What is social anxiety?

Social anxiety disorder^[1] is a chronic mental health condition. This condition (also called social phobia^[2]) causes intense worry or fear of being scrutinized, judged, humiliated, or rejected by others. It’s normal for most people to be nervous in certain situations. Public speaking, first dates, and job interviews can all cause some degree of anxiety. But in people with social anxiety disorder, everyday interactions—not just high-stress situations—can trigger severe anxiety, embarrassment, and self-consciousness.The symptoms of social anxiety can be so extreme that they significantly disrupt everyday life. Social anxiety can make it difficult to perform daily routines, go to work or school, and enjoy social activities. Things that may seem trivial to others, such as making a phone call or using a public restroom, may cause intense fear and be avoided entirely. For these reasons, some people with social anxiety may isolate themselves. Fear of the potential negative consequences of social interactions may become so overwhelming that avoiding others seems the best way to deal with it. People with social anxiety are also at increased risk^[3] for developing major depressive disorder and substance abuse problems. While social anxiety disorder is a difficult condition to live with, it is possible to manage its symptoms and even overcome it. Different types of treatment—from psychotherapy to medication, to a combination of the two—offer solutions to help those with social anxiety live happy, productive lives.

How common is social anxiety?

It is estimated that social anxiety disorder affects 7% of people^[4] in the U.S. The disorder is fairly common—it is the second most commonly diagnosed^[5] anxiety disorder (after specific phobia) and the third-largest psychological problem^[6] in the United States. Despite the availability of treatments for social anxiety disorder, fewer than 5%⁴ of individuals with the condition seek treatment within one year of onset. Furthermore, over one-third of people with social anxiety report having experienced symptoms for 10 years or longer before seeking treatment.

Social anxiety disorder causes

Social anxiety disorder falls under the umbrella of anxiety disorders. Other anxiety disorders include generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder (PTSD). As with many other mental health conditions, the cause of social anxiety disorder cannot be pinpointed to one specific factor. Rather, the condition likely results from a combination of biological and environmental factors. Some researchers^[7] think that social anxiety may be partially attributable to misreading other people’s behaviors or intentions. You may think that someone is staring or laughing at you for something when in reality they aren’t. It’s also thought that underdeveloped social skills (for example, lacking confidence and experience in talking to and meeting people) may also contribute to social anxiety. Other factors^[8] that may contribute to social anxiety disorder include:

• Family history/genetics: Anxiety disorders have been shown to run in families. However, it’s not clear to what extent genetics plays a role in social anxiety disorder as opposed to learned behaviors and feelings.
• Brain structure: It has been suggested that a part of the brain called the amygdala may play a role in controlling fear responses. People with overactive amygdalas may have increased fear responses, leading them to respond to social situations with anxiety or fear.
• Environment and experiences: Some people may develop social anxiety after embarrassing or upsetting social encounters. There may also be an association between the disorder and having parents who model anxious behaviors in social situations or are overprotective or controlling towards their children.

Social anxiety triggers

In relation to mental health, a trigger^[9] is an event or circumstance that provokes distressing emotional and/or physiological thoughts, reactions, or sensations. Triggers can vary greatly from person to person. However, people with social anxiety disorder commonly experience discomfort or distress in the following situations^[10]:

• Meeting or being introduced to new people
• Being the center of attention (such as giving a presentation or being called on in class)
• Being watched or observed while doing something (such as eating)
• Being criticized or joked about (well-intentioned or not)
• Feeling out of place or insecure in social situations (such as feeling like you don’t “fit in” or “don’t know what to say”)
• Making direct eye contact
• Talking to others in person
• Phone conversations
• Doing things that might make you seem like a “nuisance” (such as returning items to a store or asking someone to repeat what they said)
• Using a public restroom

People can experience different levels of discomfort in different situations. Some people with social anxiety, for example, may feel extremely overwhelmed in large groups of people, while others may be averse to more intimate one-on-one interactions. Understanding what your triggers are is one of the first steps toward learning how to cope with them.

Risk factors for social anxiety disorder

Some factors^[11] may put you at a higher risk of developing anxiety—and, more specifically, social anxiety. These include:

• Family history/genetics: Your risk for social anxiety is higher if someone in your immediate family—such as a biological parent or sibling—has the condition.
• Negative or traumatic experiences: Children who experience bullying, teasing, rejection, or humiliation may be more prone to social anxiety than others. Traumatic life experiences, such as family problems or conflicts, trauma, or emotional or physical abuse, may also be associated with social anxiety disorder.
• Temperament: Children who are timid, shy, or withdrawn when meeting new people or put in unfamiliar situations may be more likely to develop social anxiety.

Social anxiety disorder symptoms

Being nervous under certain circumstances and in some social interactions is normal. If your heart is racing before a big presentation or a first date, it doesn’t necessarily mean you have social anxiety. Especially in children, feeling shy or uncomfortable in unfamiliar situations is normal. Furthermore, some people are naturally more outgoing, while others may tend to be more reserved or introverted. Unlike occasional anxiety or nervousness, social anxiety disorder causes fear and distress in certain social situations. The signs and symptoms^[12] of social anxiety disorder are often both emotional/behavioral and physical. Emotional and behavioral symptoms:

• Fear of being judged, humiliated, or embarrassed (or of being in situations in which this might happen)
• Severe anxiety about meeting or interacting with new people
• Worry that others will notice that you are anxious
• Fear of showing symptoms of being flustered that may be embarrassing, such as blushing, trembling, sweating, stammering, or stuttering
• Anxiety in anticipation of feared activities, events, or situations
• Dreading or expecting the worst possible outcomes from social situations
• Spending time after social interactions or situations analyzing your behavior (wondering whether you said or did the right thing, made yourself look “stupid,” or upset someone)
• Avoiding situations or interactions that may possibly trigger symptoms

#### Physical signs and symptoms of social anxiety disorder include:

• Rapid heartbeat
• Blushing
• Trembling or shaking
• Having difficulty getting words out (having a shaky voice, stammering or stuttering)
• Sweating
• Stomach upset or nausea
• Breathlessness
• Dizziness or lightheadedness
• Muscle tension
• Feeling that your mind has “gone blank”

The signs and symptoms of social anxiety disorder can change over time. In periods when you are more comfortable with yourself and your mental health, you may experience less severe symptoms. Your social anxiety may flare up when you are under a lot of stress, dealing with a high baseline level of anxiety, or experiencing low self-esteem. If you experience any of the signs or symptoms of social anxiety disorder, talk to your healthcare professional. They will be able to refer you to a specialist and recommend options for treatment.

Complications from social anxiety disorder

When left untreated, social anxiety disorder can become difficult to the point of interfering with everyday life. It can be so debilitating that you begin to withdraw and face negative impacts on work or school, personal relationships, or even your general well-being. Severe social anxiety disorder can cause^[13]:

• Declined academic and career achievement
• Low self-esteem
• Difficulty being assertive or standing up for yourself
• Hypersensitivity to criticism
• Isolation or withdrawal from social activities
• Poor social skills
• Negative self-talk (“I’m not good enough,” “I always embarrass myself”)
• Tension in relationships
• Substance dependence/abuse
• Suicidal thoughts or suicide attempts

It’s important that you seek treatment if you are struggling with social anxiety. While it can feel very isolating, you’re not alone. There is treatment available to help you better cope with your signs and symptoms and increase your confidence and overall well-being.