One of the most common anxiety disorders, this condition can cause people to avoid many social situations.
Social anxiety disorder — formerly known as social phobia — is an anxiety disorder characterized by a strong, persistent fear of being judged by others, and by frequent feelings of embarrassment.
Suma Chand, PhD, director of the cognitive behavior therapy program in the department of psychiatry and behavioral neuroscience at St. Louis University School of Medicine in Missouri, says that people with social anxiety tend to imagine others are superior to them and critical of them, and feel they need to behave perfectly in social situations because of it. But they also have a longing for acceptance, and the fear of others’ judgment can keep them from finding it.
Social anxiety disorder consists of much more than the shyness or nervousness many people feel regarding normal social engagements, such as going on a first date or giving a presentation (“stage fright”).
The condition can interfere with daily activities and even cause people to completely avoid social interactions, even though they often realize their anxiety is irrational. “I have often had my clients tell me how they are exhausted by social situations,” says Dr. Chand.
“This is because when they look back at these events, they see how their need to be perfect in social situations has caused them to experience high levels of anxiety before and during social situations. As a result, they often avoid many social situations — even though they feel bad about doing so,” she says.
But, adds Chand, those with the disorder can learn to change the distortions in their thinking that lead to avoidance.
How Common Is Social Anxiety Disorder?
Compared with other anxiety disorders, social anxiety disorder is fairly common. According to the National Institute of Mental Health, it affects 7.1 percent of the U.S. adult population in a given year.
Social anxiety disorder usually develops early in life, usually beginning at around age 13.
What Are the Causes of Social Anxiety Disorder?
As with other anxiety disorders, it’s not clear what causes social anxiety disorder. Possible causes include:
Genetics This disorder sometimes runs in families.
Traumatic events Sexual or physical abuse may trigger the condition.
Social skills Limited social engagement and lack of confidence in social skills may also contribute.
Brain structure Researchers believe that those with social anxiety disorder may have differences in the areas of the brain that regulate fear and anxiety.
Other health conditions A person may also develop the disorder if they have a condition that noticeably affects their physical appearance and may draw unwanted attention.
Family history Research suggests that being raised by parents who engage in negative parental practices, such as being overprotective, overly anxious, or rejecting, may lead to social anxiety.
What Are the Symptoms of Social Anxiety Disorder?
People with social anxiety disorder tend to:
- Feel anxious about being around and talking with other people
- Feel very self-conscious or embarrassed in front of other people
- Have a difficult time making and keeping friends
- Avoid face-to-face interactions and only interact via technology
- Use alcohol or drugs to function in social situations.
In some cases, people with social anxiety disorder may fear a single situation, such as talking to a salesperson. But people with the disorder may also fear and avoid a number of situations in which they feel others might judge them.
How Is Social Anxiety Disorder Diagnosed?
In people with social anxiety disorder, these symptoms of fear, anxiety, and avoidance are persistent and usually last for at least six months.
According to the Anxiety and Depression Association of America, 36 percent of people with social anxiety disorder live with symptoms for at least 10 years before seeking help.
Diagnosis of the disorder is based on your signs and symptoms, but your doctor will also conduct a physical exam and order blood tests to rule out other possible causes of your symptoms.
Can Social Anxiety Disorder Be Cured?
There are treatments that can help you overcome your social anxiety.
One type of psychotherapy — called cognitive behavioral therapy, or CBT — has been shown to be very effective in helping people recover from their social anxiety. This treatment helps people change the way they perceive situations and develop new skills to deal with their anxiety and fear of social engagements.
It may even create lasting and positive changes in the brain. A study published in August 2017 in Molecular Psychiatry found that when those with social anxiety disorder participated in 10 weeks of CBT group therapy, it reduced the size of parts of the brain that process and regulate emotions. (3) Scientists call this process “normalizing,” and the changes were more pronounced when the therapy was most successful.
Antidepressants and anti-anxiety medications called benzodiazepines are also used to treat social anxiety disorder.
Another type of medication — called beta-blockers — is used to treat many physical symptoms of the disorder and they’re usually prescribed on an as-needed basis when people fear very specific situations.
By Joseph Bennington-Castro Medically Reviewed by Kathryn Keegan, MD