Social anxiety disorder (SAD), also known as social phobia, is a type of anxiety disorder where people fear and avoid the judgment of others. SAD is different from the expected anticipation of social situations. Those with social anxiety have overwhelming symptoms more than just feeling shy or nervous. They experience intense anxiety and fear.
An estimated 12.1% of U.S. adults experience social anxiety disorder at some point in their lives.
Social Anxiety Disorder Symptoms
Social anxiety disorder will affect the person before, during, and/or after a social situation. Symptoms can be split between physical and emotional or behavioral symptoms.
Physical symptoms of SAD include:
- Fast heartbeat
- Stomach upset and/or nausea
- Trouble catching breath
Emotional or Behavioral
Emotional or behavioral symptoms of SAD include:
- Avoiding social situation
- Avoiding being the center of attention
- Spending time worrying about how they appear to others
- Intense anxiety before a social situation
- Overanalyzing social situation
- Ruminating on past social experiences
If you or a loved one are struggling with social anxiety disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
The causes of social anxiety disorder vary by person. Research has found this disorder can start in teens or later in life, and affects men and women equally.
Some possible causes of SAD include:
- Limited social experiences
- Overprotective parents
- History of bullying or public humiliation
Identifying Social Anxiety Disorder
Social anxiety disorder can present differently in each person, with some having visible outward symptoms like blushing, shaking, and sweating, and others feeling more internal symptoms of anxiety and fear.
There are various online screening tests to help you identify if it is social anxiety disorder, screening questions you can ask yourself include:
- Do you experience intense and persistent feat someone may judge you?
- Does a feared situation lead to a panic attack?
- Do you go to great lengths to not participate in social events?
- Have your symptoms interfered with daily life?
While an online screening tool cannot diagnose you, it can give you an idea of what someone with SAD may experience, and provide you with a basis to bring to an appointment with your doctor.
To know for sure if you are experiencing more than the “typical” anxiety around social situations, a healthcare provider can help by discussing your symptoms and behaviors with you.
While SAD feels uncontrollable, be assured that there are options. The goal is to control symptoms and the ability to function in uncomfortable situations.
There are thre main treatment options: Cognitive behavioral therapy, systematic desensitization, and social skills training. The success of these treatments will depend on the severity of fears.
Cognitive Behavioral Therapy
Cognitive behavioral therapy, or CBT, is a form of therapy used in the treatment of SAD, as well as other anxiety disorders including obsessive-compulsive disorder (OCD).
CBT is a therapy that will help the person to recognize thoughts and behaviors related to SAD, and help to work on challenging and changing those thoughts and behaviors. Therapists will provide tools to replace fear-based thoughts and actions with productive thoughts and actions.
Systematic Desensitization Therapy
Systematic desensitization therapy is also called exposure therapy, where patients are exposed to their fears and given tools to overcome it. The therapy will start with imagining various fears and eventually, the patient will graduate to exposing themselves to it gradually in real life.
Typical exercises of desensitization for social anxiety disorder can be a hierarchy including:
- Asking someone for the time
- Talking to someone in an elevator
- Giving someone a compliment
Eventually, working toward:
- Going out to lunch with a group
- Hosting a part in your own home
Social Skills Training
Another common treatment for social anxiety disorder is social skills training, where people build social skills and practice exposure therapy in group role-plays. While children do well in treatment alongside parents, experts determine adults can work one on one with a therapist or in a group therapy setting and get positive results.
Social skills training includes role-playing everyday experiences to confront and control anxiety, receive feedback, and get comfortable in these situations. Examples of role-playing topics include:
- Practicing a tough conversation with a boss
- Practicing a one on one conversation on a date
- Practicing contributing to group conversations
Work with your healthcare provider to determine if medication is right for you. Medications have proven to be useful in the first line of treatment.
Selective serotonin reuptake inhibitors (SSRIs) are used for SAD and other mental illnesses. It’s important to be aware of the side effects of these medications and work with your doctor to stop taking a medication, as SSRIs require tapering off.
Commonly used SSRIs for social anxiety disorder include:
- Paxil CR (paroxetine)
- Luvox CR (fluvoxamine)
- Zoloft (sertraline)
- Lexapro (escitalopram)
- Celexa (citalopram)
- Prozac (fluoxetine)
Social anxiety is an overwhelming, frustrating disorder that can wreak havoc on a person’s everyday life. With that said, there are ways to cope with and lessen the burden. While seeking treatment may be the right move, there are also ways to cope outside of the therapist’s office.
Allow yourself to be open and honest with the people around you. By sharing your struggles with people you are around, you can feel more confident in knowing someone is there and cares, and can help if you are feeling overwhelmed.
Self-care is huge in coping with many mental illnesses. Self-care will look different for each person, depending on what your body and mind needs. Those who have social anxiety disorder may find relaxing, calming activities can help to de-stress and settle the body.
Self-care practices for social anxiety might include:
- Deep breathing practices
Be One Step Ahead
If you are struggling with social anxiety disorder, you should practice being one step ahead in your daily life. Prepare for meetings and presentations by being early, taking medication if necessary, dedicating time to self-care, and other ways to settle and prepare yourself for an uncomfortable situation.
A Word From Verywell
Social anxiety disorder can feel isolating, but it is more common than you’d think. The good news is, there are plenty of ways to take this disorder into your own hands and seek treatment. It can take work, but you have the ability to overcome this disorder.