Appointments & care

At Mayo Clinic, we take the time to listen, to find answers and to provide you the best care.

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.

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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.

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
• 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
• Avoiding situations where you might be the center of attention
• Having anxiety in anticipation of a feared activity or event
• 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:

• Fast heartbeat
• Upset stomach or nausea
• Trouble catching your breath
• Dizziness or lightheadedness
• Confusion or feeling "out of body"
• Diarrhea
• Muscle tension

Avoiding normal social situations

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

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

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

When to see a doctor

See your doctor or mental health provider if you fear and avoid normal social situations because they cause embarrassment, worry or panic. If this type of anxiety disrupts your life, causes severe stress and affects your daily activities, you may have social anxiety disorder or another mental health condition that requires treatment to get better.

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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. In addition, there may be an association between social anxiety disorder and parents who are more controlling or protective of their children.

Source: http://www.mayoclinic.com

Appointments & care

At Mayo Clinic, we take the time to listen, to find answers and to provide you the best care.

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

When you decide to seek treatment for social anxiety disorder symptoms, your doctor may:

• Perform a physical exam to determine if there may be any physical causes triggering your symptoms
• Ask you to describe your signs and symptoms, how often they occur and in what situations
• Review a list of situations to see if they make you anxious
• Have you fill out psychological questionnaires to help pinpoint a diagnosis

Many experts use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, to diagnose mental conditions. This manual is also used by insurance companies to reimburse for treatment. Criteria include:

• Persistent (typically 6 months or longer) fear of or intense anxiety about social situations in which you believe you may be scrutinized or act in a way that's embarrassing or humiliating
• 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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Left untreated, social anxiety disorder may 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, major depressive disorder, substance abuse problems and certain other mental health disorders can often occur with social anxiety disorder.

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There's no way to predict what will cause someone to develop an anxiety disorder in the first place, 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 provider 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.
• 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.

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Several herbal remedies have been studied as treatments for anxiety, but more research is needed to fully understand the risks and benefits. Here's what researchers know — and don't know:

• Kava. Kava appeared to be a promising treatment for anxiety, but reports of serious liver damage — even with short-term use — caused several European countries and Canada to pull it off the market. The Food and Drug Administration has issued warnings but not banned sales in the United States. Avoid using kava until more rigorous safety studies are done, especially if you have liver problems or take medications that affect your liver.
• Valerian. In some studies, people who used valerian reported less anxiety and stress, but in other studies, people reported no benefit. Discuss valerian with your doctor before trying it. While it is generally well-tolerated, there are a few case reports of people developing liver problems when taking preparations containing valerian. If you have been using valerian for a long time and want to stop using it, many authorities recommend that it be tapered down to prevent withdrawal symptoms.
• Passionflower. A few small clinical trials suggest that passionflower might help with anxiety. In many commercial products, passionflower is combined with other herbs, making it difficult to distinguish the unique qualities of each herb. Passionflower is generally considered safe when taken as directed, but some studies found it can cause drowsiness, dizziness and confusion.
• Theanine. This amino acid is found in green tea and some supplements. Preliminary evidence shows that theanine may make some people feel calmer, but there is limited evidence that it helps treat anxiety.

Before taking herbal remedies or supplements, talk to your doctor to make sure they're safe for you and won't interact with any medications you take.

Source: http://www.mayoclinic.com

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

• Reach out to people with whom you feel comfortable
• Join a local or Internet-based support group
• 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

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 in situations that aren't overwhelming.

Consider practicing these situations:

• Eat with a close relative, friend or acquaintance in a public setting
• 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.
• Adopt 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.

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

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These coping methods may help ease your anxiety:

• Reach out to friends and family members
• Join a local or Internet-based support group
• Join a group that offers opportunities to improve communication and public speaking skills, such as Toastmasters International
• Do pleasurable 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

Social anxiety disorder is one of the most common mental disorders. It usually begins in the early to midteens, although it can sometimes start earlier in childhood or in adulthood.

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 or sexual 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. Meeting new people, giving a speech in public or making an important work presentation may trigger social anxiety disorder symptoms for the first time. These symptoms usually have their roots in adolescence, however.
• Having a health condition that draws attention. Facial disfigurement, stuttering, Parkinson's disease and other health conditions can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.

Source: http://www.mayoclinic.com