social anxiety disorder (or social phobia) are extremely anxious about what
they will say or do in front of other people. This includes public speaking and
day-to-day social situations. But it is more than just being shy or nervous
before public speaking. The fear can begin weeks or months before an event. It
can cause a fast heartbeat and make it hard to focus.
fear only one or a few types of social situations. For other people, many
situations cause stress. This problem affects your daily life. You may be so
stressed or afraid that you avoid public situations, including missing work and
know what causes social anxiety disorder. They think it may run in families. But they are not sure if it's because of
genetics or a response to a traumatic situation.
Social anxiety disorder
causes both emotional and physical symptoms:
diagnose social anxiety disorder, your doctor will examine you and ask about
your symptoms. He or she may ask other questions to see how you are doing
emotionally. This is called a mental health assessment.
doctor may also do blood or urine tests to rule out other conditions, such as
thyroid problems that can cause similar symptoms.
Treatment of social anxiety
disorder includes counseling and sometimes medicine, such as antidepressants.
Whether you need medicine depends on how much the problem affects your daily
life. If you already feel anxious around other people, it may be hard to ask
for help. But treatment for social anxiety disorder works for many people.
Some people with social anxiety disorder turn to alcohol or drugs
to help them relax. This can lead to
addiction problems. They may also have
depression. It is important to treat these issues
Learning about social anxiety disorder:
Health Tools help you make wise health decisions or take action to improve your health.
Social anxiety disorder causes unreasonable,
debilitating fear of being judged or publicly humiliated. You may avoid or
severely limit encounters with other people—which can keep you from daily
activities. You may develop physical symptoms such as a rapid heartbeat,
shortness of breath, or tightness in your chest when faced with a feared social
When you have social anxiety disorder, common social
situations—such as eating in public, writing in front of other people, using a
public restroom, or speaking in front of others—can cause overwhelming fear and
You may be more afraid of people noticing your
anxiety than of the actual feared situation. A vicious
cycle can emerge of avoiding or worrying about the social event (such as
speaking in public) because you are afraid others will see you as weak,
anxious, or foolish—this, in turn, leads to more anxiety. This may lead to
avoiding or limiting contact with other people.
Symptoms of social
anxiety disorder may differ in adults and children.
Adults and teenagers with social anxiety disorder usually
recognize their fears of being publicly humiliated are unreasonable or
excessive. But children who have this disorder may not.
Expressions of anxiety in adults or adolescents
Expressions of anxiety in children include:1
People with social anxiety disorder often underachieve at work or
at school to avoid the attention of a promotion or to avoid being forced to
participate in a group. They tend to have few friendships and have trouble
dating or developing relationships. In prolonged or severe cases, many people
develop other psychological conditions (such as
Social anxiety disorder
is among several types of
phobias that many people experience, such as
a specific phobia (fearing an object, like a spider, or
a frightening situation, such as being stuck in an elevator).
Social anxiety disorder is diagnosed based on your
physical exam, and sometimes a
mental health assessment, which is an evaluation of
Blood or urine tests may also be done to
other medical conditions that can cause similar symptoms (such as
social anxiety disorder involves psychological
counseling and sometimes medicines (such as antidepressants) to reduce
related anxiety and depression.
combination of medicines and professional counseling may be effective for
long-term treatment for people who have generalized anxiety and fear over many social
situations.2 For those who fear only one or a few social situations (such as
public speaking or eating in front of others), professional counseling to
overcome the fear may be all that is needed.
people don't seek treatment for anxiety disorders. You may not seek treatment
because you think the symptoms are not bad enough or that you can work things
out on your own. But getting treatment is important.
If you need
help deciding whether to see your doctor, see
some reasons why people don't get help and how to overcome them.
social anxiety disorder is based on how bad your emotional and physical symptoms are and how able you are to function in daily
activities. People who have social anxiety disorder often have
depression also. They may also have alcohol or
substance abuse problems. Your doctor may
ask you certain questions to see whether you might be drinking too
much or abusing drugs.
Social anxiety disorder often goes
undetected for years before treatment is sought. By that time, you may have
developed behaviors that accommodate the fears. These habits or behaviors must
be overcome to successfully manage social anxiety disorder.
First, your doctor must determine whether you are generally
anxious about all social encounters or whether a specific situation triggers
Treatment with a combination of medicines and
professional counseling is often effective for generalized social anxiety
disorder (fear of most public interaction). Some people need treatment
throughout their lives, while others may recover completely after a period of
treatment with counseling and medicines
It is possible to
overcome the fears linked with social anxiety disorder. Working through
fears with a specific type of therapy—cognitive-behavioral therapy that
includes exposure therapy—may be the best approach for treating your anxiety.
