Social anxiety disorder (social phobia) 

  • Overview

Introduction 

Anxiety: Jo’s story

Jo has had social anxiety since her childhood. In this video, she describes how she went through childhood and adolescence accompanied by constant worries and fears and how this affected her ability to take part in social activities or form relationships. Find out what helped her to manage her anxiety as an adult.

Media last reviewed: 16/09/2014

Next review due: 16/09/2016

Social anxiety disorder (social phobia) is a persistent fear about social situations and being around people. It's one of the most common anxiety disorders.

Much more than just "shyness", social anxiety disorder causes intense, overwhelming fear over what may just be an everyday activity like shopping or speaking on the phone. People affected by it may fear doing or saying something they think will be humiliating.

Social anxiety disorder disrupts normal life, interfering with social relationships and quality of life, and impairing performance at work or school.

It's generally more common in women than men and often starts in adolescence, or sometimes as early as childhood.

If you think you may have social anxiety disorder, don't be afraid to see your GP. It is a recognised condition that can be effectively treated.

What are the signs of social anxiety disorder?

A child with social anxiety disorder may cry a lot, freeze, or have tantrums. They may fear going to school and participating in class and school performances.

Teens and adults with social anxiety disorder may:

  • dread everyday activities such as:
    • meeting strangers
    • talking in groups or starting conversations
    • speaking on the telephone
    • talking to authority figures
    • working
    • eating or drinking with company
    • going shopping
  • have low self-esteem and feel insecure about their relationships
  • fear being criticised
  • avoid eye-to-eye contact
  • misuse drugs or alcohol to try to reduce their anxiety  

They may just fear one particular situation, such as speaking on the phone, or all social situations.

Panic attacks

Sometimes, the fear and anxiety of a social situation can build up to a panic attack, a period of usually just a few minutes when the person feels an overwhelming sense of fear, apprehension and anxiety.

There may be physical symptoms too, such as feeling sick, sweating, trembling and having heart palpitations.

These feelings reach a peak and then pass rapidly. They are alarming but cannot cause any physical harm.

Learn how to deal with panic attacks

Other mental health problems

Many people with social anxiety disorder will also have another mental health problem, such as depression, generalised anxiety disorder, panic disorder and/or post-traumatic stress disorder.

Some people may have a substance or alcohol misuse problem, as they use drugs or alcohol as a way of coping with their anxiety.

See a table drawn from information guidelines by the National Institute of Health and Care Excellence (NICE) on the signs and symptoms of social anxiety disorder (PDF, 45kb).

What are the causes?

We don't really know what causes social anxiety disorder, but it is likely to involve a combination of factors. Genes may play a role.

Also, the behaviour of parents may have an influence on whether their child will develop social anxiety disorder. According to Anxiety UK, people with the disorder have described their parents as:

  • overprotective
  • not affectionate enough
  • constantly criticising them and worrying they may do something wrong
  • overemphasising the importance of manners and grooming
  • exaggerating the danger of approaching strangers

Getting help

If you think you may have social anxiety disorder, don't be afraid to see your GP for help.

They'll make it as easy as possible for you to have a consultation with them. You might be offered an assessment over the phone if you find that easier, or an appointment at a time when the surgery is less crowded or busy, before or after normal hours. 

If your anxiety is severe, or you'd like your child to be assessed, your GP may be able to visit you at home. 

Getting a diagnosis

Your doctor may ask you some questions from a diagnostic questionnaire, such as the Social Phobia Inventory, Social Phobia Scale or Social Interaction Anxiety Scale. These give a score that indicates your level of anxiety in social situations (there are similar scales designed for use on children).

The sorts of questions your GP might ask you are:

  • do you/does your child tend to avoid social places or activities?
  • do you/does your child get scared about doing things with other people, like talking, eating and going to parties?
  • do you/does your child find it difficult to do things when others are watching?

