Social anxiety can be a debilitating mental health condition that can cause a person to feel fearful in a variety of social situations.
Whether you are experiencing social anxiety yourself or you know someone who may be showing signs of it, you aren't alone – social anxiety is a very common condition. An estimated 7% of US adults suffer from a social anxiety disorder.
Having a better understanding of social anxiety can make it easier to manage symptoms and seek the right treatment.
Social anxiety disorder is more than the normal feeling of nervousness or butterflies in certain social situations.
Everyone feels anxious from time to time, whether it's a slight case of nerves about going on a date or a little nervousness about going to a big event, job interview, or meeting.
Social anxiety disorder, on the other hand, can cause immense feelings of anxiety, embarrassment, or fear related to going out in public or at general social events.
If you have a social anxiety disorder, you likely experience excessive fear of being judged or scrutinized by others in social situations.
Social anxiety disorder can occur in a wide range of social settings. Sometimes people can experience specific triggers, while other times they may feel a vague, generalized sense of anxiety any time they have to interact with others.
Common situations where social anxiety can arise include:
While many people feel uncomfortable at the idea of speaking or presenting to an audience if you have social anxiety you may feel debilitating panic at the idea of having to stand up and speak in front of others.
Meeting new people
If you have social anxiety, you may be relatively comfortable around those they already know but may have serious difficulties when it comes to meeting people for the first time.
Social anxiety can make it incredibly difficult to do something for the first time, from ordering at a new restaurant to going to an event you have never been to before.
Dating is inherently an intimate social interaction, which can be very triggering if you have social anxiety.
Going to parties
Parties can be overwhelming if you have social anxiety, with the focus on conversation and interacting with others one-on-one or in a group.
Going to school
Some children can suffer immense social anxiety at the idea of going to school, especially if they are entering a new school environment for the first time. School and college can also cause social anxiety for teenagers and adults.
If you have social anxiety, it is common to struggle with the feeling of fear that others will judge you negatively for perceived inadequacies. Even minor scenarios can be built up into much more serious issues due to social anxiety.
The symptoms of social anxiety may vary from person to person, but there are some common physical and psychological symptoms.
Many people with social anxiety notice a number of physical symptoms, including:
Excessive sweating (underarms, palms, other body parts)
Increased heart rate
Trembling or shaking
Nausea, vomiting, or diarrhea
Trouble catching your breath
The emotional symptoms of social anxiety can be very challenging to overcome. Even if you hide the signs of social anxiety well on the outside, you may be struggling internally. If you have negative self-talk, this can worsen your symptoms.
Common emotional symptoms of social anxiety include:
Expect the worst, including thinking through extremely negative scenarios or playing them out in your mind.
Being very harsh on yourself, including berating yourself for minor mistakes.
Constantly worrying about interacting with other people, including friends and loved ones.
Excessive analysis of your social performances, including how others may have reacted to it.
Overreacting to perceived negative reactions from people around you, including friends and loved ones.
Fear of the physical symptoms that go along with anxiety or that people will notice them.
Feeling fearful of imagined outcomes or scenarios.
Often, if you have social anxiety you will start to consciously or unconsciously avoid triggers that you know will increase your anxiety levels. As a result, you may begin to avoid speaking to people or struggle to interact socially.
Periods of isolation, including periods like those experienced during COVID-19 lockdowns, can increase social anxiety, since they may make it more difficult for you to improve your social skills and face your social fears to overcome them.
Social anxiety can impact your life in a number of ways. While not everyone will experience social anxiety in the same way, or show the symptoms, it can have a debilitating impact on the way you interact with others and live your life.
Many people with social anxiety will begin to avoid everyday situations, from ordering at a new restaurant to applying to jobs, out of fear of being negatively judged by others in those situations.
Social anxiety causes you to miss out on work opportunities, social events, milestones, and important events due to the symptoms you experience.
There is no single cause of social anxiety, as it can stem from a variety of potential factors.
Risk factors contributing to the development of social anxiety include:
Studies have shown that there can be a genetic bias¹ toward social anxiety. That is, if others in your family have social anxiety, you may have a greater risk of experiencing social anxiety yourself.
The amygdala, which is located near the base of the brain, helps to activate the ‘fight or flight’ response.
An overactive amygdala can trigger social anxiety by creating a sense of fear or an overreaction to minor stimuli when you feel uncomfortable or uncertain about a situation you are facing.
An overactive amygdala can cause you to feel an immense emotional reaction to even minor social pressure, which could result in increased social anxiety.
Bullying or abuse
Bullying and abuse² can cause long-lasting psychological trauma that can impact victims in many ways, often long after the situation has ended.
In many cases, bullying and abuse can lead to feelings of social anxiety, since you may become hypersensitive to any potential bullying or negative reaction from others in the future, including that someone may dislike or react angrily towards you.
Family history and environment
The environment in which a child has been raised can impact their risk of developing social anxiety later in life. A child with parents who do not display emotion and appear disconnected³, for example, is significantly more likely to experience social anxiety as they get older.
Not only does a parent's treatment of a child contribute to the risk of social anxiety, but if a parent has anxiety or depressive disorder, their child is more likely to develop social anxiety.
People who have experienced trauma may be at a greater risk of developing social anxiety, especially if the trauma involved bullying or occurred in a public place.
Personality or temperament can increase the risk of you developing social anxiety. Some people are naturally more introverted and prefer interacting with smaller groups of people.
If this describes you, you are at a higher risk of experiencing social anxiety than those who are naturally more extroverted and comfortable with larger groups of people.
