Many people experience some anxiety in certain social situations, such as going to a job interview or giving a speech at a wedding. It is normal to expect to feel nervous or worried about such situations.
However, for people who experience social anxiety, these anxious feelings can occur in most or all social situations. The anxiety can be so intense that it negatively affects their life.
What is Social Anxiety?
Social anxiety disorder, also known as social phobia, is an anxiety disorder characterized by intense fear and anxiety in social situations.
People with social anxiety disorder often experience excessive worries about being judged or scrutinized by others and may avoid social situations altogether or endure them with extreme discomfort. This disorder can significantly impair daily functioning and negatively impact quality of life.
They may experience social anxiety in many areas of life, such as at school, at work, at social events, and when out in public.
Individuals may find social situations so distressing that they might avoid or escape them, so they do not have to face their fears.
Social anxiety can occur when individuals fear social situations in which they anticipate negative evaluations by others or perceive that their presence will make others feel uncomfortable (Heimberg et al., 2014).
Social anxiety disorder can differ in range and severity, with some fearing most social situations, whilst others may only experience anxiety in one or two social situations.
Below is a list of some of the social situations that someone with social anxiety disorder may find challenging:
- Public speaking
- One-on-one conversations
- Group interactions
- Social events, e.g., parties
- Meeting new people
- Making phone calls
- Job interviews
- Initiating and maintaining conversations
- Giving presentations
- Work meetings
- Walking in view of others
- Using public toilets
- Eating or drinking in front of people
- Being assertive with others
- Talking to authority figures
What is it Like to Live With Social Anxiety?
People with social anxiety may experience a combination of cognitive, behavioral, and physical signs.
The cognitive signs of social anxiety are usually negative beliefs, biases, and thoughts about oneself or social situations and can include the following:
Cognitive signs
- Fear of talking to strangers
- Worry of being embarrassed
- Fear of situations where there is the possibility of being negatively judged
- Fear that others will notice the anxiety
- Fear of physical sensations associated with anxiety
- Intense anxiety during social situations
- Fear of analysis of performance
- Dreading upcoming events
- Expecting the worst possible consequence from a negative experience during a social situation
The behavioral signs of social anxiety are the actions performed by the socially anxious individual as a result of their anxiety, including:
Behavioral signs
- Avoiding speaking
- Avoiding being the center of attention
- Leaving or escaping social situations
- Using safety behaviors
- Missing school or work
The physical signs of social anxiety are those which are typically experienced before, during, and after a social situation; usually, sensations typically experienced during the fight or flight response, including:
Physical signs
- Blushing
- Sweating
- Rapid heartbeat
- Nausea
- Feeling breathless
- Feeling as if the mind has gone blank
- Light-headedness
- Muscle tension
These signs will not be the same for everyone who experiences social anxiety, as some may experience only a few whilst others may experience a lot more. It is important to keep in mind that social anxiety can be unique to every person.
What does social anxiety feel like?
Below are some quotes from experts and individuals who have experienced social anxiety who describe what it really feels like.
Therapist Angela Dierks describes how she has encountered clients with social anxiety who experience a lot of shame:
‘Very often, somebody with social anxiety is not very shame-resistant. They’re very shame-prone. They’re very likely to experience the (signs of) flushing cheeks and going red in the face as being deeply shameful.’
Dierks goes on to explain how egocentricity (the excessive focus on oneself) plays a big role in many people with social anxiety:
‘You become quite egocentric when you are anxious… there’s this sense that the whole world is paying attention to you, that people are paying intense attention to you. That people notice every single emotion that you might be experiencing… The truth is often that most people wouldn’t notice. They don’t know exactly what’s going on for you. They may not even be that interested.’
In a study by Mohammadi et al. (2019), one participant described how restricting social anxiety can feel:
‘When I am in stressful situations I can’t speak or move, it is like I am in a cage.’
People who have experienced social anxiety often describe feeling powerless or unworthy in social situations:
‘I think something makes me most vulnerable in these situations and that is I don’t feel worthy enough.’
From Mohammadi et al. (2019)
This feeling was shared by Kate when she described her personal experience:
‘but I think that’s a lot of what social anxiety is is feeling out of control and like you don’t have the power in a conversation or don’t have the power to hold a conversation.’
Likewise, individuals who experience social anxiety may find ways to cope that involve putting in more effort than may be necessary into navigating social situations, as described by Ryan:
‘My social anxiety really stemmed from not knowing what to say. And I found that I would be planning dialogue in my head before having a conversation with somebody. And I would always try to be like two or three steps ahead of the conversation.’
What Causes Social Anxiety?
The exact causes of social anxiety are not fully understood, but there are several factors that may contribute to its development.
