People with social anxiety disorder tend to experience anxiety that is out of proportion to the social circumstances involved. Feared situations can be so difficult that sufferers will avoid them or endure them under significant distress. The condition is sometimes confused with shyness but the disorder has a different and much more profound impact on people’s lives. Please see our page on the difference between social anxiety and shyness for more details.
Social anxiety can have a significant effect on multiple aspects of your personal, social and working life. The scope of the anxiety may be focused on specific types of social situations or generalised to almost any social encounter. It may affect self-confidence, self-esteem and leave some feeling extremely isolated. Fear of rejection is common and sufferers may watch for indications that they are at risk of rejection or embarrassment.
Perceiving a social situation as difficult can trigger a cascade of panicky thoughts and symptoms (see fight or flight response). These symptoms are sometimes physical but also affect emotions, behaviours and make it hard to think or socialise normally. For some, any interaction in public situations is difficult. Sufferers know that their anxiety is excessive and unwarranted but feel they have little power 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 to hide.
Those living with social anxiety often know something is wrong. They may not know that there is a recognised condition, but they will usually be aware that they feel overly anxious in certain social or public situations. The following link lists some well-known psychological tests for the condition (these are not to be treated as a substitute for the medical advice of your own doctor or any other health care professional): How do I know if I have social anxiety?
Getting better usually works best as part of a comprehensive cognitive-behavioural approach (see what is CBT?) that involves changing multiple aspects of our thoughts, feelings and behaviours.
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
• entering a room or a shop alone
• being observed in public situations like walking or shopping
• parties and social events
• interacting with people you are attracted to
• asking for help or refunds or making a complaint
What keep social anxiety going?
There are four main factors that keep the cycle of social anxiety going:
Self-focused attention: • hyper-vigilance on your own anxiety level • thoughts and energy focused on fighting the anxiety • judging your own performance and how you are being perceived by others
Physical symptoms: blushing • feeling hot or sweating • trembling or shaking • disjointed speech • racing heart • tension in head, neck, or shoulders • nausea or butterflies • mind going blank or hard to think straight
Avoidance and safety behaviours: avoiding eye contact • speaking too fast • keeping quiet • playing with phone • leaving situations early or avoiding events entirely
Unhelpful thoughts and images • automatic negative thoughts/beliefs about yourself • thinking people can see how anxious you are • images of yourself looking strange or anxious
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 e.g. avoiding eye contact, playing with your phone, or censoring what you have to say. These are generally 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. See our page on avoidance and safety behaviours.
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 leaving their home when others might be around. They may have difficulty accessing work and healthcare, making friends, finding a partner or spending time with their own family. Children and young people with social anxiety may avoid school. Severe social anxiety has the potential to impact every aspect of communication and interaction with others, such as speaking on the telephone, answering the door 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 our page on severe social anxiety.
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 and 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.
How many people have social anxiety disorder?
The NICE Social Anxiety Guidance (Full Guidance 2013) states there are no UK epidemiological surveys that specifically report data on social anxiety disorder in adults. However, section 2.1.2 goes on to quote “…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”.
The higher 12% lifetime prevalence (based on the USA data) would equate to over 6 million adults in the UK. Using the stricter USA clinical criteria, lifetime prevalence is 5% and would equate to over 2.5 million adults in the UK, with children and teenagers bringing the totals much higher.
We currently know of no specific UK data on prevalence but further USA data is available at www.nimh.nih.gov/health/statistics/social-anxiety-disorder and Harvard Medical School – National Comorbidity Survey (NCS).
NHS Treatment options
The key document outlining NHS treatment options is written by the National Institute for Health and Care Excellence (NICE)- see NICE guidance for the general public.
The NICE Guidance states that Cognitive Behavioural Therapy (CBT) with a therapist is “the first treatment you should be offered”. It should be a type of CBT that has been specifically designed to treat social anxiety disorder. See the SAAUK page on What is CBT.
The NHS website social anxiety page states “CBT is generally considered the best treatment” but also references:
Other NHS treatment options and the following NHS self-help guide for social anxiety.
NHS CBT is delivered by the NHS Talking Therapy service and accessed via your GP or self-referral.
We know many with social anxiety find talking to their GP about their mental health difficult – please see our page Talking to your GP.
Self-help and other options
Whilst CBT Therapy with a qualified therapist has the largest evidence base, please also see Self-help, Glossary of other psychological therapies, Finding a private therapist.
How many people seek treatment?
Despite the extent of suffering and impairment, previous research showed only about half of adults with the disorder ever seek treatment, and those who do generally only do so after 15 to 20 years of symptoms (Grant et al., 2005a). However, now that awareness is growing, and with NHS and other therapies available, the number seeking help is increasing.
An NHS Self-Help guide
Click below to access the NHS Self-help guide produced by Cumbria, Northumberland, Tyne And Wear NHS Foundation Trust
NHS Cumbria, Northumberland, Tyne And Wear Social Anxiety PDF – An NHS self-help guide
Self-help via the Australian Centre for Clinical Interventions (CCI) Self-help resources
Please also see this free series of PDFs that give an overview of social anxiety and various CBT style techniques: www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Social-Anxiety.
Getting better
Getting better is completely possible. 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 to give yourself credit for small wins, even if you think they are things that others find easy.
The good news is that social anxiety can be treated and can respond well to therapy. There are several different ways to access support and treatment for social anxiety, including what the NHS offers, NHS webpages and guidance, private therapy, self-help books, support groups and forums, courses and practical help, other internet websites and other resources on this website.
Please also see our A-Z of pages.
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