Your GP will want to rule out other possible causes of your fear, such as generalised anxiety disorder or agoraphobia (a fear of being in situations where escape might be difficult, or where help wouldn't be available if things go wrong).

Learn more about phobias.

They'll also want to explore whether you have any other problems that would need to be treated separately, such as depression or a drugs or alcohol problem.

Read about the treatment of depression, treatment of drug misuse and treatment of alcohol misuse.

Treating social anxiety disorder in adults

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is one of the most effective types of treatment for social anxiety disorder. You'll be offered individual CBT specially developed for social anxiety disorder, which is usually 14 sessions over approximately four months. 

Generally, CBT works by helping you identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to change your behaviour and replace unhelpful beliefs with more realistic and balanced ones.

CBT teaches you new skills and helps you understand how to react more positively to situations that would usually cause you anxiety.

Your therapy sessions may include education about social anxiety, video feedback to correct distorted views of yourself, and behavioural exercises and experiments.

Supported self-help

If you wish to try a different psychological therapy to CBT, you may be offered supported self-help. You may, for example, be offered a CBT-based book or computer programme to try over three to four months.

Learn more about self-help therapies.

Antidepressants

Some people may benefit from trying a type of antidepressant medication, usually an SSRI (selective serotonin reuptake inhibitor), either instead of or in combination with individual CBT.

SSRIs increase the level of a chemical called serotonin in your brain. They can be taken on a long-term basis.

As with all antidepressants, SSRIs can take several weeks to start working. You will usually be started on a low dose, which will gradually be increased as your body adjusts to the medicine.

You will probably be offered escitalopram or sertraline, and should initially see your GP every few weeks to check your progress and see if you are responding well to it.

Common side effects of SSRIs include:

  • nausea (feeling sick)
  • low sex drive 
  • blurred vision 
  • diarrhoea or constipation 
  • dizziness 
  • dry mouth 
  • loss of appetite 
  • sweating 
  • feeling agitated 
  • insomnia (problems sleeping)

When you and your GP decide that it is appropriate for you to stop taking your SSRI medication, you will gradually be weaned off it by slowly reducing your dose. Only stop taking medication when your GP specifically advises you to.

Psychotherapy

If all of the above interventions are not right for you, for whatever reason, you may be offered interpersonal psychotherapy or short-term psychotherapy specifically designed for social anxiety disorder.

Psychotherapy generally involves talking to a trained therapist either one-to-one, in a group, or with your wife, husband or partner. It allows you to look deeper into your problems and worries and deal with troublesome habits and a wide range of mental disorders.

Interpersonal psychotherapy aims to link social anxiety to relationship problem areas and address these. You'll probably be offered 16-20 sessions over four to five months.

Short-term psychotherapy for social anxiety disorder aims to improve your social skills, among other things, and encourage you to face feared social situations outside therapy sessions. It is normally 25-30 sessions over six to eight months. 

Treating social anxiety disorder in children

The psychological therapies offered to adults outlined above should also be considered for children aged 15 and older.

Group-based CBT should be offered for children and young people aged seven and older. Group sessions aim to gradually expose affected children to feared or avoided social situations, and train them in social skills. There may be eight to 12 sessions, each 90 minutes long.

For younger children, parent-driven CBT is more appropriate. Parents are trained to use CBT-based materials with their children, such as books designed to treat their child's anxiety problem.

