Social anxiety disorder (social phobia)

Social anxiety disorder, which is also known as social phobia, is a common mental health condition that affects all ages but often first develops during the teenage years. It causes an individual to feel anxiety and fear in social situations. 

This is different to feeling shy. Unlike shyness, which can also make social situations challenging, social anxiety disorder is overwhelming and persistent and often has a significant negative impact on your quality of life and ability to carry out everyday tasks, such as shopping, engaging in work meetings or using public transport.

Here, we will explore the causes, symptoms and risk factors of social anxiety, as well as how it is diagnosed and treated, including tips on how to manage social anxiety day-to-day. 

Social anxiety vs general anxiety

The difference between social anxiety and general anxiety lies in the types of feelings they trigger and when. 

General anxiety causes feelings of worry, irritability and restlessness, which can make you easily startled or panicked. It can occur whether you are alone or surrounded by people. 

Social anxiety is triggered specifically when in the company of other people, in anticipation of an upcoming social situation or soon after taking part in a social situation. While it also causes feelings of worry, it often triggers intense feelings of fear, self-doubt and self-consciousness as well.

Causes of social anxiety

It isn’t entirely clear why some people develop social anxiety disorder and others don’t. However, multiple factors are thought to be involved, including your genetics ie whether you have a family history of anxiety disorders, and whether you have experienced very stressful or traumatic life events eg bullying, abuse, loss of a loved one or a chronic (long-term) or prolonged illness. 

How you were parented may also play a role ie overly controlling or protective parents may increase the risk of social anxiety in their child. 

Symptoms of social anxiety

The most common symptoms of social anxiety include nausea, sweating, blushing, a rapid heartbeat (palpitations), trembling or shaking, dizziness and lightheadedness. 

You may also find that your body takes on a rigid stance, your mind seems to go blank and you struggle to speak.

Social anxiety can lead to hypervigilance too. This occurs when you become acutely aware of your surroundings and constantly scan your environment focusing on other people’s perceived reactions to you eg signs of criticism, rejection or being made fun of. 

As a consequence of these symptoms, you may try to blend into the background and avoid eye contact and conversations. 

What makes social anxiety worse?

Social anxiety disorder is a persistent mental health condition; however, you may experience periods where your social anxiety is more intense. 

This may occur if you’re dealing with a particularly stressful situation or change in your life eg starting a new job, moving house, having children or caring for a loved one who is ill. 

Your social anxiety may also get worse over time if you don’t seek help. A common short-term coping mechanism is to avoid social situations; however, in the long term, this is usually impractical and leads to worse social anxiety when you are then forced to face a social situation. 

Getting a diagnosis

If you’re concerned that you have social anxiety disorder, see your GP. They will ask you about your symptoms and medical history. In particular, they may ask you if you find yourself avoiding social situations or activities and if you feel fearful or embarrassed in social situations. 

They may then refer you for a more comprehensive assessment. Your diagnosis will depend on the results of this assessment, after which, your doctor will explain your treatment options.

Treating social anxiety disorder

Social anxiety disorder is most often treated through a talking therapy called cognitive behavioural therapy (CBT), which aims to change the way you behave and think. 

Your doctor may also recommend self-guided help, where you practise CBT approaches via an online course with support from a therapist. 

Other therapies that may be recommended include exposure therapy where a therapist helps you gradually face social situations and group therapy where you can learn to engage in social situations in a controlled environment with others who are dealing with social anxiety. 

If these approaches aren’t enough to manage your symptoms, your doctor may also recommend antidepressant medication, specifically a selective serotonin reuptake inhibitor (SSRI).

Tips for preventing and managing social anxiety

Dealing with social anxiety can feel overwhelming and intense. By learning more about social anxiety and, in particular, recognising the thought patterns and behaviours that you experience when feeling anxious, you can better control your symptoms. 

One way to do this is by keeping an anxiety diary where you note down the thoughts, feelings and behaviours you experience during an episode of social anxiety. 

You can also practise relaxation techniques before facing a social situation, such as deep breathing, mindfulness or meditation. Practising these techniques daily can also help lower your overall stress levels, which can lessen your social anxiety symptoms when you’re in a social situation.

Other ways to reduce your stress levels and, consequently, your social anxiety include following a healthy, balanced diet, keeping to a regular bedtime routine, exercising regularly and avoiding stimulants (eg caffeine).

When faced with a social situation, focus on small steps rather than thinking about what may potentially occur during the entire event. By breaking down a social situation into smaller parts and focusing on how you will cope with each particular part, you can help relax your body and mind as you overcome each challenge. 

Also, when engaging with people, try to ignore thoughts that assume the worst. Instead, focus on what people are saying to you and try not to second-guess yourself. 

Finally, don’t try to manage your social anxiety alone. Talk to trusted friends and family, and, if needed, a therapist or healthcare professional.

Where to find help

If you are dealing with social anxiety, you can find information, help and support from a variety of UK charities including Anxiety UK, MIND, YoungMinds, Triumph Over Phobia UK, Social Anxiety UK and No Panic.