Social anxiety disorder is a mental health condition that causes intense, ongoing fear of being watched, judged or embarrassed in everyday social situations. It goes well beyond shyness: the fear leads people to avoid conversations, meetings, meals and other activities, and it can disrupt work, school and relationships. The good news is that it is very treatable with therapy, medication or both.
If you dread speaking up in class, skip work events or replay conversations for hours afterward, you are not alone and you are not simply “too shy.” This guide covers the warning signs, what causes the condition, how it is diagnosed and the treatments that help people take their lives back.
What Is Social Anxiety Disorder?
Social anxiety disorder, sometimes called social phobia, is one of several anxiety disorders. According to the National Institute of Mental Health (NIMH), it involves intense fear in situations where you might be evaluated or judged by others, such as public speaking, meeting new people or eating in front of others.
It is also common. NIMH estimates that 12.1% of U.S. adults experience the condition at some point in their lives, and about 7.1% had it in the past year. Among adults who had it in the past year, nearly 30% had serious impairment in their daily lives.
Social Anxiety vs. Shyness
Many people feel nervous before a big presentation. The difference is scale and impact. As the Mayo Clinic explains, with this disorder the fear and anxiety lead to avoidance that can disrupt your life. Shyness may make a party uncomfortable; social anxiety may keep you from going at all, or leave you in distress for days before and after.
Signs and Symptoms of Social Anxiety
Symptoms show up in your thoughts, your behavior and your body. You might notice several of the following.
Emotional and Behavioral Signs
- Constant fear of being judged negatively or embarrassing yourself
- Intense fear of talking with strangers or people you do not know well
- Trouble making eye contact
- Avoiding social situations, or enduring them with a lot of distress
- Picking apart your “flaws” in a conversation after it is over
- Feeling your mind “go blank” when it is your turn to talk
Physical Symptoms
NIMH lists physical signs such as blushing, sweating, trembling, a rapid heart rate and an upset stomach. Mayo Clinic adds dizziness, trouble catching your breath and muscle tension. These reactions are real, and worrying that others will notice them can make the anxiety worse.
Situations That Often Trigger Symptoms
- Meeting new people or going to parties and gatherings
- Starting conversations, dating or speaking in meetings
- Eating or drinking in front of others
- Using a public restroom
- Performing, giving a speech or competing in sports
For some people, the fear shows up only in performance situations, such as a speech, a sports competition or a musical performance on stage. If you also have sudden surges of intense fear with a pounding heart and trouble breathing, read our guide to panic attacks vs. anxiety attacks.
What Causes Social Anxiety?
There is no single cause. Cleveland Clinic notes that researchers do not know the exact cause but point to several contributing factors. Mayo Clinic describes a mix of biological and environmental influences, including:
- Family history: Social anxiety disorder can run in families.
- Brain structure: The amygdala, a part of the brain involved in the fear response, may play a role.
- Life experiences: Bullying, teasing, rejection, humiliation or childhood trauma may raise risk.
- Temperament: Children who are shy, timid or withdrawn around new people may be at higher risk.
- New social demands: A new job, a first presentation or other new pressures can bring symptoms to the surface.
The condition usually begins in childhood or adolescence. Mayo Clinic says it typically starts in the early to mid-teens, and NIMH notes it is more common in women than in men.
How Social Anxiety Affects Your Life and Health
Left untreated, social anxiety can make it hard to finish school, interview for jobs and build friendships or romantic relationships. Mayo Clinic lists complications such as low self-esteem, isolation, trouble at school or work, substance misuse and suicidal thoughts.
Many people wait a long time to get help. The Anxiety and Depression Association of America reports that more than a third of people with the disorder have symptoms for 10 or more years before seeking help. ADAA also notes that they are at higher risk for major depressive disorder and alcohol use disorders.
Social Anxiety and Alcohol or Drug Use
Some people drink or use drugs to get through social situations. It can feel like it takes the edge off, but it often makes anxiety worse over time and can lead to a substance use disorder. Learn more about how alcohol affects anxiety. When anxiety and substance use happen together, care that treats both at once tends to work best.
If you ever have thoughts of harming yourself, call or text the 988 Suicide & Crisis Lifeline right away. In an emergency, call 911.
How Social Anxiety Is Diagnosed
A doctor or mental health professional will talk with you about your symptoms, may do a physical exam to rule out other causes and may use questionnaires. According to Mayo Clinic’s overview of diagnosis and treatment, the criteria include persistent, intense fear or anxiety about specific social situations, avoidance or enduring them with intense distress, anxiety that is out of proportion to the situation, and symptoms that interfere with daily life. Cleveland Clinic notes the anxiety must last at least six months.
Treatment for Social Anxiety Disorder
Treatment works, and most plans combine several of the approaches below.
Therapy
- Cognitive behavioral therapy (CBT): NIMH calls CBT the “gold standard” of psychotherapy for social anxiety. It helps you notice and change the thoughts that fuel fear.
- Exposure therapy: You gradually and safely face the situations you fear, building confidence step by step.
- Social skills training: Role-playing and practice help you feel more at ease in conversations.
- Acceptance and commitment therapy (ACT): Uses mindfulness and goal-setting to help you act on your values even when anxiety shows up.
Medication
Antidepressants called SSRIs and SNRIs are commonly used and may take several weeks to start working. Beta-blockers can help control physical symptoms such as a racing heart during a speech. Benzodiazepines work quickly but carry a risk of dependence, so they are generally used with caution. Our guide to anxiety medications explains each option in more detail. Always make medication decisions with a prescriber.
Support and Self-Care
Support groups let you practice social skills and hear from people who understand. Regular exercise, good sleep and cutting back on alcohol and caffeine can also help. Social anxiety often overlaps with other conditions, such as generalized anxiety disorder or depression, which a full evaluation can sort out.
When Weekly Therapy Isn’t Enough
If anxiety keeps you from working, attending school or leaving home, a more structured program may help. Our mental health intensive outpatient program (IOP) offers three-hour group sessions three days a week while you live at home, typically for about 5-6 weeks. Group therapy can feel scary with social anxiety, but it is also a safe place to practice the exact skills that help most. For more support, our partial hospitalization program (PHP) provides full-day programming five days a week.
Frequently Asked Questions
Is social anxiety the same as being shy?
No. Shyness is a personality trait that causes some discomfort. Social anxiety disorder causes intense, lasting fear and avoidance that interferes with work, school or relationships.
Can social anxiety go away on its own?
Symptoms can change over time, but many people live with them for years without help. Treatment such as CBT and medication can greatly reduce symptoms, so it is worth reaching out.
What is the best treatment for social anxiety?
CBT is considered the gold standard of therapy for this condition. Many people also benefit from exposure therapy, social skills training or medication. A provider can help you find the right mix.
Can social anxiety lead to substance use?
It can. Some people use alcohol or drugs to cope in social settings, and people with social anxiety are at higher risk for alcohol use disorders. Integrated treatment can address both.
Get Help for Social Anxiety in Lancaster, PA
You don’t have to keep avoiding the life you want. The Ranch Pennsylvania Outpatient Services offers mental health treatment in Lancaster, including CBT, DBT, group and individual therapy, and psychiatric care, with PHP and IOP options and integrated care if you also struggle with alcohol or drug use. Learn more about anxiety treatment in Pennsylvania, or verify your insurance to see what your plan covers. Our admissions team is available 24/7, and calls are free and confidential.
