Social Phobia/Social Anxiety Disorder Comparison. Social Anxiety Association. What is Social Anxiety Disorder? Symptoms, Treatment, Prevalence, Medications, Insight, Prognosis. Tillfors M, Furmark T, Marteinsdottir I, et al.Cerebral Blood Flow in Subjects with Social Phobia During Stressful Speaking Tasks: A PET Study. Am J Psychiatry. 2001;158(8):1220-1226. https://doi:10.1176/appi.ajp.158.8.122.x Psychiatry Online. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596.x Muris P, van Brakel AM, Arntz A, Schouten E. Behavioral Inhibition as a Risk Factor for the Development of Childhood Anxiety Disorders: A Longitudinal Study. J Child Fam Stud. 2011;20(2):157–170. https://doi:10.1007/s10826-010-9365-8.x National Social Anxiety Center. Shy Bladder Syndrome (Paruresis). National Social Anxiety Center. Conversational Anxiety. The National Social Anxiety Center. Male Sexual Performance Anxiety. National Social Anxiety Center. Public Speaking Anxiety. National Social Anxiety Center. LGBT Anxiety. Goldin PR, Ziv M, Jazaieri H, Weeks J, Heimberg RG, Gross JJ. Impact of cognitive-behavioral therapy for social anxiety disorder on the neural bases of emotional reactivity to and regulation of social evaluation. Behav Res Ther. 2014;62:97-106. https://doi: 10.1016/j.brat.2014.08.005.x Harvard Health. Treating Social Anxiety Disorder. HelpGuide. Social Anxiety Disorder. Health Harvard. Omega-3s for Anxiety? By Michelle Pugle Michelle Pugle, BA, MA, is an expert health writer with nearly a decade of contributing accurate and accessible health news and information to authority websites and print magazines. Her work focuses on lifestyle management, chronic illness, and mental health. Michelle is the author of Ana, Mia & Me: A Memoir From an Anorexic Teen Mind. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit