Overview
It's normal to feel nervous in some social situations. For example, going on a date or giving a presentation may cause that feeling of butterflies in your stomach. But in social anxiety disorder, also called social phobia, everyday interactions cause significant anxiety, self-consciousness and embarrassment because you fear being scrutinized or judged negatively by others.
In social anxiety disorder, fear and anxiety lead to avoidance that can disrupt your life. Severe stress can affect your relationships, daily routines, work, school or other activities.
Social anxiety disorder can be a chronic mental health condition, but learning coping skills in psychotherapy and taking medications can help you gain confidence and improve your ability to interact with others.
Symptoms
Feelings of shyness or discomfort in certain situations aren't necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on personality traits and life experiences. Some people are naturally reserved and others are more outgoing.
In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interfere with relationships, daily routines, work, school or other activities. Social anxiety disorder typically begins in the early to mid-teens, though it can sometimes start in younger children or in adults.
Emotional and behavioral symptoms
Signs and symptoms of social anxiety disorder can include constant:
- Fear of situations in which you may be judged negatively
- Worry about embarrassing or humiliating yourself
- Intense fear of interacting or talking with strangers
- Fear that others will notice that you look anxious
- Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice
- Avoidance of doing things or speaking to people out of fear of embarrassment
- Avoidance of situations where you might be the center of attention
- Anxiety in anticipation of a feared activity or event
- Intense fear or anxiety during social situations
- Analysis of your performance and identification of flaws in your interactions after a social situation
- Expectation of the worst possible consequences from a negative experience during a social situation
For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.
Performance type of social anxiety disorder is when you experience intense fear and anxiety during speaking or performing in public but not in other types of more general social situations.
Physical symptoms
Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:
- Blushing
- Fast heartbeat
- Trembling
- Sweating
- Upset stomach or nausea
- Trouble catching your breath
- Dizziness or lightheadedness
- Feeling that your mind has gone blank
- Muscle tension
Avoiding common social situations
Common, everyday experiences may be hard to endure when you have social anxiety disorder, including:
- Interacting with unfamiliar people or strangers
- Attending parties or social gatherings
- Going to work or school
- Starting conversations
- Making eye contact
- Dating
- Entering a room in which people are already seated
- Returning items to a store
- Eating in front of others
- Using a public restroom
Social anxiety disorder symptoms can change over time. They may flare up if you're facing a lot of changes, stress or demands in your life. Although avoiding situations that produce anxiety may make you feel better in the short term, your anxiety is likely to continue over the long term if you don't get treatment.
When to see a doctor
See your doctor or a mental health professional if you fear and avoid normal social situations because they cause embarrassment, worry or panic.
Causes
Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of biological and environmental factors. Possible causes include:
- Inherited traits. Anxiety disorders tend to run in families. However, it isn't entirely clear how much of this may be due to genetics and how much is due to learned behavior.
- Brain structure. A structure in the brain called the amygdala (uh-MIG-duh-luh) may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.
- Environment. Social anxiety disorder may be a learned behavior — some people may develop significant anxiety after an unpleasant or embarrassing social situation. Also, there may be an association between social anxiety disorder and parents who either model anxious behavior in social situations or are more controlling or overprotective of their children.
Risk factors
Several factors can increase the risk of developing social anxiety disorder, including:
- Family history. You're more likely to develop social anxiety disorder if your biological parents or siblings have the condition.
- Negative experiences. Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder. In addition, other negative events in life, such as family conflict, trauma or abuse, may be associated with this disorder.
- Temperament. Children who are shy, timid, withdrawn or restrained when facing new situations or people may be at greater risk.
- New social or work demands. Social anxiety disorder symptoms typically start in the teenage years, but meeting new people, giving a speech in public or making an important work presentation may trigger symptoms for the first time.
- Having an appearance or condition that draws attention. For example, facial disfigurement, stuttering or tremors due to Parkinson's disease can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.
Complications
Left untreated, social anxiety disorder can control your life. Anxieties can interfere with work, school, relationships or enjoyment of life. This disorder can cause:
- Low self-esteem
- Trouble being assertive
- Negative self-talk
- Hypersensitivity to criticism
- Poor social skills
- Isolation and difficult social relationships
- Low academic and employment achievement
- Substance abuse, such as drinking too much alcohol
- Suicide or suicide attempts
Other anxiety disorders and certain other mental health disorders, particularly major depressive disorder and substance abuse problems, often occur with social anxiety disorder.
Prevention
There's no way to predict what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you're anxious:
- Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
- Keep a journal. Keeping track of your personal life can help you and your mental health professional identify what's causing you stress and what seems to help you feel better.
- Set priorities in your life. You can reduce anxiety by carefully managing your time and energy. Make sure that you spend time doing things you enjoy.
- Avoid unhealthy substance use. Alcohol and drug use and even caffeine or nicotine use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your health care provider or find a treatment program or support group to help you.