What Is Social Anxiety Disorder or Social Phobia?

Written by Matt McMillen, WebMD Editorial Contributor
Medically Reviewed by Jabeen Begum, MD on January 22, 2025
12 min read

We all know the occasional feeling of being nervous, shy, or, well, anxious in a social situation, such as when meeting someone new or making a big presentation. That’s normal, and most people get through those situations. Social anxiety is different. It can lead you to avoid such situations altogether due to your worry and fear about being judged harshly by other people.

If you have social anxiety disorder (SAD), also known as social phobia, the stress of these situations is too much to handle. You might, for example, avoid all social contact because things that other people consider “normal” — like making small talk and eye contact — make you very uncomfortable. The disorder impacts your relationships, work life, and other daily activities. Depending on the severity of your SAD, not just your social life, all aspects of your life could start to fall apart.

Social anxiety disorder affects about 15 million adults in the U.S. Women and people assigned female at birth (AFAB) are almost twice as likely to develop SAD as men and people assigned male at birth (AMAB). SAD typically begins in the early teen years. About 90% of people with SAD are diagnosed before age 23. Some research suggests that developing the disorder in adulthood ups your risk of other conditions, such as panic disorder and posttraumatic stress disorder (PTSD). 

SAD is one of the most common mental disorders but can be treated effectively. The tough part is asking for help. Here’s how to know if your social fears have gone beyond shyness to a point where you need to see a doctor.

Experts divide SAD into a few different categories, based on the situations that trigger the anxiety as well as how severely it affects you.

Generalized SAD. In this type, you feel anxiety in most or all social settings and occasions when you have to perform in front of others, such as giving a speech or presentation. In fact, the number and variety of anxiety-inducing situations may be so great that if you tried to list them all, you’d likely forget at least a few.

Nongeneralized (specific) SAD. This type of SAD troubles you in only a few social situations, perhaps just one. For example, you may become quite anxious when eating with others but be at ease in other social circumstances.

Social anxiety is also classified by its severity.

Mild social anxiety. If your SAD is mild, you may experience symptoms but still be able to take part in social activities - or at least get through them. You’re more likely to have nongeneralized SAD, in which only a limited number of social situations bother you.

Moderate social anxiety. In this type, you feel SAD symptoms in social settings. You’re able to participate in some of them, but you avoid others.

Extreme social anxiety. In this type, the intensity of your symptoms, including panic attacks, leads you to avoid many if not all social situations.

Social anxiety disorder does not affect everyone who has it in the same ways. But here are some common situations that people tend to have trouble with:

  • Talking to strangers
  • Speaking in public
  • Dating
  • Making eye contact
  • Entering rooms
  • Using public restrooms
  • Going to parties
  • Eating in front of other people
  • Going to school or work
  • Starting conversations

Some of these situations might not cause a problem for you. For example, giving a speech may be easy, but going to a party might be a nightmare. Or you could be great at one-on-one conversations but not at stepping into a crowded classroom.

All socially anxious people have different reasons for dreading certain situations. But in general, it’s an overwhelming fear of:

  • Being judged or watched by others in social situations
  • Being embarrassed or humiliated — and showing it by blushing, sweating, or shaking
  • Accidentally offending someone
  • Being the center of attention

Again, the experience is different for everyone, but if you have social anxiety and you’re in a stressful situation, you may feel:

  • Very self-conscious in social situations
  • A persistent, intense, and chronic fear of being judged by others
  • Shy and uncomfortable when being watched (giving a presentation, talking in a group)
  • Hesitant to talk to others
  • The need to avoid eye contact

You also might have physical symptoms such as:

  • Rapid heartbeat
  • Muscle tension
  • Stiff posture
  • Dizziness and lightheadedness
  • Blushing
  • Crying
  • Sweating
  • Trembling
  • Shaky or soft voice
  • Stomach trouble and diarrhea
  • Inability to catch breath
  • An “out-of-body” sensation
  • Feeling as if your mind has gone blank
  • A choking sensation
  • Chest pain

You may start having symptoms and getting anxious immediately before an event, or you might spend weeks worrying about it. Afterward, you could spend a lot of time and mental energy worrying about how you acted.

No one thing causes social anxiety disorder. Genetics likely has something to do with it. If you have a family member with social phobia, you’re more at risk of having it, too. It could also be linked to having an overactive amygdala — the part of the brain that controls your fear response.

Social anxiety disorder usually comes on around 13 years of age. It can be linked to a history of abuse, bullying, or teasing. Shy kids are also more likely to become socially anxious adults, as are children with overbearing or controlling parents. If you develop a health condition that draws attention to your appearance or voice, that could trigger social anxiety, too.

