Everyone feels a bit nervous about social situations from time to time. That is completely normal. However, for some people, the thought or reality of social experiences causes severe or overwhelming anxiety. This is known as social anxiety, social anxiety disorder or social phobia—and it is surprisingly common.

Social anxiety is far more than mere ‘shyness’. It is a long-term condition, often starting during the teenage years, and can be very debilitating. It may prevent people from functioning or doing ‘normal’ things such as meeting friends or going to school or work.

This page explains more, including how it is treated, and provides some ideas that you can use for ‘self-help’.

Signs and Symptoms of Social Anxiety

How would you know if you may be experiencing social anxiety?

After all, we all get nervous about social situations from time to time.

For a start, your symptoms need to have gone on for some time. This is not a short-term condition, even though it may be triggered by a single event.

Some of the signs that you may have social anxiety include:

• Worrying about ‘everyday’ activities, such as meeting new people, going into a shop, talking on the phone, or working;

• Avoiding or worrying about social activities, such as parties, eating with friends, or group conversations;

• Being constantly worried that you might do something embarrassing, such as not seeming to know what you are doing, making a mistake, or blushing without apparent cause;

• Finding it difficult to do things when people are watching, and feeling like you are being judged for what you do;

• Being afraid of being criticised, which may be coupled with low self-esteem (and our page on Improving Self-Esteem explains more about how you might recognise this);

• Experiencing physical symptoms when put into social situations. These might include sweating, racing heartbeat, shivering, blushing or feeling sick. Some people may feel dizzy or faint, or have trouble breathing. A few may even have panic attacks.

The key to distinguishing social anxiety from shyness, or ‘being a bit nervous’, is a combination of the severity of the symptoms, and how much they disrupt your life.

Generally, people with social anxiety are likely to be experiencing some or all of the symptoms above, most of the time. These symptoms are also likely to be interfering with their ability to carry on with life ‘as normal’.

Symptoms usually start during the teenage years, probably because this is when social demands tend to increase. However, it is worth noting that symptoms can come on suddenly and unexpectedly if new demands are placed on you. For example, being required to do a big presentation for the first time may cause symptoms of social anxiety to start.

The Effects of Social Anxiety

One of the signs of social anxiety rather than shyness is the inability to carry on with life ‘as normal’.

People with social anxiety often try to manage it by avoiding social situations entirely.

They may, for example, try to avoid starting conversations, attending parties, or making eye contact. They may avoid going into shops where they might have to talk to someone, perhaps by shopping online. These are not huge issues—but over time, they build up. After a while, it may feel impossible to go to school or work, or go out anywhere or meet anyone, especially someone new. Social isolation then becomes a lot more likely, and it becomes even harder to build relationships with others.

This is highly debilitating, because we all need social contact to function.

In the longer term, ongoing social anxiety is linked to low self-esteem, problems being assertive, and negative self-talk.

You can find out more about how to address these issues in our pages on Improving Self-Esteem, Assertiveness, and Managing Your Internal Dialogue.

People with social anxiety also often have low performance at school, college or work. They may turn to substances such as alcohol to help them to feel more confident. Ultimately, they may develop other mental health problems, such as depression or more generalised anxiety.

Causes of Social Anxiety

It is not always clear what causes social anxiety. It is most likely that it arises from a combination of circumstances, including:

• Genetics

  Anxiety disorders often run in families, although it is very hard to tell whether this is because of learned behaviour, or genetics. It is notoriously difficult to identify genes associated with mental health problems.

• Environmental issues

  It is considered possible that social anxiety may be learned as a result of experience. This might happen in several different ways. For example, you might learn to be anxious in social situations if your parents often seem uncomfortable in those situations. You might also become more anxious after an unpleasant experience.

• Brain structure

  It is also possible that there are physical differences in the brain between those who experience social anxiety and those who do not. In particular, a part of the brain called the amygdala has a role in managing fear responses. Those with an overactive amygdala may be more likely to experience social anxiety.

Some factors may also increase the risk of developing social anxiety.

For example, a family history of it, or previous negative social experiences, make it more likely. Similarly, people who are already shy are more likely to become socially anxious.

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Managing Social Anxiety

Social anxiety is a genuine mental health problem—and as such, you may need to seek medical help with managing it.

It is a good idea to seek help relatively early, before the symptoms and effects become too debilitating. In the first instance, your doctor should be able to advise you, or make a referral to specialist services.

However, there are also some actions that you can take yourself to try to manage the condition. These include:

• Using relaxation techniques, such as breathing activities to help reduce stress;

• Seeking to understand what makes you anxious, for example by exploring the situations that have this effect, and your thought processes around them. Keeping a diary may be helpful for this purpose, and will also be useful if you need a referral for mental health support;

• Manage your time and energy, so that you focus on the most important things in life. If you can’t manage everything, at least do the things that matter most;

• Breaking down difficult situations into smaller parts or steps, and working on getting comfortable with each one separately;

• Try to avoid using substances such as drugs and alcohol to help you cope. It is worth remembering that caffeine and nicotine can increase stress, so you may wish to cut down your use of these;

• Do things that you enjoy, because this helps to distract you from your fears;

• Building up your ‘social tolerance’ by reaching out to people you trust, and who make you feel good. Ask them for help with social situations, for example, by accompanying you to a party, and then leaving with you when you have had enough.

As with many mental health conditions, looking after yourself properly is helpful. Try to get enough sleep, eat a healthy, balanced diet, and take physical exercise on a regular basis.

Our pages on Caring for Your Body may be helpful here.

Treating Social Anxiety

There are three main options for treatment for social anxiety.

Many people opt for cognitive behavioural therapy, which helps you to identify negative thought patterns, and then change them. This may be one-to-one or group-based. Others use a guided self-help approach, which usually involves working through an online or book-based cognitive behavioural therapy course with occasional guidance from a therapist. Finally, some antidepressants may be used to treat social anxiety, particularly the selective serotonin reuptake inhibitors (SSRIs). There are some alternative medications, such as anti-anxiolytics, but they tend to be a second line of treatment.

Treatment may take a while to work, and some people also require a combination of treatments.

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In Conclusion

As with many other mental health problems, social anxiety can be debilitating, but can also be treated.

However, it is worth remembering that it is easier to treat if ‘caught’ earlier. It is wise not to delay seeking help.

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