Traits that draw attention
Some people may have specific traits that are more likely to draw attention from other people that may make them feel uncomfortable in social situations, increasing the risk that they will experience social anxiety.
These traits may include a stutter, physical disability, facial disfigurement, or other attributes that naturally draw the eye and increase the potential for uncomfortable questions or attention.
If you believe that you may be experiencing social anxiety, the best way to get the support you need is by contacting your doctor or a mental health professional for a diagnosis and treatment plan.
Your appointment will often start with a physical examination followed by a discussion of your symptoms, before going through basic questionnaires and mental health evaluations.
Most mental health professionals use a guide called the Diagnostic and Statistical Manual of Mental Health Disorders to diagnose mental health conditions.
The DSM-5 criteria for social anxiety⁴ include the following:
Marked and persistent fear of specific social situations where you may be exposed to potential scrutiny from others.
Exposure to those stimuli and situations always or almost always provokes anxiety.
The fear response is out of proportion to the context and situation.
Social situations that cause distress are avoided regularly or endured with significant fear and anxiety.
Anxiety, fear, or avoidance has persisted for more than six months.
The response to the fear causes impairment in social situations.
There is no other obvious condition or cause of the anxiety, including any side effects of a medication or substance.
There are two main types of treatment for social anxiety: psychotherapy, and medication.
If you have social anxiety, psychotherapy is a powerful tool for you to learn to manage, reduce, and even overcome the symptoms of social anxiety.
Treatment depends on the healthcare provider you choose, but may include:
Cognitive behavioral therapy (CBT) – Determining what thoughts and behaviors trigger social anxiety in you and working to change or adapt them.
Exposure-based CBT – Requiring you to expose yourself to social situations in order to decrease the anxiety response.
Group therapy – Working together with others who are experiencing similar social anxiety symptoms in a lower-stress, low-judgment environment.
In some cases, medication can be used to supplement therapeutic interventions. A variety of medications can help treat the symptoms of social anxiety and decrease its impact on your life, including:
Antidepressants – Such as SSRIs can increase your mood and decrease the negative feelings often associated with social anxiety.
Long-term or short-term anti-anxiety medication – Specifically designed to help decrease feelings of anxiety. Short-term anxiety medication may induce calmness, particularly when taken before entering a social situation that may cause anxiety.
Beta blockers – These offer a short-term anxiety remedy that may reduce the overall fight or flight reflex and make it easier for you to manage the physical symptoms of social anxiety.
It is important to carefully manage medication if you have a social anxiety disorder. You should always work closely with your doctor to discuss and identify any side effects you may be experiencing. Your doctor will be able to advise as to which medication you should take and for how long, including assisting with stopping your medication so you do not experience withdrawal symptoms.
Lifestyle changes can also help to alleviate the symptoms of social anxiety, such as:
Staying physically active
Eating a healthy diet
Practicing good sleep hygiene (sleeping enough reduces many types of anxiety and improves the brain's ability to process emotions)
Practicing social situations ahead of time with a friend or family member
Engaging in more social activities at your own pace
Your social anxiety management plan could also include joining a support group, doing activities you enjoy when you feel anxious instead of dwelling on the feelings of anxiety or checking in with friends and family to make it easier to deal with difficult situations and emotions.
When you begin treatment for social anxiety, it's important to keep going even if it doesn't feel like it's working at first. Often, symptoms will take time to resolve and you will need to commit to a treatment plan to see results.
While social anxiety can't be predicted or prevented, as it can come on at any time, there are some steps you can take to help reduce the likelihood of you experiencing social anxiety.
Often social anxiety first comes on, many people will try to avoid it. Social anxiety can also make it difficult for you to seek treatment and assistance since it can leave you feeling paralyzed with anxiety when the time comes to ask for help.
However, early intervention can help prevent social anxiety from worsening, and provide you with a better framework for dealing with the symptoms.
If seeking in-person help seems too overwhelming, there are now many affordable and effective virtual options available.
Whether you have just noticed that you’re starting to experience social anxiety, or if you have been dealing with social anxiety for some time, making positive changes to your lifestyle can reduce your symptoms.
Lifestyle changes include:
Decreasing caffeine consumption – Caffeine can increase general anxiety.
Reducing the consumption of alcohol and nicotine – These substances can increase feelings of anxiety over time, including social anxiety.
Increasing overall physical activity levels – Regular physical activity can mitigate feelings of social anxiety by reducing stress levels by up to 40%.
Social anxiety occurs in about 7.1% of US adults each year¹. It occurs more commonly in women, affecting 8% of women, compared to 6.1% of men.
Young people are also more likely than older people to suffer from social anxiety, with prevalence decreasing by age:
Approximately 91.% aged between 18–29
Approximately 8.7% aged between 30–44
Approximately 6.8% aged between 45–59
Approximately 3.1% over the age of 60
You should see a doctor for social anxiety if you find yourself starting to fear or avoid normal social situations, including going to work or eating in public.
Your doctor can provide you with valuable resources to help you move forward, and they may refer you to a mental health professional (a psychologist or psychiatrist) for diagnosis and treatment.
When you meet with a mental health professional, they will assess a number of factors, including your:
Medical history, including past trauma
Medication you take or have taken in the past
Questions you might have about social anxiety
When you have social anxiety, you may struggle to seek the support you need because you are worried about how the medical professional will react when you bring up your symptoms.
It is important to understand that social anxiety is common and you are not alone. Getting help, however, can help you to resolve symptoms of social anxiety and find more enjoyable ways to manage social interactions and enjoy life.