Social anxiety disorder prevents you from living your life. You’ll avoid situations that most people consider “normal.” You might even have a hard time understanding how others can handle them so easily.

When you avoid all or most social situations, it affects your personal relationships. It can also lead to:

  • Low self-esteem
  • Negative thoughts
  • Depression
  • Extreme sensitivity to criticism
  • Poor social skills that don’t improve
  • Feeling unable to speak up for yourself
  • Problems at work and/or school
  • Substance abuse, such as alcohol use disorder
  • Difficulties with relationships
  • Feeling isolated and lonely
  • Feeling disappointment over the things you’ve missed out on, such as hanging out with friends or trying new things
  • Thoughts of suicide and suicide attempts

If your social anxiety keeps you from doing things you want or need to do, or from making or keeping friends, you may need treatment.

But first, you must see your doctor and be properly diagnosed.

Diagnosing SAD requires several steps. Your doctor will conduct a physical exam and review your health history to find out if another health condition or medication can explain your symptoms. They will ask you to describe your symptoms, how often they occur, and in what circumstances. You’ll also go over a list of situations to see if they trigger your symptoms.

Additionally, your doctor will find out if you meet the criteria for a SAD diagnosis as laid out in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These are:

  • You experience ongoing and intense fear or anxiety about being judged or humiliated by others in social situations.
  • You avoid social situations because of that fear or anxiety.
  • Enduring such social situations causes intense fear or anxiety.
  • The anxiety or fear you experience is much greater than the situation warrants.
  • Your fear and anxiety about social situations get in the way of your daily life, including work, relationships, school, and other situations.
  • The fear and anxiety you experience can’t be explained by an underlying medical condition, a medication that you take, or a substance abuse problem.

In most cases, you need to meet the above criteria for at least six months before you receive a diagnosis of social anxiety disorder.

Prescription medication and behavioral therapy are the two effective treatments for social anxiety disorder. You may receive both at the same time.

Medications for social anxiety disorder

A few different types of medications are used to treat SAD. These are:

Antidepressants

If your doctor recommends medication, an antidepressant likely will be what you are prescribed. Though they were developed for depression, some types of antidepressants can treat SAD effectively. The most commonly prescribed antidepressants for SAD are:

  • Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), which include venlafaxine (Effexor) and duloxetine (Cymbalta).

These drugs act on brain chemicals called neurotransmitters to help manage the symptoms of SAD. But they’re not a quick fix. They can take several weeks to start working. Side effects, such as headache, nausea, and sleep problems, are usually not too troublesome, but tell your doctor about any side effects that you experience.

Benzodiazepines

These antianxiety medications act quickly to reduce your symptoms. However, you have to be careful when taking them. Benzodiazepines can be habit-forming, and overdoses can stop your breathing. Mixing them with alcohol or opioid drugs can be deadly. You do remain alert while they are active, but your reflexes slow down, making things like driving a car very dangerous. Your doctor likely won’t prescribe these for more than a short time. Some doctors prescribe them for a few weeks while waiting for your antidepressant to take effect. Lorazepam (Ativan) and alprazolam (Xanax) are examples of this drug class.

Beta-blockers

This class of medication is typically prescribed for high blood pressure and certain heart conditions. They slow the heart rate by blocking the effects of the hormone epinephrine (also known as adrenaline). Your doctor may prescribe a beta-blocker if your SAD causes your heart to beat too fast. Beta-blockers may also help if your SAD causes performance anxiety, such as public speaking. These drugs can help calm you, reducing symptoms such as sweating and trembling. Drugs in this class include propranolol (Inderal) and metoprolol (Lopressor).

The FDA has approved three medicines for social anxiety disorder: Paxil, Zoloft, and Effexor. Although these are the only medications approved specifically for the condition, other medications may also be used successfully.

The advantage of medications is that they can be very effective. But there are some downsides.

First, medication only treats symptoms. If you stop taking it, your symptoms can return. Second, some people have side effects from anxiety medications. They may include headache, stomachache, nausea, and sleep difficulties.

Also, the FDA-approved antidepressants for social anxiety disorder, including all medicines that are also used to treat depression, carry a warning from the FDA. The FDA says these medications may cause or worsen suicidal thoughts or behaviors in people aged 24 and younger. Therefore, young people who take these medicines should be monitored closely for changes in thoughts about suicide.

For many people, the advantages of medications outweigh the disadvantages. You and your doctor must weigh the choice.