It is important to continue professional counseling even if you are taking
medicines to reduce anxiety.
Types of counseling most often used to treat social anxiety
Medicines often used for chronic, severe, or generalized social
anxiety disorder include:
Ongoing treatment of social anxiety disorder usually
includes continuing psychological
counseling and regular checkups to monitor any
medicines you may be taking. If professional counseling alone has not reduced
your anxiety symptoms, medicines may be added to your treatment.
If your anxiety is triggered by many social situations (generalized), you
may need continuous and prolonged treatment with a combination of counseling
and medicines. During this time, your doctor will need to
monitor your medicines. If one medicine doesn't work for you, you and your doctor may decide you should try another.
social anxiety disorder, it is possible to progress
from debilitating fear of one social situation to having anxiety about all
social encounters (generalized). If this occurs, additional treatment is needed
that usually includes adding medicines and increasing the amount of
counseling you receive.
You may also feel
more anxious when you start professional counseling. This is because you are
thinking about the situations that cause you fear and anxiety. After the
situations have been identified, the fears can be addressed through
cognitive-behavioral therapy which includes
exposure therapy—gradually exposing you to your
If you are taking medicines to treat social anxiety
disorder, you will need regular checkups to monitor the medicines (such as
selective serotonin reuptake inhibitors) and their
potential side effects. The medicines may cause bothersome side effects that
may make your anxiety worse at first. These side effects may get better over
time. But if they do not, you may need to take a different medicine.
If social anxiety disorder is left untreated or improperly treated, it
can cause debilitating distress that interferes with daily activities. Physical
symptoms such as rapid heart rate, blushing, shortness of breath, and dizziness
can occur and need to be assessed.
Other psychological conditions
substance abuse) may accompany social anxiety
disorder, and these conditions need more treatment.
left untreated, the combination of social anxiety disorder and another
psychological condition (such as depression) can increase the risk of attempted
While counseling and medicines are
the most effective treatments for
social anxiety disorder, you may wish to
reduce your anxiety level at home by practicing a
If you drink alcohol or use drugs in an attempt to gain confidence
to face feared social situations, it is possible to develop
substance abuse problems in addition to social anxiety
For more information, see:
The Anxiety Disorders Association of America (ADAA)
works to improve the lives of people who have anxiety disorders. Members of the
association are not only people who have or are interested in anxiety disorders
but also health professionals who do research and treat people who have anxiety
This online resource is provided by the American Psychiatric Association for anyone seeking mental health information. It includes information on many common mental health concerns, including warning signs of mental disorders, treatment options, and preventive measures.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
Mental Health America (formerly known as the National
Mental Health Association) is a nonprofit agency devoted to helping people of
all ages live mentally healthier lives. Its website has information about
mental health conditions. It also addresses issues such as grief, stress,
bullying, and more. It includes a confidential depression screening test for
anyone who would like to take it. The short test may help you decide whether
your symptoms are related to depression.
The National Institute of Mental Health (NIMH) provides
information to help people better understand mental health, mental disorders,
and behavioral problems. NIMH does not provide referrals to mental health
professionals or treatment for mental health problems.
CitationsAmerican Psychiatric Association (2000). Anxiety disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 450–456. Washington, DC: American Psychiatric Association.Hollander E, Simeon D (2008). Social phobia (Social anxiety disorder). In RE Hales et al., eds., American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 536–546. Washington, DC: American Psychiatric Publishing.Wagstaff AJ, et al. (2002). Spotlight on paroxetine in psychiatric disorders in adults. Drugs, 62(4): 655–703.Schneier FR (2006). Social anxiety disorder. New England Journal of Medicine, 355(10): 1029–1036.U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.Other Works ConsultedIacoviello BM, Mathew SJ (2010). Anxiety disorder. In EG Nabel, ed., ACP Medicine, section 13, chap. 1. Hamilton, ON: BC Decker.Merikangas Kr, Kalaydjian AE (2009). Epidemiology of anxiety disorders. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1856–1864. Philadelphia: Lippincott Williams and Wilkins.Zal HM (2003). Social phobia: Treatment issues. Psychiatric Times, 20(6): 80–83.
July 11, 2011
E. Gregory Thompson, MD - Internal Medicine & Lisa S. Weinstock, MD - Psychiatry
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