Social Anxiety

Social anxiety is a chronic mental health condition defined by intense fear or worry about social interactions. While occasional nervousness in social situations is normal, social anxiety interferes with daily routines, work, relationships, school, and other activities.

Symptoms of social anxiety may be emotional, physical, or social:

• Emotional symptoms: Fear, low self-esteem, trouble focusing, procrastination, “blanking out,” or anxiety about judgment and social mistakes.
• Physical symptoms: Sweating, rapid heartbeat, breathlessness, trembling, shaking, stuttering, blushing, or restlessness.
• Social symptoms: Avoidance of social situations, difficulty building relationships, isolating from others, fidgeting, and avoiding eye contact.

The exact cause of social anxiety is not fully understood. Brain areas related to fear and anxiety, genetics, stress, and environmental factors all contribute. Research suggests social anxiety can run in families.

Risk factors include:

• Family history of anxiety disorders
• Previous negative social experiences
• Shy or reserved temperament
• New social or professional demands
• Noticeable physical traits or conditions that draw attention (stuttering, tremors, disfigurement, etc.)

Autism spectrum disorder (ASD) and social anxiety disorder can share similar symptoms, but there are key differences.

• Shared symptoms: Social fear, anxiety, difficulty forming relationships, avoiding eye contact, isolating from others.
• More common with autism: Confusion in social settings, sensory overwhelm, “masking” behavior, talking loudly, standing too close.
• More common with social anxiety: Fidgeting only in social situations, soft-spoken, sweating, rapid heartbeat, stuttering, blushing, fear of using social skills.

ADHD involves difficulty with focus, hyperactivity, and impulsivity. Social anxiety involves fear of social interactions.

• Shared symptoms: Restlessness, low self-esteem, difficulty socializing, trouble completing tasks, avoidance of social situations.
• Key difference: Social anxiety is driven by fear of judgment, while ADHD involves general distractibility and impulsivity not specifically tied to social situations.

Agoraphobia is fear of being in places where escape may be difficult. Social anxiety is fear of judgment or embarrassment in social situations.

Both involve fear of judgment, but awareness differs:

• Social anxiety: The person recognizes their anxiety may be excessive.
• Avoidant personality disorder: The person may believe their fears are justified and feel inherently unworthy.

Shyness is a personality trait; social anxiety is a chronic condition that interferes with daily life.

Yes. Extroverts may crave social interaction but still experience social anxiety that interferes with relationships or work.

Social anxiety can cause substantial disability and reduced quality of life. Anxiety disorders are recognized by the U.S. Social Security Administration as qualifying conditions.

Social anxiety typically requires persistence and a combination of treatment methods. Common treatments include:

• Cognitive behavioral therapy (CBT)
• Exposure-based CBT
• Medication

• Antidepressants: SSRIs (Citalopram, Paroxetine, Escitalopram, Fluoxetine, Sertraline), SNRIs (Duloxetine), Bupropion
• Beta-blockers: Propranolol

With therapy and medication, it is possible to manage and reduce social anxiety over time.

CBT is a skills-based psychotherapy aimed at changing thoughts and behaviors that maintain anxiety.

Exposure therapy gradually introduces anxiety-inducing social situations in a controlled manner to reduce fear over time.

Professional treatment is the first step. Research suggests your anxiety may distort your perception—your friends may not see your social difficulties the same way you do.

Seek treatment if social anxiety interferes with your job. Therapy and medication can improve functioning and relationships in the workplace.