Overall, social anxiety is likely caused by a combination of genetic, environmental, and biological factors.
Can I inherit social anxiety from my family?
A possible cause of social anxiety is genetics, as individuals with a family history of anxiety disorders may be more likely to develop social anxiety.
Likewise, the stronger the genetic closeness of the person with anxiety/depression (e.g., parent or sibling), the more likely it is that someone may develop social anxiety.
Therefore, if you have a parent with social anxiety, you may be more likely to develop social anxiety yourself.
What are some possible biological causes of social anxiety?
Studies have suggested that imbalances of the neurotransmitters serotonin and dopamine could play a role in developing social anxiety.
One study, for instance, found that there was increased serotonin and dopamine activity in brain regions associated with fear (amygdala) and rewards (nucleus accumbens), with greater activity being correlated to symptom severity (Hjorth et al., 2019).
Imaging studies have demonstrated that those with social anxiety disorder demonstrated selective activation of their amygdala when exposed to fear-relevant stimuli (Birbaumer et al., 1998) or showed differing patterns of amygdala activation during aversive conditioning (Schneider et al., 1999).
A further study found that those with social anxiety disorder had increased blood flow in their amygdala. In contrast, those without social anxiety disorder showed increased blood flow to their cerebral cortex (area of thinking and evaluation).
This suggests that those with social anxiety have overstimulated fear regions that override parts of the brain that involve logical reasoning.
Can environment and life events cause social anxiety?
There could also be environmental factors that could contribute to the development of social anxiety. Life stressors, such as work, school, or a traumatic event, could trigger the onset of social anxiety.
Early learning as a child could also be a potential contributing factor. If an individual’s family is overly critical of the child, controlling, or overly protective, this could make it more likely that a child will become anxious.
Also, fearful and anxious parents could unknowingly transfer their own worries and fears of social situations onto their children. If a parent worries excessively about what others think of them, this could be picked up by the child, who may then also have the same worries.
‘I was raised in a family full of tension and stress that were beyond my ability to manage.’
Interview extarct from Mohammadi et al. (2019).
Those with social anxiety often report being very shy or withdrawn as a child, which could stem from various environmental factors. If the shy child is the victim of bullying or abuse due to being shy, this could also reinforce shyness, which could develop into social anxiety.
Being socially isolated and loneliness are also thought to be linked to people developing social anxiety (Eres et al., 2023).
What Keeps Social Anxiety Going?
With social anxiety, a big part that keeps it going is that individuals will think about the probability and cost of the feared social situation.
The probability is the idea of how likely they believe their fears will happen, whereas the cost is how bad they believe the situation will be if their fears come true.
For instance, if someone is planning to give a presentation to their class, they may believe it is highly likely that they will make a mistake or stutter when speaking – this is the probability.
If the mistake or stuttering happens, they may believe they will be criticized or laughed at by others – this is the cost. Due to these thoughts can cause the individual giving the speech to feel highly anxious, and they may tremble, blush, sweat, or feel nauseous as a result.
Individuals with social anxiety may be preoccupied with many fears of physical sensations such as a fear of shaking, blushing, and sweating. They may also fear appearing anxious, boring or incompetent (Hofmann et al., 2010). Having such fears may contribute toward more physical sensations and thus keep the individual socially anxious.
According to research, perfectionism and social anxiety are closely linked (Ferber et al., 2024). Individuals with perfectionistic tendencies set unrealistic standards for their social performance, harshly criticize themselves when falling short, and fear negative evaluation from others.
To compensate for perceived inadequacies, they may engage in behaviors to project an image of perfection while concealing flaws. However, this often backfires, as their self-consciousness and dread of judgment fuel further anxiety.
Other ways in which social anxiety can keep going are:
-
- Being triggered by ‘social threats’
- Negative thoughts about the self
- How strongly we believe a ‘social catastrophe’ will occur
- Self and environment-focused attention
- Safety behaviors
- Avoidance strategies
- How you think others perceive you
- Core beliefs
How Do People With Social Anxiety Use Avoidance?
Avoidance behaviors are common among individuals with social anxiety. They may avoid situations they fear in order to reduce their anxiety.
This provides instant relief and temporarily reduces anxiety.
People who rely on avoidance as a coping mechanism tend to avoid unfamiliar people, large groups, phone calls, appointments, school, or work.
Why is avoiding social situations a problem?
While avoiding social situations may make socially anxious individuals feel safe in the short term, it poses long-term problems as it can perpetuate anxiety.
Avoidance prevents individuals from challenging their negative thoughts and reinforces them. It also limits opportunities for positive social experiences that could motivate them to engage in more social activities.