More information

NICE: social anxiety disorder 

Page last reviewed: 16/04/2013

Next review due: 16/04/2015

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Comments

The 10 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Torimoon said on 10 May 2014

I think i might have this condition, i have bad blushing issues wether its talking to someone im not close with or answering a question in class.
its so embarssing and i avoid eye contact too and i hate it when someone notices it or crowds around me.
Its the worst feeling ever.
i used to have a nervois shake in my legs but that comes around less often but only if im talking infront of alot of people

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Scribner said on 18 March 2014

I have not been diagnosed but I'm betting this is one of my problems. I am scared to go see someone as I hate sharing my problems but I know it will help. Can anyone who has social anxiety disorder please help me?

https://www.beyondblue.org.au/connect-with-others/online-forums/anxiety

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SarahT1984 said on 05 January 2014

I understand the frustrations that people have mentioned with their GP's and receiving help for conditions such as Social phobia. I first sought help for depression over 10 years ago and was only offered antidepressants (I was 17) and at the time I didn't feel that that was the solution and stopped taking them. Then about 5 years ago I went to a different GP as I had started struggling really badly with anxiety. I had tried counselling which didn't work for me as I find it hard to talk about my problems, and again was prescribed antidepressants which made me feel more anxious and I stopped taking them, but that doctor was more empathetic than my previous experience.

A few months ago I went back to my doctors and saw a different GP as my anxiety had become worse again and I was petrified that if I didn't get the help I needed this time then I would never try again, and was feeling really down about my future as my anxiety was stopping me from doing things. The GP I saw was amazing, she listened, she gave me all the options and didn't try to steer me towards a certain treatment. I opted for CBT and have been getting treatment for a couple of months. It felt a bit weird and patronising at first but I have just been told that I probably have social phobia which had never crossed my mind before, but actually makes a lot of sense. I am feeling a bit more positive about the possibility that I may be able to find a way to manage my anxieties.

I think a lot of GP's out there fall way short of offering the right kind of help, but in my experience it has improved over the last 10 years, so to anyone who is finding that they are banging their head against a brick wall, keep trying different GP's, there are good and empathetic ones out there too.

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WheresThatGuy said on 19 December 2013

One particular thing that I have found both saddening and sickening (to the core), is the false-sense of hope the NHS website gives, and the positive-can do attitude it portrays of it's doctors and staff.

From experience, this is certainly not the case. I went to my doctor three years ago for help. Still to this day I am waiting for them to do anything but give me the maximum dose of antidepressant recommended. It is absolutely ridiculous. I have made countless complaints which have been dismissed. Doctors contradict each other in a daily basis. What is social anxiety to one, is not an issue to another. They promise CBT but I've been on a waiting list for god knows how long.

They refer you to early intervention places, and mental health teams who are not willing to support you or offer their time. The best thing they did was refer me to a charity. What kind of sick world do we live in where we pay our taxes for our so called National health Service to pass on the responsibility to a charity set up in recognition of the nhs's shortcomings towards mental health.

Your doctors could do with being educated on mental health, and should have easier access to support when needed. Don't tell me on your website it's a simple case of going to my GP, as it's a well-recognised condition and there's treatment available. What a load of rubbish.

Doctors will add to your anxiety, not help reduce it. That's my experience anyway. Three years on from first reaching out.

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Ellie305 said on 14 December 2013

Just over a year ago I plucked up the courage to see my GP about having Social Phobia. I always knew that I had a problem with social situations, but I had no idea that it was a recognised medical condition and I was too afraid to ask anyone for help. I didn't think there was anything anyone could do to help me. One day I read an article online and suddenly realised that there was a name for what I was experiencing. I was also suffering from mild depression due to the effect that it was having upon my life. I felt incredibly low at the time, and it took a lot of courage for me to go the doctor, explain my situation and to ask for help.
Fortunately, my GP was very understanding and supportive and referred me to my local counselling service. I had weekly/ fortnightly sessions of CBT with an excellent counsellor over about 4 months. I did find it a difficult thing to do - opening up to a complete stranger was not easy, but it really did make a difference to how I was feeling, my behaviour and my attitude to life. I started to make the changes in my life that I needed to, and my depression went away.
I wish there was a magical solution to this problem, but the truth is there isn't one. This is something that I will have to deal with everyday for the rest of my life, but it hasn't taken over my life - because I won't let it. I promise you, it will take time, but it does get easier. Asking for help was the best decision I ever made, and I do not regret it.
I'm sorry for you that you had such a bad experience with your GP. I would suggest going to see another doctor, or failing that it is possible to refer yourself to your local counselling service without the need for a GP. I know how difficult it is to ask for help, but please don't give up. There are people out there who can and do want to help you, and if you let them, they will :)

