It’s normal to feel nervous in some social situations. For example, going on a date or giving a presentation may cause that feeling of butterflies in your stomach. But in social anxiety disorder, also called social phobia, everyday interactions cause significant anxiety, fear, self-consciousness and embarrassment because you fear being scrutinized or judged by others.
Social anxiety disorder is a chronic mental health condition, but treatment such as psychological counseling, medication and learning coping skills can help you gain confidence and improve your ability to interact with others.
Symptoms. Feelings of shyness or discomfort in certain situations aren’t necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on the individual’s personality traits and life experiences. Some people are naturally reserved and others are more outgoing. In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interferes with your daily routine, work, school or other activities.
Signs and symptoms of social anxiety disorder can include persistent:
Fear of situations in which you may be judged
Worrying about embarrassing or humiliating yourself
Concern that you’ll offend someone
Intense fear of interacting or talking with strangers
Fear that others will notice that you look anxious
Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice
Avoiding doing things or speaking to people out of fear of embarrassment
Causes. Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of environment and genes. Possible causes include:
Inherited traits. Anxiety disorders tend to run in families. However, it isn’t entirely clear how much of this may be due to genetics and how much is due to learned behavior.
Brain structure. A structure in the brain called the amygdala (uh-MIG-duh-luh) may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.
Environment. Social anxiety disorder may be a learned behavior. That is, you may develop the condition after witnessing the anxious behavior of others.
Treatments and drugs. The two most common types of treatment for social anxiety disorder are medications and psychotherapy. These two approaches may be used in combination.
Psychotherapy. Psychological counseling (psychotherapy) improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations.
First choices in medications. Several types of medications are used to treat social anxiety disorder. However, selective serotonin reuptake inhibitors (SSRIs) are often the first type of medication tried for persistent symptoms of social anxiety. Your doctor may prescribe Paroxetine (Paxil) or Sertraline (Zoloft).