Overview

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.

In social anxiety disorder, fear and anxiety lead to avoidance that can disrupt your life. Severe stress can affect your daily routine, work, school or other activities.

Social anxiety disorder is a chronic mental health condition, but learning coping skills in psychotherapy and taking medications can help you gain confidence and improve your ability to interact with others.

Social anxiety disorder care at Mayo Clinic

Source: http://www.mayoclinic.com

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 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 interfere with daily routine, work, school or other activities. Social anxiety disorder typically begins in the early to mid-teens, though it can sometimes start in younger children or in adults.

Emotional and behavioral symptoms

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
• 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
• Avoiding situations where you might be the center of attention
• Having anxiety in anticipation of a feared activity or event
• Enduring a social situation with intense fear or anxiety
• Spending time after a social situation analyzing your performance and identifying flaws in your interactions
• Expecting the worst possible consequences from a negative experience during a social situation

For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.

Performance type of social anxiety disorder is when you experience intense fear and anxiety only during speaking or performing in public, but not in other types of social situations.

Physical symptoms

Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:

• Blushing
• Fast heartbeat
• Trembling
• Sweating
• Upset stomach or nausea
• Trouble catching your breath
• Dizziness or lightheadedness
• Feeling that your mind has gone blank
• Muscle tension

Avoiding common social situations

Common, everyday experiences that may be hard to endure when you have social anxiety disorder include, for example:

• Interacting with unfamiliar people or strangers
• Attending parties or social gatherings
• Going to work or school
• Starting conversations
• Making eye contact
• Dating
• Entering a room in which people are already seated
• Returning items to a store
• Eating in front of others
• Using a public restroom

Social anxiety disorder symptoms can change over time. They may flare up if you're facing a lot of stress or demands. Although avoiding situations that produce anxiety may make you feel better in the short term, your anxiety is likely to continue over the long term if you don't get treatment.

When to see a doctor

See your doctor or mental health professional if you fear and avoid normal social situations because they cause embarrassment, worry or panic.

Source: http://www.mayoclinic.com

Causes

Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of biological and environmental factors. 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 — some people may develop the condition after an unpleasant or embarrassing social situation. Also, there may be an association between social anxiety disorder and parents who either model anxious behavior in social situations or are more controlling or overprotective of their children.

Source: http://www.mayoclinic.com

Diagnosis

Your doctor will want to determine whether other conditions may be causing your anxiety or if you have social anxiety disorder along with another physical or mental health disorder.

Your doctor may determine a diagnosis based on:

• Physical exam to help assess whether any medical condition or medication may trigger symptoms of anxiety
• Discussion of your symptoms, how often they occur and in what situations
• Review of a list of situations to see if they make you anxious
• Self-report questionnaires about symptoms of social anxiety
• Criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

DSM-5 criteria for social anxiety disorder include:

• Persistent, intense fear or anxiety about specific social situations because you believe you may be judged, embarrassed or humiliated
• Avoidance of anxiety-producing social situations or enduring them with intense fear or anxiety
• Excessive anxiety that's out of proportion to the situation
• Anxiety or distress that interferes with your daily living
• Fear or anxiety that is not better explained by a medical condition, medication or substance abuse

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Complications

Left untreated, social anxiety disorder can run your life. Anxieties can interfere with work, school, relationships or enjoyment of life. Social anxiety disorder can cause:

• Low self-esteem
• Trouble being assertive
• Negative self-talk
• Hypersensitivity to criticism
• Poor social skills
• Isolation and difficult social relationships
• Low academic and employment achievement
• Substance abuse, such as drinking too much alcohol
• Suicide or suicide attempts

Other anxiety disorders and certain other mental health disorders, particularly major depressive disorder and substance abuse problems, often occur with social anxiety disorder.

Source: http://www.mayoclinic.com

Prevention

There's no way to predict what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you're anxious:

• Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
• Keep a journal. Keeping track of your personal life can help you and your mental health professional identify what's causing you stress and what seems to help you feel better.
• Prioritize issues in your life. You can reduce anxiety by carefully managing your time and energy. Make sure that you spend time doing things you enjoy.
• Avoid unhealthy substance use. Alcohol and drug use and even caffeine or nicotine use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a treatment program or support group to help you.

Lifestyle and home remedies

Although social anxiety disorder generally requires help from a medical expert or qualified psychotherapist, you can try some of these techniques to handle situations that are likely to trigger your symptoms:

• Learn stress reduction skills
• Get physical exercise or be physically active on a regular basis
• Get enough sleep
• Eat a healthy, well-balanced diet
• Avoid alcohol
• Limit or avoid caffeine
• Participate in social situations by reaching out to people with whom you feel comfortable

Practice in small steps

First, consider your fears to identify what situations cause the most anxiety. Then gradually practice these activities until they cause you less anxiety. Begin with small steps by setting daily or weekly goals in situations that aren't overwhelming. The more you practice, the less anxious you'll feel.

Consider practicing these situations:

• Eat with a close relative, friend or acquaintance in a public setting
• Purposefully make eye contact and return greetings from others, or be the first to say hello
• Give someone a compliment
• Ask a retail clerk to help you find an item
• Get directions from a stranger
• Show an interest in others — ask about their homes, children, grandchildren, hobbies or travels, for instance
• Call a friend to make plans

Prepare for social situations

At first, being social when you're feeling anxious is challenging. As difficult or painful as it may seem initially, don't avoid situations that trigger your symptoms. By regularly facing these kinds of situations, you'll continue to build and reinforce your coping skills.

These strategies can help you begin to face situations that make you nervous:

• Prepare for conversation, for example, by reading the newspaper to identify an interesting story you can talk about.
• Focus on personal qualities you like about yourself.
• Practice relaxation exercises.
• Learn stress management techniques.
• Set realistic goals.
• Pay attention to how often the embarrassing situations you're afraid of actually take place. You may notice that the scenarios you fear usually don't come to pass.
• When embarrassing situations do happen, remind yourself that your feelings will pass, and you can handle them until they do. Most people around you either don't notice or don't care as much as you think, or they're more forgiving than you assume.

Avoid using alcohol to calm your nerves. It may seem like it helps temporarily, but in the long run it can make you feel more anxious.

Source: http://www.mayoclinic.com

Coping and support

These coping methods may help ease your anxiety:

• Routinely reach out to friends and family members.
• Join a local or reputable internet-based support group.
• Join a group that offers opportunities to improve communication and public speaking skills, such as Toastmasters International.
• Do pleasurable or relaxing activities, such as hobbies, when you feel anxious.

Over time, these coping methods can help control your symptoms and prevent a relapse. Remind yourself that you can get through anxious moments, that your anxiety is short-lived and that the negative consequences you worry about so much rarely come to pass.

Source: http://www.mayoclinic.com

Risk factors

Several factors can increase the risk of developing social anxiety disorder, including:

• Family history. You're more likely to develop social anxiety disorder if your biological parents or siblings have the condition.
• Negative experiences. Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder. In addition, other negative events in life, such as family conflict, trauma or abuse, may be associated with social anxiety disorder.
• Temperament. Children who are shy, timid, withdrawn or restrained when facing new situations or people may be at greater risk.
• New social or work demands. Social anxiety disorder symptoms typically start in the teenage years, but meeting new people, giving a speech in public or making an important work presentation may trigger symptoms for the first time.
• Having an appearance or condition that draws attention. For example, facial disfigurement, stuttering or tremors due to Parkinson's disease can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.

Source: http://www.mayoclinic.com