Social anxiety disorder is sometimes called social phobia. Social anxiety disorder is not just shyness; it is more severe than this.
What is social anxiety disorder?
Social anxiety disorder is a mental health condition. People with social anxiety disorder become very anxious about what other people may think of them or how they may be judged by others. As a result they can have difficulty in social situations which can affect their day-to-day life.
Social anxiety symptoms
The main symptoms of social anxiety are:
- A marked fear or dread of social situations.
- Weeks of negative thoughts or anxiety prior to a social event.
- Avoiding social situations as much as possible.
- Becoming very anxious and distressed in a feared situation.
- Sometimes having panic attacks.
With social anxiety, people fear that they will act in an embarrassing or humiliating way and that other people will think they are stupid, inadequate or foolish etc.
In some cases the fear is only for certain situations or social interactions where people will be looked at by others, even if they are known to them.
For example, some people may become very anxious if having to 'perform' in some way, such as giving a talk or presentation or taking part in a discussion at work or school. However, they may be fine in informal social gatherings.
In other cases the fear occurs for most social situations where they may meet strangers. This can even include eating or drinking in public places, as they fear they may act in an embarrassing way.
When going to the feared situation, they become very anxious and distressed. Read more about symptoms in our separate leaflet called Anxiety.
As a side-effect of social anxiety, some people may have a panic attack. See the separate leaflet called Panic Attacks and Panic Disorder. People are usually aware that their fear and anxiety levels are excessive.
Social anxiety disorder can greatly affect people's lives. People with social anxiety disorder:
- May not do as well at school or work as they might have done, as they tend to avoid any group work, discussions, etc.
- May find it hard to stay in a job. This may be because they feel unable to cope with the social aspects needed for many jobs, such as meeting with people.
- May become socially isolated and find it difficult to make friends.
What causes social anxiety disorder?
Some causes of anxiety disorder include:
- Traumatic childhood experiences.
- Genetic 'makeup'.
Many people with social anxiety disorder have had traumatic events in childhood. These can include having been bullied at school, having lived with controlling or authoritarian parents, having experienced abuse or living with family conflict.
There is a genetic component as well; people are more likely to develop social anxiety disorder if a parent or sibling has been similarly affected.
It is now known that early negative childhood experiences can affect the development of the brain so situations like neglect, abuse or ridicule in very young children can cause mental health conditions such as social anxiety disorder in later childhood/teens/adulthood.
In one study about half of affected people said their phobia began after one memorable embarrassing experience. The other half said it had been present for 'as long as they could remember'.
How common is social anxiety disorder?
It is one of the most common mental health conditions. As many as 1 in 10 adults have some degree of social anxiety disorder.
It usually develops in the teenage years and can be a lifelong problem unless treated. Just over twice as many women as men are affected.
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How is social anxiety disorder diagnosed?
Three features are needed for a diagnosis of social anxiety disorder:
- The symptoms must not be the result of some other mental health condition (for example, a delusion).
- The feeling of anxiety is entirely or mostly in social situations.
- One of the main symptoms will be the avoidance of social situations.
Social anxiety treatment
Cognitive and behavioural therapies
Cognitive behavioural therapy is a talking therapy that attempts to help people change their thought patterns. Often negative thoughts and feelings can lead to a cycle of persistent negative thinking - CBT attempts to change those negative patterns by breaking down problems which seem overwhelming into smaller more manageable sections.
There are several things that can help before trying other treatments:
- Keeping a diary. By recording what has happened, what was happening and the thoughts that went alongside that, it is possible to start to better understand the anxiety.
- Trying to break up a very stressful situation into smaller (more manageable) parts.
- Practising each part individually until more comfortable and then bringing them together.
- Not making assumptions about what people are thinking or why they are doing something.
- Trying some breathing exercises to help manage stress levels.
Medicines for social anxiety
The usual medicines that may be used are:
- Antidepressants; selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) seem to be the best antidepressant medicines for anxiety disorders.
- Benzodiazepines a short course of up to a few days may be an option but they are not a long term option as they are highly addictive and do not work in the longer term. They can also impair functioning. They are not often used nowadays.
- A beta-blocker (for example, propranolol) can ease some of the physical symptoms of anxiety. Often with anxiety, a vicious circle develops where the mental "feelings" of anxiety cause a racing pulse, excess sweating and shakiness. Because the body has evolved to perceive these symptoms as signs of danger (the "fight or flight response") the brain then becomes more anxious. This cycle can be interrupted by the use of beta-blockers which calm down the physical symptoms very quickly.
In some cases a combination of treatments such as cognitive therapy and an antidepressant may work better than either treatment alone.
Some people find that support and advice from a group of people going through the same issues can be helpful. There are several UK based support groups on the internet, such as Mind, YoungMinds and AnxietyUK.
Social anxiety and alcohol
Although alcohol may ease symptoms in the short term, in the long run it makes social anxiety worse. Drinking alcohol to 'calm nerves' can lead to problem drinking and may make problems with social anxiety (and any depression that may accompany it) worse in the long term.
It is best to seek medical attention if drinking alcohol (or taking street drugs) to ease social anxiety.
What is the outlook for social anxiety disorder?
Not much is known about the natural progress of the condition. However, with treatment there is a good chance that symptoms can be greatly improved. Without treatment, social phobia can be associated with depression in later life.
Further reading and references
Social anxiety disorder: recognition assessment and treatment; NICE Clinical Guideline (May 2013)
Rose GM, Tadi P; Social Anxiety Disorder
Williams T, Hattingh CJ, Kariuki CM, et al; Pharmacotherapy for social anxiety disorder (SAnD). Cochrane Database Syst Rev. 2017 Oct 1910:CD001206. doi: 10.1002/14651858.CD001206.pub3.
Koyuncu A, Ince E, Ertekin E, et al; Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs Context. 2019 Apr 28:212573. doi: 10.7573/dic.212573. eCollection 2019.