This can lead to missed personal and professional growth opportunities, such as avoiding job interviews for desired positions due to fear of humiliation or being put on the spot.
Avoidance can also have negative effects on self-esteem, causing individuals to feel unsatisfied with their social lives, experience isolation, and possibly develop depression.
The avoidance behavior can extend to other areas of life, eroding confidence in relationships and work performance.
Furthermore, when individuals with social anxiety are eventually confronted with unavoidable social situations, their anxiety may be even more intense due to a lack of exposure and preparation.
How do People With Social Anxiety Use Safety Behaviors?
Safety behaviors may be used in situations that can’t be avoided.
These behaviors, although more subtle, serve as a form of avoidance by preventing feared outcomes and increasing comfort in social settings.
Some safety behaviors include:
- Staying quiet in social situations
- Wearing headphones
- Planning out what to say ahead of time
- Limiting eye contact
- Using alcohol or drugs
- Speaking quietly
- Keeping the focus of the conversation on others
- Wearing inconspicuous clothing
- Carrying anxiety medication
Safety behaviors can go unnoticed and vary depending on the situation. However, like avoidance behaviors, they only offer temporary relief and can exacerbate anxiety in the long run.
While individuals may not completely avoid the situation, safety behaviors hinder them from fully testing their fears. By repeatedly challenging negative thoughts, individuals may realize that their predictions rarely come true, thereby reducing these negative thoughts.
Ironically, safety behaviors can lead to worse outcomes than if individuals faced the situation without relying on them, potentially fulfilling the very outcomes they seek to prevent.
For example, relying on alcohol to ease social discomfort can result in visible intoxication and embarrassing behavior that wouldn’t have occurred without the reliance on alcohol.
When safety behaviors are used, and the feared outcome doesn’t materialize, individuals may mistakenly attribute this success to their safety behaviors.
They may believe that these behaviors prevented negative outcomes, leading to a greater reliance on them in future social situations and increased anxiety when unable to employ these behaviors.
Furthermore, engaging in safety behaviors can shift individuals’ focus inward, diverting attention from the social situation at hand (such as a conversation) and leading to additional difficulties.
In summary, safety behaviors, like avoidance behaviors, provide short-term relief but can ultimately reinforce anxiety. They limit opportunities for testing fears, can produce self-fulfilling prophecies, and hinder full engagement in social interactions.
How is social anxiety treated?
Social anxiety treatment typically involves a combination of psychotherapy and sometimes medication.
Cognitive-behavioral therapy (CBT) is the most recommended psychotherapy approach, helping individuals identify and change negative thought patterns and behaviors. Exposure therapy, a form of CBT, gradually exposes people to feared social situations to reduce anxiety over time.
Other helpful strategies include:
- Relaxation techniques (e.g., deep breathing, meditation)
- Social skills training
- Mindfulness practices
- Regular exercise
- Lifestyle changes (improving sleep, reducing caffeine/alcohol)
In some cases, medications like selective serotonin reuptake inhibitors (SSRIs) or beta-blockers may be prescribed to manage symptoms.
Support groups and self-help resources can also be beneficial. Treatment is often personalized, combining different approaches based on individual needs and severity of symptoms.
Frequently Asked Questions
Who is Most Affected by Social Anxiety?
Social anxiety disorder was recognized as an anxiety disorder in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-3) in 1980 and is believed to have a lifetime prevalence rate of 12% in the United States (Kessler et al., 2005).
Social anxiety is thought to disproportionately affect young people, with many cases diagnosed before age 23 (Kessler et al., 2005). A recent study looking into 16-29 year olds from culturally and economically diverse countries found that 1 in 3 met the criteria for social anxiety disorder (Jefferies & Ungar, 2020).
Likewise, higher rates of social anxiety are observed in females than males (Nordahl & Wells,2020).
When does social anxiety become a disorder?
While social anxiety can affect anyone to some extent, it becomes a disorder when it significantly interferes with an individual’s ability to function in daily life.
This can include avoiding social situations, experiencing excessive fear or anxiety in social situations, and experiencing physical signs such as sweating or trembling in social situations.
The fear and anxiety associated with social anxiety disorder can be persistent and intense, and can lead to significant distress and impairment in various areas of life, such as work, school, and relationships.
Can social media contribute to social anxiety?
Some studies have suggested that greater social media usage and more options for non-face-to-face communication is associated with higher levels of social anxiety (Caplan, 2007; Lee-Won et al., 2015).
A potential reason for this might be that individuals with social anxiety favor the relative ‘safety’ of online interactions (Caplan, 2007). They may feel less inclined to push themselves out of their comfort zone if there is less need to be social in person
What is the difference between social anxiety disorder and Autism?
