If you experience extreme mental and physical distress in social situations, or if you avoid engaging with others to spare yourself the agony, you might be suffering from social anxiety disorder.

By Karen Pallarito
November 30, 2018

Many of us get tongue-tied making small talk with strangers or folks we hardly know. Awkward, yes, but really common and no big deal.

On the other hand, if you feel so self-conscious that you’re physically ill, or you skip the holiday party because it’s too debilitating to put yourself out there, you might want to seek professional help.

It’s not just a case of the nerves; your social anxiety may be preventing you from enjoying life’s riches, psychologists say. Not only are you sacrificing personal relationships, but this type of anxiety can hinder your career or even set you up for depression or alcohol abuse.

Debra Hope, PhD, the Aaron Douglas professor of psychology at the University of Nebraska-Lincoln, describes social anxiety as something we all contend with, “just a normal part of life,” ebbing and flowing across different situations. It’s just that some people cope with it better than others.

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Think about meeting your prospective in-laws for the first time or going on an important job interview. These sorts of social encounters can give almost anyone a case of the butterflies, she says. Most people find ways to push through their anxiety, say, by getting some extra Zz’s the night before the event, avoiding caffeine the day of the encounter, or listening to a favorite song to calm them before meeting face to face.

When these strategies fall short—when social anxiety interferes with daily life (maybe you turn down the job interview, or you’re too afraid to date because you worry you’ll botch the dinner conversation)—that’s when it becomes a clinical problem, she says.

The Diagnostic and Statistical Manual of Mental Disorders, the guide clinicians use to diagnose mental illness, defines social anxiety disorder in stark terms. It’s not just about being a shrinking violet. It’s significant fear or anxiety in social or performance situations or the avoidance of feared situations lasting six months or more.

Roughly 15 million American adults experience debilitating social anxiety at some point, making it the second most commonly diagnosed anxiety disorder after “specific phobia” (meaning extreme or irrational fear of certain objects, places, or situations), according to the Anxiety and Depression Association of America (AADA).

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What causes social anxiety?

Like many human experiences, social anxiety appears to have a hereditary component. What’s unclear is why some family members are affected and others are not, according to the National Institute of Mental Health. It may be that some people’s brains misinterpret social cues or facial expressions. And while your genes and brain chemistry may play a role, it’s likely that some combination of factors, including a person’s innate personality and upbringing, influences the risk for this type of anxiety.

If, as a kid, you had positive interactions with other children, you might be more open with people and less likely to develop social anxiety disorder, reasons David Shanley, PsyD, a Denver-based clinical psychologist. However, a child who is naturally shy, who had difficulty forming friendships early on, or whose parents indulged her habit of isolating herself in her room and skipping social activities may be at greater risk.

“Now you’re going to develop a social anxiety disorder from that avoidance of confronting the thing that maybe could have been overcome,” says Shanley, author of The Social Anxiety Workbook for Work, Public & Social Life: Strategies to Decrease Shyness and Increase Confidence in Any Situation.

For adults with social anxiety disorder, navigating life in a new city or in a new job can be difficult, Shanley notes. Of course, everyone’s situation differs. “Some people might have a few close friends, some people might have no close friends, and some might have acquaintances but have trouble taking acquaintances to close-friends level,” he says.

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Symptoms of social anxiety

If the thought of having all eyes in the room trained on you makes you queasy, you might have social anxiety. Fear of being judged by others is a common feature of the disorder.

“It’s a fear of rejection, it’s a fear of humiliation, it’s a fear of failure or looking like an idiot,” Shanley explains.

There’s also research suggesting that “positive evaluation,” like getting an award, can be just as intimidating, Hope says. It sets an expectation that people fear they cannot live up to, she says.

Avoidance is another common sign. People with social anxiety avoid putting themselves in social situations rather than coping with the anxious feelings the social encounters unleash. They tend to be more isolated, Shanley observes.

Anticipatory anxiety about uncomfortable social activities sets off the body’s fight-or-flight response, causing a cascade of physical symptoms. People blush, sweat, tremble, or get nauseous. Their heart rate accelerates, their breathing becomes rapid, their mind goes blank. And the more they worry, the worse these symptoms get.

But it’s never too late to seek help. Psychologists say social anxiety is usually treated with a form of talk therapy known as cognitive behavioral therapy, either alone or in combination with an anti-anxiety, antidepressant, or beta-blocker medication.

Now, about that upcoming social event: Why don’t you have a friend tag along? Or get your mom to text you a few encouraging words. Hope says socially anxious folks often say things to themselves like, I’m not very good at conversations. “It turns out that, almost always, they’re just fine,” she says, “but they’re worried about it.”

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