Social anxiety disorder

People with social anxiety disorder fear and avoid situations in which they may be judged by others. It may begin in the teens and may have to do with overprotective parents or limited social opportunities. Men and women are affected equally with this disorder.

People with social phobia are at high risk for alcohol or other substance misuse. This is because they may come to rely on these substances to relax in social situations.

People with social anxiety disorder become very anxious and self-conscious in everyday social situations. They have an intense, persistent, and chronic fear of being watched and judged by others, and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends.

Some of the most common fears of people with this disorder include:

• Attending parties and other social occasions
• Eating, drinking, and writing in public
• Meeting new people
• Speaking in public
• Using public restrooms

Physical symptoms that often occur include:

• Blushing
• Difficulty talking
• Nausea
• Profuse sweating
• Trembling

Social anxiety disorder is different from shyness. Shy people are able to participate in social functions. Social anxiety disorder affects the ability to function in work and relationships.

Your health care provider will look at your history of social anxiety and will get a description of the behavior from you, your family, and friends.

The goal of treatment is to help you function effectively. The success of the treatment usually depends on the severity of your fears.

Behavioral treatment is often tried first and may have long-lasting benefits:

• Cognitive behavioral therapy helps you understand and change the thoughts that are causing your condition, as well as learn to recognize and replace panic-causing thoughts.
• Systematic desensitization or exposure therapy may be used. You are asked to relax, then imagine the situations that cause the anxiety, working from the least fearful to the most fearful. Gradual exposure to the real-life situation has also been used with success to help people overcome their fears.
• Social skills training may involve social contact in a group therapy situation to practice social skills. Role playing and modeling are techniques used to help you become more comfortable relating to others in a social situation.

Certain medicines, often also used to treat depression, may be very helpful for this disorder. They work by preventing your symptoms or making them less severe. You must take these medicines every day. Do not stop taking them without talking with your provider.

Medicines called sedatives (or hypnotics) may also be prescribed.

• These medicines should only be taken under a provider's direction.
• Your provider will prescribe a limited amount of these medicines. They should not be used every day.
• They may be used when symptoms become very severe or when you are about to be exposed to something that always brings on your symptoms.
• If you are prescribed a sedative, do not drink alcohol while on this medicine.

Lifestyle changes may help reduce how often the attacks occur.

• Get regular exercise, enough sleep, and regularly scheduled meals.
• Reduce or avoid the use of caffeine, some over-the-counter cold medicines, and other stimulants.

You can ease the stress of having social anxiety by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.

Support groups are usually not a good substitute for talk therapy or taking medicine, but can be a helpful addition.

Resources for more information include:

• Anxiety and Depression Association of America -- adaa.org
• National Institute of Mental Health -- www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness

The outcome is often good with treatment. Antidepressant medicines can also be effective.

Alcohol or other substance misuse may occur with social anxiety disorder. Loneliness and social isolation may occur.

Contact your provider if fear is affecting your work and relationships with others.

Phobia - social; Anxiety disorder - social; Social phobia; SAD - social anxiety disorder

American Psychiatric Association website. Anxiety disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision (DSM-5-TR), Washington, DC: American Psychiatric Association Publishing; 2022.

Baker AW, Dekel S, Jagodnik KM, Pace-Schott EF, Post LM, Orr SP. Anxiety disorders and post-traumatic stress disorder. In: Stern TA, Wilens TE, Fava M, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 3rd ed. Philadelphia, PA: Elsevier; 2025:chap 31.

Lyness JM, Lee HB. Psychiatric disorders in medical practice. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 362.

National Institute of Mental Health website. Anxiety disorders. www.nimh.nih.gov/health/topics/anxiety-disorders. Updated April 2024. Accessed May 30, 2024.

Walter HJ, Bukstein OG, Abright AR, et al. Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2020;59(10):1107-1124. PMID: 32439401 pubmed.ncbi.nlm.nih.gov/32439401/.

Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.