What Is Social Anxiety Disorder (Social Phobia)?

Many people experience nervousness or discomfort in social situations. You may feel tense when meeting new people or notice your palms sweating before an important presentation. Public speaking or walking into a room full of strangers can be challenging, but most individuals can push through these moments.

However, if you have Social Anxiety Disorder (SAD), also known as social phobia, everyday social interactions can become overwhelming sources of stress. You may avoid engaging with others altogether because what feels routine for most—casual conversations or making eye contact—can trigger intense discomfort. This can significantly impact multiple aspects of your life, not just your social interactions, gradually disrupting your daily existence. Social Anxiety Disorder is often accompanied by other phobias, such as a fear of public speaking, claustrophobia (fear of enclosed spaces), or agoraphobia (fear of open spaces). While stress and anxiety are not phobias in themselves, they can serve as early indicators of more complex conditions.

Approximately 5.3 million people in the U.S. struggle with Social Anxiety Disorder. It typically develops in adolescence, usually between the ages of 11 and 19. It is one of the most common mental health conditions, so if you’re experiencing it, you’re not alone, and help is available. The hardest part is often taking the first step to seek support. Here’s how to recognize if your social discomfort goes beyond ordinary shyness and is affecting your life to the extent that professional help may be needed.

When Does Social Anxiety Disorder Occur?

For some individuals with SAD, anxiety is triggered by specific situations, such as public speaking or initiating conversations. Others feel anxious in almost all social interactions and avoid even minor engagements with people around them.

Everyone experiences social anxiety differently, but some common scenarios that tend to provoke distress include:

• Talking to strangers
• Public speaking
• Meeting new people
• Making eye contact
• Entering a room
• Using public restrooms
• Attending social events
• Eating in front of others
• Going to school or work
• Initiating conversations

Certain situations may be manageable for you—perhaps you’re comfortable speaking in front of an audience but feel overwhelmed by attending social gatherings. Or you may find one-on-one conversations easy but feel uneasy stepping into a crowded room.

People with Social Anxiety Disorder often fear being judged or scrutinized in social settings. They worry about embarrassment or humiliation, which may manifest physically as blushing, sweating, or trembling. There’s often a deep concern about unintentionally offending someone or becoming the center of attention, making typical social interactions seem daunting.

How Does It Feel?

While the experience varies from person to person, common symptoms of Social Anxiety Disorder in stressful situations include:

• Extreme shyness in social settings
• Persistent, intense fear of being judged
• Discomfort when attention is focused on you (e.g., during a presentation or group discussion)
• Difficulty initiating conversations
• Avoidance of being in the spotlight

Physical symptoms may also occur, such as:

• Rapid heartbeat
• Muscle tension
• Dizziness or lightheadedness
• Blushing
• Tears
• Excessive sweating
• Stomach issues or diarrhea
• Shortness of breath
• Out-of-body sensations

These symptoms may arise immediately before a social event or persist for weeks as you overthink and stress about it. Even after an event, you might dwell on how you acted, analyzing your every move and worrying about how others perceived you.

What Causes Social Anxiety Disorder?

There is no single cause of Social Anxiety Disorder, but genetics may play a role. If a family member has SAD, you may be more susceptible. Additionally, an overactive amygdala—the part of the brain responsible for fear responses—may contribute to heightened anxiety.

SAD typically emerges around age 13 and can stem from experiences like bullying, abuse, or excessive teasing. Shy children are more likely to develop social anxiety as adults, especially if raised in highly controlling or authoritarian households. Additionally, conditions that draw attention to one’s appearance or voice can trigger social anxiety. Only a qualified medical professional can diagnose SAD and recommend appropriate treatment. Anxiety is also closely linked to worry, and their causes may overlap. To learn more about these causes and their differences, read our article "Seven reasons for concern".

How Can Social Anxiety Disorder Affect Your Life?

SAD can have a profound impact on daily life. You may avoid situations that others handle effortlessly. It may feel like social interactions come naturally to others while they seem nearly impossible for you.

Avoiding social situations can negatively affect personal relationships and may lead to:

• Low self-esteem
• Negative thinking patterns
• Depression
• Heightened sensitivity to criticism
• Underdeveloped social skills

What Should You Do If You Have Social Anxiety Disorder?

If social anxiety prevents you from doing what you want or need to do, or makes it difficult to build and maintain relationships, treatment may help.

Talk to a doctor or therapist who specializes in SAD to identify the root causes of your anxiety and determine whether it is a typical social reaction or a condition requiring intervention.

Treatment Options for Social Anxiety Disorder

Prescription medications and behavioral therapy are two effective treatment options, often used together for the best results. Here’s how they work:

Medication

For some, prescription medication is a simple and effective way to manage Social Anxiety Disorder. These medications can reduce discomfort and, in some cases, significantly diminish or eliminate symptoms. However, not everyone responds to medication the same way. Some people may need to try different options before finding one that works.

The U.S. Food and Drug Administration (FDA) has approved four medications specifically for treating SAD: Paxil, Zoloft, Luvox, and Effexor. Other medications may also be effective, even if not FDA-approved specifically for SAD.

While medication is convenient and effective, it only alleviates symptoms rather than addressing the underlying causes. Additionally, stopping medication can lead to the return of symptoms. Some individuals may also experience side effects such as headaches, nausea, or sleep disturbances.

The FDA warns that antidepressants used to treat SAD may increase suicidal thoughts and behaviors in individuals under 24, so close monitoring is essential.

Behavioral Therapy

Working with a qualified therapist can help you identify and change thought patterns that trigger anxiety in social situations.

Exposure Therapy, a form of behavioral therapy, gradually exposes individuals to anxiety-inducing social situations, helping them feel more comfortable over time. Therapists typically start with less intimidating situations and progressively introduce more challenging ones as comfort levels increase. This method addresses the root cause of SAD rather than just reducing symptoms, meaning the benefits can persist even after therapy ends.

Other Treatment Options

Other methods for managing SAD include:

• Relaxation Therapy: Techniques like deep breathing and meditation may help with situational anxiety but are less effective for generalized SAD.
• Beta-Blockers: Originally used for high blood pressure, beta-blockers can help with performance-related anxiety, such as public speaking. However, they are not effective for general SAD.

When to Seek Help for Social Anxiety

If your social anxiety is extreme, it’s essential to have an open conversation with a medical professional about treatment options. Left untreated, SAD can lead to depression, substance abuse, academic or work difficulties, and a lower quality of life.

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