S ocial Anxiety Disorder (also called Social Phobia) is when certain social or performance situations (e.g., meeting new people or giving a speech) are avoided due to substantial fear of being judged or embarrassed in front of other people. When exposed to a social situation, someone with Social Anxiety Disorder is so afraid of being negatively evaluated or judged that it significantly interferes with their ability to live a normal life. This can cause them to avoid everyday social situations, like going shopping, speaking up in class, using a public bathroom, or participating in gym class.
It is perfectly acceptable to be anxious occasionally during social situations. This type of anxiety often helps us prepare for that situation. For example: practising a speech before giving it in class; making sure you have enough money before going out on a date; etc. However, usual, expected, and normal social situations almost always provoke fear or anxiety in individuals with Social Anxiety Disorder. This fear or anxiety is way out of proportion to the situation. Someone with Social Anxiety Disorder often knows that their fears are unreasonable and that other people don’t feel the same way. This can make them feel really alone and think that no one else can understand how they feel, which can lead to feelings of loneliness or sadness.
Up to about 4% of 15-24 year-old Canadians report having Social Anxiety Disorder. Social Anxiety Disorder is slightly more common in women than in men. For 75% of people with Social Anxiety Disorder, it began when they were between 8 and 15 years old. Social Anxiety Disorder is thought to be caused by a combination of genetics, the environment, and learning (i.e., modelling parental behaviour).
Social Anxiety Disorder, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or other trained health provider who has spent time with the person and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances. Please do not attempt to diagnose someone based on the symptoms you read in magazines or on the internet. If you are concerned, speak to a trained health professional.
Someone with Social Anxiety Disorder experiences significant, excessive, and persistent anxiety when in a social situation where they might be judged. The person will go to great effort to avoid the anxiety-provoking social situation and if it cannot be avoided, they will experience intense fear or anxiety. This fear significantly interferes with the person’s ability to live their life and is way out of proportion to the actual concern/event.
Someone with Social Anxiety Disorder is mostly worried that they will do something that will result in embarrassment and/or rejection. This can be something that the person actually does, or even just that they might show symptoms of anxiety (e.g., blushing, trembling, sweating, stumbling over one’s words, or staring). These feelings can be less intense if experienced around a trusted individual.
For a diagnosis of Social Anxiety Disorder, this fear must last for at least 6 months and not be caused by a substance (e.g., drug, alcohol, medication) or another medical condition.
*In accordance with the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
Remember, you cannot diagnose someone with Social Anxiety Disorder without a proper mental health assessment conducted by a properly trained health provider.
- Encourage the person to seek help (or take them to a trained health professional yourself, if appropriate).
- Ask the person a few questions to get a better sense of what is going on:
- Are there certain social situations that make you feel really anxious? How do you deal with those situations?
- What are you worried will happen in those social situations?
- How long has this been going on?
It’s important not to confuse typical social anxiety or shyness with Social Anxiety Disorder. It is normal to feel anxious in a new situation – such as meeting a person for the first time or going to a new school. Everyone has anxious feelings in certain social situations. Most people, however, are able to overcome those nervous feelings and with practice, end up being able to confront those situations without anxiety. People with Social Anxiety Disorder are unable to overcome their feelings of anxiety, which are considerably more intense than those of people without Social Anxiety Disorder.
Individuals with Social Anxiety Disorder will have anxiety that:
- Is much more intense than usually felt
- Is hard to control using usual methods such as exercise, relaxation, help from friends, etc.
- Interferes with many parts of usual life, which can significantly reduce their quality of life
If someone in your life has been diagnosed with Social Anxiety Disorder, here’s what you can do:
- Be well-informed. Learn about Social Anxiety Disorder and the treatment options available. Read books, trusted websites (like this one!), and discuss any concerns or questions with a health care provider. Check out Evidence Based Medicine for information on how to critically evaluate the information you read and Communicating With Your Health Care Provider for a list of questions to ask your health care provider.
- Encourage the person to seek help from their family doctor. Social Anxiety Disorder is very treatable.
- Listen. Listen to their thoughts, worries and problems. Be supportive but ultimately be helpful by not enabling or supporting negative thoughts.
- Give positive feedback. Notice when they are doing a good job. Praising the person in situations that you know make them nervous will help boost confidence and reduce avoidance behaviours.
- Don’t judge. Judging the person could make them withdraw from sharing their emotions. Not having someone to turn to could make them feel alone and make their symptoms worse.
- It is important to accept the perceptions and emotions of the person as genuine and valid. Even if their fears don’t make sense to you, the anxiety is very real.
- Help the person learn time management skills. Planning out your time and understanding what you have to do and how long you have to do it can help keep you from feeling overwhelmed.
- Remember that reassurance is not usually helpful and may worsen social anxiety. Although it’s natural to want to protect the person you care about from situations that frighten them, for people with Social Anxiety Disorder, this protection can backfire. Shielding the person from anxiety-provoking situations can actually make the anxiety much worse.
A variety of treatment options exist for Social Anxiety Disorder. The most common treatment for Social Anxiety Disorder is CBT. In certain cases, medication is also used. Determining which course of action is appropriate for each individual should be done with the guidance of a trained health professional. Options include:
- Psychological Treatments: Psychotherapy or “talk therapy” works by helping your brain better control your thoughts and emotions. The type of psychotherapy that has been found to be most effective for treating Social Anxiety Disorder is called Cognitive Behavior Therapy (CBT). CBT helps people learn how to overcome their fears. It includes several components, including Cognitive Restructuring (e.g., changing the way someone thinks about their fears) and Exposure (e.g., gradually exposing the person to their fears while keeping them safe and teaching them effective strategies for coping with fear). Sometimes this therapy is provided in groups.
- Medication: Medication helps the brain correct the functioning of its emotional control circuits. A variety of medications can be prescribed to relieve symptoms of Social Anxiety Disorder. These medications are used in addition to CBT, or added if the therapy has not had the expected outcome. For more information on how to properly use medications, check out MedEd.
- School Supports: Sometimes certain adaptations can be made by the school to assist a student in coping with and managing their symptoms.
- Community Supports: Community supports can include peer support groups, support groups for families, and other helpful resources.
- Arousal Decreasing Techniques: Numerous techniques for decreasing physical arousal (that means: anxious feelings, rapid heart rate, rapid breathing) can help. These include: biofeedback, mindfulness, deep muscle relaxation, meditation, etc.
- Regular Routine: Maintaining a healthy, regular daily routine is very important for a person with Social Anxiety Disorder. For help maintaining the kind of healthy lifestyle that should accompany professional treatment for Social Anxiety Disorder, check out Taking Charge of Your Health.
It’s not uncommon for people to have more than one mental illness. Other common co-occurring disorders (also called comorbid disorders) include:
- Other Anxiety Disorders (e.g., Generalized Anxiety Disorder)
- Substance Use Disorders