While social anxiety disorder and Autism can share similarities, especially in social interactions, they are distinct conditions with different signss and causes.
Social anxiety disorder is characterized by intense fear and anxiety in social situations, whereas Autism is a neurodevelopmental disorder that affects social communication and behavior.
While social anxiety disorder can be managed with therapy, self-help, and medication, there is no cure for Autism, and management can involve therapy and support to improve quality of life.
It’s important to note that social anxiety disorder can occur alongside Autism, but they are separate conditions that require different approaches to treatment.
How does social anxiety affect teenagers?
Social anxiety in teenagers can lead to withdrawal from social situations, impacting peer relationships and academic participation. They may avoid group activities, struggle with public speaking, and hesitate to engage in new experiences.
This anxiety can hinder personal development, cause feelings of loneliness, reduce self-esteem, and, in severe cases, lead to depression or other mental health issues.
Can you have GAD and social anxiety?
Yes, it’s possible to have both Generalized Anxiety Disorder (GAD) and social anxiety. GAD involves chronic, excessive worry about various aspects of life, while social anxiety is a fear of social situations and being judged by others.
Individuals can experience both generalized worries and specific fears related to social interactions concurrently.
Do you need mental health support?
USA
If you or a loved one are struggling with symptoms of an anxiety disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline for information on support and treatment facilities in your area.
1-800-662-4357
UK
Contact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; email jo@samaritans.org .
Available 24 hours a day, 365 days a year (this number is FREE to call):
116-123
Rethink Mental Illness: rethink.org
0300 5000 927
References
Bank, S., Burgess, M., Sng, A., Summers, M., Campbell, B., & McEvoy, P. (2020). Stepping Out of Social Anxiety. Perth, Western Australia: Centre for Clinical Intervention
Caplan, S. E. (2007). Online social interaction, psychosocial well‐being, and problematic Internet use. Internet addiction: A handbook and guide to evaluation and treatment, 35-53.
Cunningham, K. (2019. June 27). My experience with social anxiety (& dealing with it) [Video]. YouTube. https://www.youtube.com/watch?v=TR8yL3HvaZs&t=226s&ab_channel=KateCunningham
Dierks, A., & MacKay, T. (Hosts). (2023, June 5). Social Anxiety And How To Stop Avoiding It [Audio podcast episode]. In The Relationship Maze.
Eres, R., Lim, M. H., & Bates, G. (2023). Loneliness and social anxiety in young adults: The moderating and mediating roles of emotion dysregulation, depression and social isolation risk. Psychology and Psychotherapy: Theory, Research and Practice.
Ferber, K. A., Chen, J., Tan, N., Sahib, A., Hannaford, T., & Zhang, B. (2024). Perfectionism and social anxiety: A systematic review and meta-analysis. Clinical Psychology: Science and Practice. Advance online publication. https://doi.org/10.1037/cps0000201
Heimberg, R. G., Hofmann, S. G., Liebowitz, M. R., Schneier, F. R., Smits, J. A., & Stein, M. B. & Craske, MG (2014). Social anxiety disorder in DSM-5. Depression and anxiety, 31(6), 472-479.
Hofmann, S. G., Anu Asnaani, M. A., & Hinton, D. E. (2010). Cultural aspects in social anxiety and social anxiety disorder. Depression and anxiety, 27(12), 1117-1127.
Jefferies, P., & Ungar, M. (2020). Social anxiety in young people: A prevalence study in seven countries. PloS one, 15(9), e0239133.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). ” Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication”: Erratum.
Lee-Won, R. J., Herzog, L., & Park, S. G. (2015). Hooked on Facebook: The role of social anxiety and need for social assurance in problematic use of Facebook. Cyberpsychology, Behavior, and Social Networking, 18(10), 567-574.
Mohammadi, A., Abasi, I., Soleimani, M., Moradian, S. T., Yahyavi, T., & Zarean, M. (2019). Cultural aspects of social anxiety disorder: A qualitative analysis of anxiety experiences and interpretation. Iranian Journal of Psychiatry, 14(1), 33.
Nordahl, H., & Wells, A. (2020). Social anxiety and work status: the role of negative metacognitive beliefs, symptom severity and cognitive-behavioural factors. Journal of Mental Health, 29(6), 665-669.
Scribner, R. (2020, November 9). How I overcame social anxiety [Video]. YouTube. https://www.youtube.com/watch?v=WkGEKA25jCc&ab_channel=RyanScribner
Substance Abuse and Mental Health Services Administration. (2016). DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet].
Pelissolo A, Abou Kassm S, Delhay L. Therapeutic strategies for social anxiety disorder: Where are we now? Expert Review of Neurotherapeutics. 2019;19(12).
Related articles
