Social Anxiety Disorder

If socializing fills you with dread, you may have this anxiety disorder.

What is social anxiety disorder?

Social anxiety disorder (also known as social phobia) is an intense fear or anxiety about social situations. People with it avoid socializing as much as possible. And when they do try to socialize, they feel anxious during the event.

The biggest worries are being judged negatively, being watched, or having to talk with people. The fear of being scrutinized by others is intense. Sometimes the anxiety is so bad that it turns into a panic attack. This is not only scary, but it can be embarrassing. It reinforces a person’s belief that they should have stayed home. Social anxiety leads to people wanting to stay home alone and isolate themselves.

It can be treated with talk therapy and sometimes medications.

What is causing your symptoms?

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Most common symptoms

Pro Tip

SAD is very common. And treatable. Get started. This is true for kids and adults. The sooner kids receive treatment the less likely they are to develop other mental health issues as they get older. —Dr. Bobbi Wegner

There are two types of social anxiety disorder: Generalized (when any social event creates intense anxiety) and specific (anxiety from particular types of events, like public speaking). Both types create intense anxiety that makes daily life functioning very difficult.

Symptoms of social anxiety fall into one of these three categories: physical, emotional, and behavioral. You may experience some or all of the symptoms. They may show when you get invited to an event or while you are in social situations.

To be diagnosed with the disorder, you would have to have symptoms for six months.

Emotional

  • Worry
  • Fear
  • Sadness
  • Feeling irritable
  • Feeling embarrassed

Physical

  • Increased heart rate
  • Sweating
  • Stomach ache
  • Headache
  • Muscle tension
  • Dry mouth
  • Shortness of breath
  • Dizziness
  • Cold hands

Behavioral

  • Avoiding people and social situations
  • Isolate yourself
  • Trouble sleeping
  • Using negative habits to cope, such as substance use or overeating

Common triggers

All triggers center on socializing, whether you’re just thinking about them or actually taking part.

  • Parties or family events.
  • Having to talk to people.
  • Dating.
  • Going to work with other people.
  • Public speaking (whether to small or large groups).
  • Making phone calls.
  • Going to the bathroom at work or other social situations, where you might bump into someone on the way.

Dr. Rx

When people are avoiding events, I am always curious why. As a mental health provider, I always listen for what they are experiencing (intense symptoms of anxiety in social events) and what they are avoiding (social events, people, public speaking). Within that, I then wonder if it is just one thing they avoid (SAD-specific) or all social events (SAD-generalized). —Dr. Wegner

Next steps

Social anxiety can lead to other types of anxiety and depression. It can also lead to substance abuse. It’s critical to seek help from a mental health provider. Over a third of people with social anxiety wait more than 10 years before seeking help.

Ask your doctor to recommend someone, such as a psychiatrist, a psychologist, or a licensed social worker. Ask your insurance company for a list of providers in your network. Or, go to psychologytoday.com, where you can search for local therapists.

If left untreated, social anxiety can make you feel isolated, hopeless, and depressed. If you have thoughts of self-harm or suicide, call 911 or go to the ER. The National Suicide Prevention Lifeline (800-273-8255) is available to help 24/7.

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Can social anxiety be cured?

Pro Tip

Research shows that many people with SAD wait 10 years before receiving treatment! —Dr. Wegner

Social anxiety can be treated with talk therapy and a range of medications.

Talk therapy

Cognitive behavioral therapy (CBT) is a well researched therapy that can be helpful for people with social anxiety. It helps you change your thoughts and behaviors in order to reduce your fear and anxiety. Through what’s called cognitive restructuring, a therapist helps you notice and change negative thought patterns and helps you slowly face social situations with coping tools. About a half to two-thirds of people with social anxiety see big improvements in symptoms after about 12 weeks of CBT.

Medication

Although CBT is generally the first and best treatment for the condition, medication can also help.

  • Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, are often used to treat generalized anxiety.
  • Beta blockers are used to treat people with specific social phobias.
  • Benzodiazepines are sometimes used to treat social anxiety, although they are often prescribed with caution to minimize addiction.

Self-help tips

Along with therapy, some lifestyle and behavior changes can also help reduce the symptoms. These are often part of CBT.

  • Confront negative thoughts.
  • Try to face social situations.
  • Practice breathing exercises to lower your anxiety.
  • Learn how to meditate.
  • Exercise regularly.

Who is at risk of social anxiety disorder?

Social anxiety disorder affects 1 in 8 people over their lifetime. Women are twice as likely to have it as men. Young adults under the age of 35 are more often affected.

Both environmental factors and genetic factors cause social anxiety. People who have a family history of anxiety are more likely to develop one themselves.

People who tend to feel uncomfortable in social situations might avoid them. This leads to isolation, which can make the problem worse.

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Children and social anxiety

Children may also have social anxiety. They tend to show symptoms between the ages of 8 and 15, and complain of more physical symptoms than adults.

Children behave differently depending on their age. Very young children might cry or throw tantrums at social events, while older kids and tweens might just seem awkward and uncomfortable. Teenagers might start avoiding school, friends, or other social events.

Across the board, children with untreated anxiety have a higher risk of other mental health problems later on. It’s important to seek help for children if you notice these symptoms.

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