What is social anxiety disorder?
Social anxiety disorder involves marked fear or anxiety in one or more social situations in which the person may be scrutinised by others: meeting new people, speaking in public, eating in front of others, using public toilets, attending meetings or parties. The fear is out of proportion to the actual threat, the situations are avoided or endured with intense distress, and the problem lasts six months or more and interferes with life.
Symptoms
- Emotional: intense fear of embarrassment, humiliation or negative judgement; worry for days or weeks before an event.
- Physical: blushing, sweating, trembling, a racing heart, dry mouth, nausea, a shaky voice, muscle tension.
- Cognitive: self-critical thoughts, mind going blank, replaying the interaction afterwards (post-event processing).
- Behavioural: avoiding situations, speaking little, avoiding eye contact, staying on the edge of groups, using alcohol or phones to cope.
- In children: crying, tantrums, clinging, freezing or refusing to speak in social situations.
Social anxiety versus shyness
Shyness is a personality trait: feeling uneasy with new people, usually without major distress or avoidance. Social anxiety disorder causes much greater distress and impairment: it affects school or work, friendships and romantic life, and often leads to avoidance of important opportunities. It is also associated with depression, substance misuse and other anxiety disorders.
Causes and risk factors
- Genetic vulnerability and an anxious or behaviourally inhibited temperament.
- Overprotective or critical parenting, or modelling of anxious behaviour.
- Bullying, humiliation or negative social experiences.
- Differences in brain areas involved in fear and threat detection.
- Appearance-related or speech differences (such as a stutter) that raise self-consciousness.
- Stressful life changes and social media pressures.
What keeps it going
Several processes maintain social anxiety: focusing attention on yourself and how you think you appear, predicting that others will judge you, using “safety behaviours” (rehearsing sentences, avoiding eye contact, staying quiet), avoiding situations so that fears are never tested, and replaying events afterwards. These make you seem more awkward to yourself and prevent learning that feared outcomes rarely happen.
Cognitive behavioural therapy
CBT for social anxiety, recommended by NICE as first-line treatment, includes education about anxiety, identifying and testing negative predictions through behavioural experiments, shifting attention from yourself to the task and other people, dropping safety behaviours, and gradual exposure to feared situations. It usually takes 12–16 sessions, and group or individual formats are both effective. Many people experience lasting improvements.
Medication
- SSRIs (sertraline, escitalopram, paroxetine) and SNRIs (venlafaxine) are first-line medicines, taking 4–12 weeks to work.
- Beta-blockers are sometimes used for performance situations (such as a single presentation) to reduce palpitations and trembling.
- Benzodiazepines are generally avoided because of dependence risk and reduced benefit of exposure.
- Medication can be combined with CBT, and a doctor will review progress.
Self-help strategies
- Make a list of situations you avoid and rank them from easiest to hardest; start with small steps.
- Stay in the situation long enough for anxiety to fall; avoid escaping.
- Shift attention outward: listen to the person and notice your surroundings.
- Challenge predictions: ask what actually happened afterwards.
- Practise slow breathing and relaxation. See deep breathing for anxiety.
- Limit alcohol and caffeine.
- Build confidence with assertiveness practice and small social goals. See autoconfianza (Spanish).
- Join a support group or practise social skills in structured settings.
When to seek help
- Fear of social situations lasting six months or more.
- Avoidance of work, study or relationships.
- Use of alcohol or drugs in social situations.
- Low mood, hopelessness or thoughts of self-harm.
- A child or teenager who avoids school, speaking or friends because of fear.
Three common situations
A student who avoids speaking in class and skips presentations: graded exposure and CBT can build confidence step by step.
An adult who rehearses every sentence before phone calls and avoids social events: drop safety behaviours and test predictions.
A teenager who stopped seeing friends and plays online only: seek assessment; early treatment prevents long-term impact.
Social anxiety at school and work
Social anxiety can affect performance and careers: avoiding presentations, meetings or networking, turning down promotions or struggling with group projects. Useful strategies include preparing but not over-rehearsing, asking for adjustments (such as submitting written work or practising with a small group first), taking on small speaking tasks to build experience and talking to a trusted colleague or manager. Occupational health and counselling services can help.
Key points to remember
Social anxiety disorder is common, disabling and highly treatable. CBT with exposure, sometimes combined with medication, helps most people. Start with small steps and ask for help early. Our psychology team can support you.
This guide is for general information and does not replace an assessment by a qualified health professional.
Questions about social anxiety disorder
These answers are general information and do not replace an examination or individual medical advice.
What is the difference between shyness and social anxiety disorder?
Shyness is a trait with mild discomfort; social anxiety disorder causes intense fear, avoidance and impairment.
Can social anxiety be cured?
Many people recover or improve greatly with CBT and, if needed, medication.
What is the best treatment?
CBT with exposure is first-line; SSRIs or SNRIs are also effective.
Does it start in childhood?
It commonly starts in the early to mid-teens, but can begin earlier or later.
Can I treat it on my own?
Self-help and guided programmes can help mild cases, but professional treatment is advisable for moderate to severe ones.
Is alcohol a good way to cope?
No. It can worsen anxiety and lead to dependence.
Sources
- NICE · Social anxiety disorder: recognition, assessment and treatment (CG159)
- NHS · Social anxiety (social phobia)
- NIMH · Social anxiety disorder: more than just shyness
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.