Social Anxiety Disorder

What is social anxiety disorder?

Social anxiety disorder is also called social phobia. People with this disorder fear that if they do things in public, they will look stupid and will be embarrassed. People with social anxiety disorder feel that everyone is watching and judging them. The fear may be tied to a common action such as public speaking, going to a party, eating a meal, or using a public restroom. As a result, they avoid situations in which they have to do these kinds of things.

Social anxiety disorder is not just being shy. Shy people may be uncomfortable in social situations, but it does not stop them from doing things. A person with social anxiety disorder is unable to work or take part in school or social activities because of the fear of doing something embarrassing.

This disorder does not go away by itself and can get in the way of day-to-day life. From 3 to 13% of people in the US have had this condition during their lives. Most people with social anxiety disorder don't know that they have a treatable disorder.

How does it occur?

The cause of social anxiety disorder is unknown. Both genetic and environmental factors may play a part. This disorder tends to run in families. It usually begins in the teen years, but may begin in childhood.

What are the symptoms?

People who have social anxiety disorder:

• have a trembling voice, changes in heart rate, sweaty palms, nausea, headaches, or stomach aches
• fear being embarrassed or being rejected
• may be anxious when they are the focus of attention, even for a short time
• know that their anxiety is not logical or reasonable
• have a lot of anxiety or even a panic attack (intense fear, a sense of doom, sweating, dizziness) when they think about being in a social situation.
• are afraid that other people will notice how nervous they are
• are afraid of unfamiliar places and stay away from them
• are unable to work or take part in school or social activities because of the fear of doing something embarrassing

How is it diagnosed?

Your healthcare provider or therapist will ask about your symptoms and any drug or alcohol use. You may be asked to have lab tests to rule out medical problems. There are no lab tests which directly diagnose social anxiety disorder.

How is it treated?

Cognitive behavioral therapy (CBT) may help you learn to change your response to situations. Replacing negative thoughts with more positive ones can help you to control the fear. Relaxation techniques such as deep breathing may help. Exposure and response prevention therapy (ERPT) helps people to face their fears. They learn ways to control their body's response to anxiety, like breathing exercises. Assertiveness training may help you feel self-confident and less scared. Support groups are very helpful. Hypnosis can also be very helpful in treating phobias.

Several medicines can help treat social anxiety disorder. Your healthcare provider will work with you to carefully select the best one for you.

How long will the effects last?

Without treatment, social anxiety disorder can last many years and sometimes an entire lifetime.

What can I do for myself?

• Discuss your worries with your healthcare provider or therapist.
• Avoid caffeine.
• Talk with your healthcare provider about any medicine you may be taking.
• Realize that you are not alone and that you can beat your fears.
• Do not use alcohol or other drugs to manage your anxiety.
• Go to an assertiveness training class in your local community.
• Listen to the "Overcoming Social Anxiety: Step by Step" audio tape series available at most libraries.

For further information, see:

Social Phobia: Resources.

You may also want to contact Mental Health America (formerly the National Mental Health Association or NMHA). NMHA's toll-free Information Center number is 1-800-969-NMHA. NMHA's web site address is http://www.NMHA.org.