Call your doctor immediately if you take medication for social anxiety disorder and get any side effects, including feeling down and depressed. And never stop taking any anxiety medication without talking to your doctor first. Suddenly stopping an anxiety medication may cause serious side effects.

Therapy for social anxiety disorder

Talk therapy — also called psychotherapy — with a psychologist, clinical social worker, or other mental health counsellor can be very effective for SAD. The following types of therapy can be helpful:

Cognitive behavioral therapy (CBT)

CBT is the most effective form of talk therapy for SAD. With your therapist, you will examine the types of situations that trigger your anxiety and learn skills that will enable you to respond to them more positively. In time, this will help you overcome your fears and build your confidence. Such therapy may be done one-on-one or in groups. Both are equally effective.

CBT typically requires 12-20 weekly sessions. However, some practitioners use a new and more intense approach that could be completed in as little as a day, a weekend, a week, or a month. This fast-track option may not be effective for everyone. You and your doctor can discuss what’s best for you.

One type of CBT is called exposure therapy. It's frequently used for social anxiety disorder. Exposure therapy works by gradually exposing you to social situations that are uncomfortable and waiting until you feel comfortable. During this process, your brain learns that a social situation you were afraid of is actually not so bad.

Most therapists who practice exposure therapy begin with small exposures to uncomfortable situations, then move on to more difficult ones once you feel comfortable. The advantage of this therapy is that you are treating the underlying problem, not just the symptoms of social anxiety disorder. So if you stop behavioral therapy, the chance of your symptoms returning is less likely.

Mindfulness 

Mindfulness is a form of meditation in which you focus on the present moment — what you’re feeling and sensing right now — without judging yourself or trying to make sense of things. Therapies based on mindfulness, also called mindfulness-based interventions, have been shown to be effective for SAD. One of these, mindfulness-based stress reduction, is an eight-week program that can be done online or in person.

You likely will not have to live with SAD for long once you start an effective treatment. Still, they will take at least several weeks to show results. However, getting treated requires seeing a doctor and receiving a diagnosis. If you have symptoms of SAD, make that your priority. Here’s what else you can do to help yourself:

  • Get good sleep every night.
  • Exercise regularly.
  • Avoid alcohol as well as recreational drugs.
  • See your doctor regularly and follow your treatment plan, taking your medications as prescribed and going to your therapy sessions as scheduled.
  • Seek support from people close to you and let them know what you’re going through.
  • Think about joining a support group of others with SAD.

First, it's important to know that you are not abnormal if you have social anxiety. Many people have it. If you have unusually high anxiety and fear about social situations, talk openly with your doctor about treatment. If left untreated, social anxiety disorder may lead to depression, drug or alcohol problems, school or work problems, and a poor quality of life.

Once you’re in treatment, keep in regular touch with your doctor. Reach out right away if your symptoms get worse or you develop new symptoms that trouble you. Talk to your doctor if your treatment plan does not seem to be helping. Keep in mind — there’s more than one treatment for SAD; if your first treatment does not work, another may help.

Social anxiety disorder can make life extremely difficult. It leads to fear and avoidance of social situations, with impacts on your relationships, job, and other aspects of your day-to-day life. Treatment for SAD can be very effective, though it will take time. The sooner you talk to your doctor and get diagnosed, the sooner you will feel better.

What are three symptoms of social anxiety?

In social situations that trigger your SAD, you may feel very self-conscious and fearful that you’re being judged. Your heart may start to race. You also might feel sick to your stomach. Not everyone with SAD has the same symptoms, though. Some people with SAD feel distressed only in certain social situations, while others may be distressed in most or all social settings.

Is social anxiety curable?

It can be. Some people with SAD see great improvements after being on medication and/or therapy only for a while. However, others may struggle with it and need medications long-term to manage their symptoms effectively. The alternative — remaining untreated — is worse. It can mean having SAD for the rest of your life, as well as a higher risk of developing depression and alcohol use disorder.

How to support a person with social anxiety

There are several ways you can support someone with SAD:

  • Learn about SAD so you better understand what they’re going through.
  • Listen to them, take their feelings seriously, show empathy, and try to imagine yourself going through a similar experience.
  • If they’re not already being treated, encourage them to see a doctor.
  • Stick it out with them. Treatment takes time and requires patience, but progress will happen with consistent care.

What makes social anxiety worse?

SAD can get worse if it remains untreated, and it can lead to depression and problems with alcohol, so don’t wait to see your doctor. The longer you wait, the harder SAD becomes to treat. Alcohol, recreational drugs, nicotine, and caffeine also can make SAD worse.