Social anxiety disorder (also called social phobia) is a mental health condition. It is an intense, persistent fear of being watched, humiliated, judged and/or rejected. The fear is so strong that they feel it is beyond their ability to control. As a result, it gets in the way of going to work, attending school, or making friends.
Doing everyday things in front of people—such as eating or drinking in front of others or using a public restroom can also cause anxiety or fear. People with social anxiety disorder may worry about these and other things for weeks before or after a public event.
Some people with the disorder do not have anxiety in social situations but have performance anxiety instead. They feel physical symptoms of anxiety in situations such as giving a speech, playing a sports game, dancing or playing a musical instrument on stage.
Social anxiety disorder usually starts during youth in people who are extremely shy. Social anxiety disorder is not uncommon; research suggests that about 7 percent of Americans are affected. Without treatment, social anxiety disorder can last for many years or a lifetime and prevent a person from reaching his or her full potential.
When having to perform in front of or be around others, people with social anxiety disorder tend to:
Blush, sweat, tremble, feel a rapid heart rate, or feel their “mind is going blank”
Feel nauseous or sick to their stomach.
Show a rigid body posture, make little eye contact, or speak with an overly soft voice
Find it scary and difficult to be with other people, esp. those they don’t already know, and have a hard time talking to them even though they wish they could
Be very self-conscious in front of other people and feel embarrassed or awkward
Be very afraid that other people will judge them
Stay away from places where there are other people.
CAUSES OF SOCIAL ANXIETY DISORDER
Social anxiety disorder sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety. Some researchers think that misreading of others’ behavior may play a role in causing or worsening social anxiety. For example, you may think that people are staring or frowning at you when they truly are not.
Underdeveloped social skills are another possible contributor to social anxiety. For example, if you have underdeveloped social skills, you may feel discouraged or embarrassed after talking with people and may worry about being embarrassed again in the future.
First, talk to your doctor or health care professional about your symptoms. Your doctor should do an exam and ask you about your health history to make sure that an unrelated physical problem is not causing your symptoms. Your doctor may refer you to a mental health specialist, such as a psychiatrist, psychologist, clinical social worker, or counselor. The first step to effective treatment is to have a diagnosis made, usually by a mental health specialist. Social anxiety disorder is generally treated with psychotherapy (sometimes called “talk” therapy), medication, or both.
Cognitive behavioral therapy (CBT) is especially useful for treating social anxiety disorder. CBT teaches you different ways of thinking, behaving, and reacting to situations that help you feel less anxious and fearful. It can also help you learn and practice social skills. CBT delivered in a group format can be especially helpful.
Many people with social anxiety also find support groups helpful. In a group of people who all have social anxiety disorder, you can receive unbiased, honest feedback about how others in the group see you. This way, you can learn that your thoughts about judgment and rejection are not true or are distorted. You can also learn how others with social anxiety disorder approach and overcome the fear of social situations.
Anti-anxiety medications are powerful and begin working right away to reduce anxious feelings; however, people can build up a tolerance if they are taken over a long period of time and may need higher and higher doses to get the same effect. To avoid this problem, doctors usually prescribe anti-anxiety medications for short periods.
Antidepressants are mainly used to treat depression, but are also helpful for the symptoms of social anxiety disorder. In contrast to anti-anxiety medications, they may take several weeks to start working. Antidepressants may also cause side effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects that you have.
Beta-blockers are medicines that can help block some of the physical symptoms of anxiety on the body, such as an increased heart rate, sweating, or tremors. Beta-blockers are commonly the medications of choice for the “performance anxiety” type of social anxiety.
For basic information about these and other mental health medications, visit www.nimh.nih.gov/health/topics/mental-health-medications