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What is social anxiety disorder?

While virtually everyone knows what it is like to feel self-conscious in some situations, those with social anxiety disorder suffer to an extent that can limit life opportunities and significantly affect their mental and emotional health.

The anxiety those with the condition experience is often out of proportion to circumstances. Feared situations can be so difficult that sufferers will avoid them or endure them under significant distress. Social anxiety disorder does overlap with shyness, but generally it has a more profound impact on people’s lives. Please see our page on the difference between social anxiety and shyness for more details.

Having social anxiety can have a huge effect on your daily life. It may affect your self-confidence and self-esteem and can make you feel extremely isolated. It can make it difficult to develop and maintain relationships and can interfere with your ability to work and perform everyday tasks.
Fear of rejection is common and sufferers become hyper-focused on how they are appearing to others. They scan the room looking for signs of threat and disapproval or indications that they might have slipped up and are at risk of rejection.

The ‘Fight or Flight’ response is an automatic physiological reaction to an event that is perceived as stressful or frightening. These responses are evolutionary adaptations to increase chances of survival in threatening situations. Unfortunately, many with social anxiety develop threat systems which become over-active, even in social situations that others find easy. They know that their anxiety is excessive and unwarranted but feel powerless to control it. The energy required to try to look, feel, speak and act normally can be exhausting. In fact, trying to control how they look and feel can exacerbate the symptoms they are trying hide.

This means that with social anxiety it’s not quite as simple as just “Face your fears and they’ll go away”. People with social anxiety have constantly faced their fears – they’ve had to – but often the fear remains. Getting better usually works best as part of a comprehensive cognitive-behavioural approach, changing mutiple aspects of our thoughts, feelings and behaviours.

How do I know if I have social anxiety?

Those living with social anxiety often know something is wrong. They may not know that there is a recognised condition called “social anxiety disorder” but they will usually be aware that they feel overly anxious in certain social or public situations. Our page on How do I know if I have social anxiety? lists some common tests for the condition.

Situations that might be difficult

Everyone with social anxiety has their own unique pattern of things they find challenging, so that what is easy for one person might feel impossible to another. But some of the most common situations that can lead to feelings of social anxiety might include:
• small talk
• meeting people (including strangers)
• talking in meetings or in groups
• telephone calls
• lunch or coffee breaks with friends or colleagues
• starting or ending conversations
• eating or drinking while being observed
• preparing to enter a room or shop
• queues
• asking for help or refunds or making a complaint

Common social anxiety symptoms and feelings

There are four main types of social anxiety symptom:
Physical : • racing thoughts • blushing • feeling hot or sweating • trembling or shaking • disjointed speech • palpitations • tension in head, neck, or shoulders • inability to think of what to say

Behavioural : • avoidance • safety behaviours • poor eye contact • speaking too fast • being too quiet • leaving situations before things get worse

Emotional : • poor self esteem • depression • unassertiveness

Cognitive : • negative thoughts • negative beliefs

Avoidance and safety behaviours

If you have social anxiety, you may go out of your way to avoid the situations you fear. Or you may use safety behaviours (for example avoiding eye contact or censoring what you have to say) in an attempt to avoid drawing attention to yourself or being judged. Avoidance and safety behaviours tend to maintain social anxiety, and therefore targeting them is an important part of recovery.

How does social anxiety disorder affect people’s lives?

Social anxiety disorder is a spectrum. Some sufferers may live full working and family lives or may even reach the top of their profession, yet still struggle in particular social situations.

In more extreme forms social anxiety can prevent people even leaving their home when others might be around. They may have difficulty accessing work, healthcare, making friends, finding a partner or spending time with their own family. Children and young people with social anxiety may be unable to attend school. Severe social anxiety has the potential to impact every aspect of communication and interaction with others, such as speaking on the telephone, participating in video calls, sending emails, writing letters, or being watched or seen from afar. Selective mutism is an anxiety disorder where a person is unable to speak at all in certain social situations. See https://www.nhs.uk/mental-health/conditions/selective-mutism/.

Despite the extent of distress and impairment that can occur, only about half of those with the disorder ever seek treatment, and those who do generally only seek treatment after 15–20 years of symptoms.

Social Anxiety in children and teenagers

Social anxiety often develops in childhood or adolescence and has a median age of onset at 13. We have further information in our pages on children and social anxiety and teenagers an social anxiety.

The Causes of Social Anxiety Disorder

People may have social anxiety disorder for a number of reasons, perhaps involving a mixture of being more genetically predisposed to anxiety, but also as a result of their life experiences. See our page on the causes of social anxiety here.

How many people have social anxiety disorder

Figures vary but the NHS NICE Social Anxiety Guidance (Full Guidance) comments  “…it is clear that social anxiety is one of the most common of all the anxiety disorders. Lifetime prevalence rates of up to 12% have been reported (Kessler et al., 2005a) compared with lifetime prevalence estimates for other anxiety disorders of 6% for generalised anxiety disorder (GAD), 5% for panic disorder, 7% for post-traumatic stress disorder (PTSD) and 2% for obsessive compulsive disorder (OCD). Twelve-month prevalence rates as high as 7% have been reported for social anxiety disorder (Kessler et al., 2005b). Using strict criteria and face-to-face interviews in the US, the lifetime and yearly prevalence figures are halved to 5% and 3%, respectively”.
Even on the stricter criteria that’s 1.59 MILLION adults in the UK this year.
Further data is available at www.nimh.nih.gov/health/statistics/social-anxiety-disorder.

Getting better

Getting better is completely possible. Although some techniques have more clinical evidence for their efficacy, there is also an element of individual trial and error. You should experiment and find the techniques that work best for you.

Some of getting better means accepting invitations to go places and do things that make you feel uncomfortable. Although it may be difficult, the growth, freedom and improved self-confidence that come from pushing through your fears will be worth it.
Be pleased with any progress that you make. Every journey begins with small steps, and it’s important give yourself credit for small wins, even if you think they are things that others find easy.

The good news is that there are many effective ways social anxiety can be treated. Although it may be difficult, the growth, freedom and improved self-confidence that come from pushing through your fears will be worth it. There is a UK online discussion board, some support groups, social anxiety Meetup groups such as the London Shyness Group with 15,000 members, self help books, articles on how to make progress, and links to access NHS therapy.

Disclaimer

The content in this resource is provided for general information only. It is not intended to, and should not be, treated as a substitute for the medical advice of your own doctor or any other health care professional.

Emergency Help

If you need urgent support, please contact the Samaritans 24 hour support line on 116 123 or see our Getting help in a crisis page