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.
So, with social anxiety it’s not quite as simple as just “Face your fears and they’ll go away”. Many people with social anxiety already face their fears on a regular basis (they have to!)- but often the fear remains. Getting better usually works best as part of a comprehensive cognitive-behavioural approach that involves changing multiple aspects of our thoughts, feelings and behaviours.
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?
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
• parties and social events
• interacting with people you are attracted to
• asking for help or refunds or making a complaint
Common social anxiety symptoms and feelings
There are four main types of social anxiety symptoms that may occur:
Physical: • racing thoughts • 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
Behavioural: • avoidance • safety behaviours • avoiding eye contact • speaking too fast • keeping quiet • leaving situations early
Emotional: • if untreated may lead to poor self-esteem. unassertiveness, low mood or depression
Cognitive: • automatic negative thoughts/beliefs about yourself, your performance or how you appear to others
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. 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) states that social anxiety disorder is the third most common psychiatric condition after major depression and alcohol dependence (see section 2.1.2)
Exact prevalence figures vary, but the NICE guidance linked above also states “…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 equates to over 6 million adults in the UK. Using the stricter clinical criteria, lifetime prevalence equates to over 2.5 million adults, with children and teenagers bringing the totals much higher. An estimated 9.1% of adolescents had social anxiety disorder, and an estimated 1.3% had severe impairment.
Further data is available at www.nimh.nih.gov/health/statistics/social-anxiety-disorder.
NHS Treatment options
In May 2013 the National Institute for Health and Care Excellence (NICE) published key guidance and recommendations – see: NICE Social Anxiety Public Guidance.
The first treatment you should be offered on the NHS is a psychological therapy called cognitive behavioural therapy (‘CBT’ for short). Referral is typically via a GP although you can also self-refer via the NHS Talking Therapy Search Page. CBT has the largest evidence base for successful treatment although it does not suit everyone.
If you choose not to have NHS CBT with the NHS Talking Therapies Service the guidance also recommends CBT supported self-help, medication, and short-term psychodynamic psychotherapy. Some people need to try a combination of treatments (under the advice of your GP)
See our pages on What the NHS offers, What is CBT?.
Self-help and other options
Whilst CBT Therapy with a qualified therapist has the largest evidence base Other psychological therapies, Finding a private therapist and Self-help are also possible.
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
We would still recommend seeking professional help but 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 gently 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 Find out more.
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