It’s normal to feel nervous in some social situations. Going on a date or giving a presentation may cause that feeling of butterflies in your stomach, for instance. But in social anxiety disorder, also called social phobia, everyday interactions cause irrational anxiety, fear, self-consciousness and embarrassment.
Social anxiety disorder is a chronic mental health condition, but treatment such as psychological counseling, medication and learning coping skills can help you gain confidence and improve your ability to interact with others.
Social anxiety disorder affects your emotions and behavior. It can also cause significant physical symptoms.
Emotional and behavioral social anxiety disorder signs and symptoms include:
- Intense fear of interacting with strangers
- Fear of situations in which you may be judged
- Worrying about embarrassing or humiliating yourself
- Fear that others will notice that you look anxious
- Anxiety that disrupts your daily routine, work, school or other activities
- Avoiding doing things or speaking to people out of fear of embarrassment
- Avoiding situations where you might be the center of attention
- Difficulty making eye contact
- Difficulty talking
Physical social anxiety disorder signs and symptoms include:
- Trembling or shaking
- Fast heartbeat
- Upset stomach
- Shaky voice
- Muscle tension
- Cold, clammy hands
Worrying about having symptoms
When you have social anxiety disorder, you realize that your anxiety or fear is out of proportion to the situation. Yet you’re so worried about developing social anxiety disorder symptoms that you avoid situations that may trigger them. This type of worrying creates a vicious cycle that can make symptoms worse.
When to see a doctor
See your doctor or mental health provider if you fear and avoid normal social situations because they cause embarrassment, worry or panic. If this type of anxiety disrupts your life, causes severe stress and affects your daily activities, you may have social anxiety disorder or another mental health condition that requires treatment to get better.
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 from individual to individual due to personality traits and life experiences. Some people are naturally reserved and others are more outgoing. What sets social anxiety disorder apart from everyday nervousness is that its symptoms are much more severe, causing you to avoid normal social situations.
Common, everyday experiences that may be difficult to endure when you have social anxiety disorder include:
- Using a public restroom or telephone
- Returning items to a store
- Interacting with strangers
- Writing in front of others
- Making eye contact
- Entering a room in which people are already seated
- Ordering food in a restaurant
- Being introduced to strangers
- Initiating conversations
Social anxiety disorder symptoms can change over time. They may flare up if you’re facing a lot of stress or demands. Or if you completely avoid situations that would usually make you anxious, you may not have symptoms. Although avoidance may allow you to feel better in the short term, your anxiety is likely to persist over the long term if you don’t get treatment.
Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of environment and genes. 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 chemistry. Natural chemicals in your body may play a role in social anxiety disorder. For instance, an imbalance in the brain chemical serotonin (ser-oh-TOE-nin) may be a factor. Serotonin is a neurotransmitter that helps regulate mood and emotions, among other things. People with social anxiety disorder may be extra-sensitive to the effects of serotonin.
- 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.
- 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 or sexual abuse, may be associated with social anxiety disorder.
Social anxiety disorder is one of the most common mental disorders. It usually begins in the early to midteens, although it can sometimes begin earlier in childhood or in adulthood.
A number of factors can increase the risk of developing social anxiety disorder, including:
- Being female. Females are more likely than males to have social anxiety disorder.
- Family history. You’re more likely to develop social anxiety disorder if your biological parents or siblings have the condition.
- Environment. Social anxiety disorder may be a learned behavior. That is, you may develop the condition after witnessing the anxious behavior of others. In addition, there may be an association between social anxiety disorder and parents who are more controlling or protective of their children.
- 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. Meeting new people, giving a speech in public or making an important work presentation may trigger social anxiety disorder symptoms for the first time. These symptoms usually have their roots in adolescence, however.
- Having a health condition that draws attention. Facial disfigurement, stuttering, Parkinson’s disease and other health conditions can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.
Lifestyle and home remedies
Although social anxiety disorder generally requires help from a medical expert or qualified psychotherapist, you can try some self-help techniques to handle situations likely to trigger your symptoms.
First, consider your fears to identify what situations cause the most anxiety. Then gradually practice these activities until they cause you less anxiety. Begin with small steps in situations that aren’t overwhelming.
Situations to practice may include:
- Eating with a close relative, friend or acquaintance in a public setting.
- Making eye contact and returning greetings from others, or being the first to say hello
- Giving someone a compliment
- Asking a retail clerk to help you find an item
- Getting directions from a stranger
- Showing an interest in others — ask about their homes, children, grandchildren, hobbies or travels, for instance
- Calling a friend to make plans
At first, being social when you’re feeling anxious is challenging. As difficult or painful as it may seem initially, don’t avoid situations that trigger your symptoms. By regularly facing these kinds of situations, you’ll continue to build and reinforce your coping skills.
The following techniques can help you begin to face situations that make you nervous:
- Prepare for conversation. For instance, read the newspaper to identify an interesting story you can talk about.
- Focus on personal qualities you like about yourself.
- Practice relaxation exercises.
- Adopt stress management techniques.
- Set realistic goals.
- Pay attention to how often the embarrassing situations you’re afraid of actually take place. You may notice that the scenarios you fear usually don’t come to pass.
- When embarrassing situations do happen, remind yourself that your feelings will pass, and you can handle them until they do.
Avoid using alcohol to calm your nerves. It may seem like it helps, but in the long run it can make you feel more anxious.