Laurie B. Rosenblum, MPH
We all get butterflies at some point in our lives, but when fear of social interaction threatens to take over your life, it is time to seek help.
Suzanne, an intelligent woman in her thirties, had been lonely for much of her life. She had been stuck in the same secretarial job because she was afraid of working with people above her job level. She wanted to meet a man, but was sure she would say something stupid and be rejected. Her few good friends could not get her to go to restaurants or even parties because she was afraid other people might think she was a sloppy eater. The few times she agreed to go, her heart was pounding and she began to blush and perspire. When her primary care doctor finally referred her to a psychologist with experience in anxiety disorders, she was relieved to discover she had a treatable condition with a name, social anxiety disorder.
Many people get nervous in certain social or business situations. There is nothing unusual about feeling anxious before making a presentation, going out on a first date, going to a party where you do not know many people, or having dinner with the boss.
What is different about social anxiety disorder is that you have an extreme fear of being judged by other people and acting in ways that might embarrass or humiliate you. You are also afraid of becoming the center of attention and worry that everyone is looking at you. As a result, you go to great lengths to avoid the social situations you fear. If you find yourself in one of these situations, such as a party, you experience intense
that is out of proportion to the event.
Social anxiety disorder usually begins in childhood or adolescence, although symptoms like extreme shyness may occur in earlier years. The disorder is chronic, although
may cause the intensity to fluctuate.
On the surface, shyness and social anxiety disorder may seem the same. The main difference is the reaction of the person with the disorder. People with social anxiety disorder often avoid social situations and have intense, physical symptoms.
Although social anxiety disorder responds readily to treatment, many people remain undiagnosed or misdiagnosed, in part because many people who suffer from social anxiety disorder are
to admit it.
In addition, many clinicians do not know how to recognize social anxiety disorder and provide appropriate treatment. Because a large number of people with social anxiety disorder also suffer from
depression, or alcohol or drug problems, diagnosis and treatment can become more complicated.
Some people are afraid of a specific situation, often involving public speaking or performing. This severe stage fright may dampen the career of a musician, actor, or salesperson. Other people have generalized social anxiety disorder, which is a fear of several, if not most, social situations.
In both types of social anxiety disorder, anxiety before, during, and after events and avoidance of feared situations significantly interfere with everyday life. However, generalized social anxiety disorder usually has more serious effects because it occurs in a number of different situations.
In both types of social anxiety disorder, physical symptoms may occur. They may include
You also fear that others will judge you negatively for having these symptoms, which further fuels the symptoms.
The exact cause of social anxiety disorder has not yet been identified. However, researchers believe it is a combination of biological and environmental factors. Some people may be genetically predisposed to social anxiety disorder. When they experience negative social interactions or a particularly stressful event, the disorder may be set off or worsen.
Many people treated for social anxiety disorder experience significant improvement and are able to get the disorder under control. Treatment includes one or more of the following:
Most people with social anxiety disorder can be helped by
cognitive-behavioral therapy (CBT), in which they learn:
Some people may also have exposure therapy, where they are gradually exposed to situations that cause the anxiety. After repeated exposures and practice coping with the anxiety, they begin to realize that there is no need to feel embarrassed and that they can succeed at the task at hand. As more positive experiences occur with less anxiety, they feel less need to avoid previously feared situations. Relaxation training also can help in coping with the anxiety.
CBT may have the greatest impact on the treatment of social anxiety disorder when it is done in a group because the main feature of the disorder is anxiety triggered by interactions with other people. Training in social skills is a useful adjunct to CBT, as is learning new ways of acting in different situations.
Medication can also be helpful for treatment of social anxiety disorder. Different medications work for different people. People with a specific social anxiety disorder may benefit from taking a beta blocker only before specific performances. However, people with generalized social anxiety disorder usually require medication on a regular basis. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) may be helpful in people with generalized social anxiety disorder.
Suzanne is a good example of someone who benefited from treatment. Within several months, she began to feel more confident in new social situations. A year later, she has a boyfriend and has just accepted a job promotion. She still gets anxious in some situations, but not enough to keep her from doing the things she wants to do.
If you think you or someone you know may have social anxiety disorder, seek help from a mental health professional who has experience treating this disorder. You can get help to overcome your fears, feel more comfortable interacting with other people, and lead a fulfilling life.
Anxiety and Depression Association of America
Social Anxiety Association
Canadian Mental Health Association
Canadian Psychiatric Association
Phobias. Mental Health America website. Available at: http://www.mentalhealthamerica.net/go/phobias. Accessed February 24, 2017.
Post-traumatic stress disorder (PTSD). Mental Health America website. Available at: http://www.mentalhealthamerica.net/conditions/post-traumatic-stress-disorder. Accessed February 24, 2017.
Social anxiety disorder. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115906/Social-anxiety-disorder. Updated November 8, 2016. Accessed February 24, 2017.
Social phobia. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/social-phobia.html. Updated April 2014. Accessed February 24, 2017.
Last reviewed February 2017 by
Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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