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Social anxiety disorder (social phobia)

It's normal to feel nervous in some social situations. For example, going on a date or giving a presentation may cause that feeling of butterflies in your stomach. But in social anxiety disorder, also called social phobia, everyday interactions cause significant anxiety, fear, self-consciousness and embarrassment because you fear being scrutinized or judged by others.

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.

Symptoms Causes Risk factors Complications Prevention

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, depending on the individual's personality traits and life experiences. Some people are naturally reserved and others are more outgoing.

In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interferes with your daily routine, work, school or other activities.

Emotional and behavioral symptoms

Signs and symptoms of social anxiety disorder can include persistent:

  • Fear of situations in which you may be judged
  • Worrying about embarrassing or humiliating yourself
  • Concern that you'll offend someone
  • Intense fear of interacting or talking with strangers
  • Fear that others will notice that you look anxious
  • Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice
  • Avoiding doing things or speaking to people out of fear of embarrassment
  • Avoiding situations where you might be the center of attention
  • Having anxiety in anticipation of a feared activity or event
  • Spending time after a social situation analyzing your performance and identifying flaws in your interactions
  • Expecting the worst possible consequences from a negative experience during a social situation

For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.

Performance type of social anxiety disorder is when you experience intense fear and anxiety only during speaking or performing in public, but not in other types of social situations.

Physical symptoms

Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:

  • Fast heartbeat
  • Upset stomach or nausea
  • Trouble catching your breath
  • Dizziness or lightheadedness
  • Confusion or feeling "out of body"
  • Diarrhea
  • Muscle tension

Avoiding normal social situations

Common, everyday experiences that may be hard to endure when you have social anxiety disorder include, for example:

  • Using a public restroom
  • Interacting with strangers
  • Eating in front of others
  • Making eye contact
  • Initiating conversations
  • Dating
  • Attending parties or social gatherings
  • Missing work or school
  • Entering a room in which people are already seated
  • Returning items to a store

Social anxiety disorder symptoms can change over time. They may flare up if you're facing a lot of stress or demands. Although avoiding anxiety-producing situations may make you feel better in the short term, your anxiety is likely to persist over the long term if you don't get treatment.

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.

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 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.
  • 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.

Social anxiety disorder is one of the most common mental disorders. It usually begins in the early to midteens, although it can sometimes start earlier in childhood or in adulthood.

Several factors can increase the risk of developing social anxiety disorder, including:

  • Family history. You're more likely to develop social anxiety disorder if your biological parents or siblings have the condition.
  • 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.
  • 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.

Left untreated, social anxiety disorder may run your life. Anxieties can interfere with work, school, relationships or enjoyment of life. Social anxiety disorder can cause:

  • Low self-esteem
  • Trouble being assertive
  • Negative self-talk
  • Hypersensitivity to criticism
  • Poor social skills
  • Isolation and difficult social relationships
  • Low academic and employment achievement
  • Substance abuse, such as drinking too much alcohol
  • Suicide or suicide attempts

Other anxiety disorders, major depressive disorder, substance abuse problems and certain other mental health disorders can often occur with social anxiety disorder.

There's no way to predict what will cause someone to develop an anxiety disorder in the first place, but you can take steps to reduce the impact of symptoms if you're anxious:

  • Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
  • Keep a journal. Keeping track of your personal life can help you and your mental health provider identify what's causing you stress and what seems to help you feel better.
  • Prioritize issues in your life. You can reduce anxiety by carefully managing your time and energy.
  • Avoid unhealthy substance use. Alcohol and drug use and even caffeine or nicotine use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a treatment program or support group to help you.
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