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Julie3000 said on 13 December 2013

I went to the doctors today after reading this page and finally deciding to get help. The doctor first said it was my personality and then asked 'what do you want me to do?
I explained I had scored really highly on above tests and think I have drink problem from this and she said that social anxiety disorder was 'just another name for it all' and asked if I wanted antidepressants. I don't. I asked about cbt and was told its really popular but doesn't work in the long term. She seemed a bit miffed that I had gone to her with this 'personality trait'.
I'll change doctor and try again. It's just really disheartening. I stayed awake all night nervous about going and even wrote notes about what I would say and rehearsed it so I made sure I said what I wanted to! It was so hard to go, the first time I've managed to leave the house in a week. It takes so much energy to seek help and then to not get taken seriously is so shattering

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Wizardme1 said on 14 November 2013

Albertus - it's never too late mate, don't give up hope! You'll be fine.

Maybe try online dating, but take it slowly and one step at a time? Sign up and send some messages, get used to speaking to some women and see how it goes? You don't have to meet up if you don't want to.

Don't be put off by anything negative - there are lots of negative people and negative comments in the world (and online), but screw that, negative energy is such a waste of time.

andy1973 - maybe try some internet forums and discuss your issues with other people who share these feelings? You'll probably get on better and find it really good talking to other people who have things in common?

Good luck with whatever happens guys :)

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Wizardme1 said on 14 November 2013

Albertus - it's never too late mate, don't give up hope! You'll be fine.

Maybe try online dating, but take it slowly and one step at a time? Sign up and send some messages, get used to speaking to some women and see how it goes? You don't have to meet up if you don't want to.

Don't be put off by anything negative - there are lots of negative people and negative comments in the world (and online), but negative energy is such a waste of time.

andy1973 - maybe try some internet forums and discuss your issues with other people who share these feelings? You'll probably get on better and find it really good talking to other people who have things in common?

Good luck with whatever happens guys :)

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albertus said on 04 November 2013

I suffer from what they now call love shyness. Is it to late for me now to get any help? I am a 68 year old male & have never had sex or a girlfriend. I have always been a nervous person since childhood. Any help appreciated as I am running out of time......Thanks.

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andy1973 said on 16 October 2013

Glad to read I am not the only one whos been having the same symptoms, I had what I thought was a heart attack a couple of year ago whilst at a friends house, after checks and tests from the GP it turned out that there was physically nothing wrong, After a few more visits see a few different GP's I was told that I had, had a panic attack (rubbish I said), over the next few moths I believed this was the case as the symptoms came on maybe once a month, (numb fingers, pain in chest, edgey, muscle aches). I have managed to cope with one coming on by takin deep breaths and thinking of nice things, so all was ok. However a couple of weeks ago I have started to get these attacks coming on and have not been able to use the deep breaths etc to cope with it, These attack have been happening daily sometimes 3 to 4 hours at a time and sometimes most the day, The symptoms have increased to aches in the backs of my legs numb fingers, painful shoulder, The most worrying is like that I am not able to control my head and feel very unsettled, don't get me wrong I am not thinking any horrible thoughts and I am not thinking of doing anything stupid either. The only way I can describe it at the minute is like someone has a remote control on me and they are taking the mickey. Seen My GP this morning and she wanted to put me on medication which I declined until I have had some sessions with experts who can hopefully help me cope with theses anxiety attacks, What I cannot understand is what has triggered this, I am a very happily married 40 year old man with 3 wonderful young kids, I have a nice home, my own business which is ticking over nicely, and a great bunch of family and friends, Any tips help or chat with other would be very much appricated. Thanks Andy

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