Social anxiety disorder: signs, causes, how to overcome

It’s common to feel a little nervous in a new situation or standing up in front of a crowd. But for some people, it’s more than just shyness. Social anxiety disorder can turn a simple hello into an event causing intense embarrassment and fear. 

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Social anxiety is a type of anxiety disorder defined as an excessive fear of embarrassment, humiliation, or rejection by others during social interactions. Social anxiety is sometimes called social phobia.

It can affect your relationships, work, school, and other daily activities, as it often leads to avoiding social situations of all kinds. 

Up to 15% of people experience social anxiety disorder (Rose, 2021). Social phobia is a chronic mental health condition lasting longer than six months, which means it can significantly impact the lives of those who experience it. 

Most people with social phobia fear multiple social situations. One common subtype is performance social anxiety disorder—a fear of being scrutinized while performing or speaking in front of people.

Across subtypes, people with a social anxiety disorder may experience anxiety when:

• Meeting new people

• Going to an unfamiliar location

• Talking to people at work or school

• Being called on to speak in front of others

• Having to speak to a cashier in-store or waitress at a restaurant 

• Eating or drinking in public

• Exercising in public

• Using a public restroom

• Going on a job interview

• Having to give a speech or presentation to others

Although people may acknowledge their fear of talking in front of others, many people assume their shyness is just a part of their personality. 

Social anxiety affects your physical and mental health. Symptoms tend to occur in one or more types of social situations. Social anxiety causes both emotional and physical symptoms, which may include (Rose, 2021):

• Blushing

• Avoiding eye contact

• Fear of social situations or public speaking

• Intense fear in the days or weeks leading up to an event

• Feeling self-conscious

• Low self-esteem

• Panic attacks

• Negative thoughts about yourself

• Intense fear of negative feedback 

• Avoiding social situations

• Missing work or school 

• Increased heart rate

• Sweating

• Trembling or shaking

• Trouble talking or stumbling over words

• Nausea and digestive distress

• Using alcohol to tolerate socializing

Social anxiety affects all areas of people’s lives. Children with this condition are more likely to have lower grade point averages, fewer friends, and report lower quality relationships (Leigh, 2018).

Experiencing social anxiety disorder may also increase your risk for other conditions like depression, alcohol use, and substance use. So, it’s essential to address this issue and get the help you need.  

A combination of factors likely causes social anxiety disorder. Most people develop symptoms before age 20 (Rose, 2021). Your genetics, family history of anxiety, and other life events likely play a role in developing a social anxiety disorder.

Adverse and stressful life events, like bullying, family conflict, and abuse, increase the risk of developing social anxiety. Some research suggests parenting style may play a role in social anxiety. Overprotective and controlling parenting styles seem to increase the risk (Rose, 2021).

Your healthcare provider may ask you questions about your medical history and complete a physical exam to rule out any medical causes for your symptoms. If you get the medical all-clear, they may then refer you to a mental health professional.

A trained mental health professional will ask you about your symptoms, including when they occur and how often. This information will help them create the best treatment plan for you.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes the following criteria for diagnosing social anxiety disorder (Rose, 2021):

• Intense fear or anxiety around social situations where a person may encounter other people's negative opinions of them

• Fear that actions or words will be judged negatively by others

• Fear or anxiety is more significant than would be expected for the social situation

• Avoidance, fear, or anxiety lasts for at least six months and causes problems in the person’s daily life

Your healthcare provider will rule out other possible causes before diagnosing you with a social anxiety disorder.

Treatment for social anxiety includes medications, cognitive-behavioral therapy (CBT), or combining the two (Rose, 2021). A mental health professional will help you find the most effective treatment plan for you to help you feel better in social situations.

Medications

Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), effectively treat social anxiety disorder. Other anti-anxiety medications, like benzodiazepines, may also be effective (Rose, 2021). 

Follow medical advice for recommended medications and doses. Contact your healthcare provider if you have any questions about your medications before making any changes. 

Cognitive-behavioral therapy (CBT)

CBT is a type of psychotherapy that focuses on changing negative thoughts, feelings, and behaviors to more positive thoughts, feelings, and behaviors. This type of therapy helps build coping skills so you can manage your reactions to social situations. 

Your mental health professional may also recommend a type of therapy called exposure therapy. This approach uses a process to slowly increase your comfort level with situations that provoke anxiety, helping you build social skills. Your therapist will help you gradually build up your ability to handle social occasions in a safe environment. Over time, this approach can be effective in reducing anxiety symptoms (Scheurich, 2019).

Anxiety is a very personal experience. Many people with social anxiety recognize they have fear and assume it is just part of their personality. If you're experiencing intense fear in social situations, there is hope. With time, self-care, and practice, you may become more comfortable in social situations.

Here are some tips that may help with overcoming social anxiety:

• Limit caffeine, especially before social events or situations that make you feel nervous.

• Try mindfulness meditation: Research shows that mindfulness practices may help develop a more positive self-view and reduce social anxiety symptoms (Thurston, 2017).

• Practice deep breathing exercises: A 2017 research study found that diaphragmatic breathing exercises helped reduce stress hormones, decrease anxiety, and improve mental health (Ma, 2017).

• Get enough sleep: Research shows that poor sleep increases the severity of social anxiety symptoms (Kushnir, 2014). You can try to improve your sleep quality by going to bed at the same time every night; sleeping in a dark, cool, room; limiting noise; and spending less time in front of electronic devices before bed. 

• Exercise regularly: Frequent exercise helps to reduce anxiety symptoms (Aylett, 2018). Possible ways to increase your physical activity include taking the stairs, walking, bike rides, or weight lifting. 

• Slowly get out of your comfort zone: Working with a therapist on getting out of your comfort zone can help you process your emotions. It's best to do this with a professional's help. Still, you can work on this on your own by exposing yourself to social situations. Although this may be scary at first, over time, pushing past your comfort level may help to improve your overall social anxiety symptoms. 

Social anxiety is a common mental health condition. You may be feeling anxious around other people, feeling on edge in the weeks leading up to an event, or avoiding social situations entirely. It doesn't have to stay that way.

There are effective treatments to help you feel less anxious and better overall. Don't be afraid to ask for help. Yes, it's a big first step, but it can help take the stress away from talking with other people.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

June 23, 2021

Written by

Ashley Braun, RD, MPH

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.