Social Anxiety Disorder

Social anxiety disorder (social phobia) isn’t just shyness. People might assume Link from The Legend of Zelda is shy because he doesn’t talk, but actually he could have social anxiety, a common misconception. When you have social anxiety you can become very anxious about what other people might think of you or how they could judge you.

This can cause great difficulty in social situations which can have a big impact on your day-to-day life. Social anxiety is one of the most common mental health problems across the globe, so you are not alone!



Different people can experience different forms of social anxiety, some of the most common are:

  • A significant fear or dread of social situations. You might fear that you will act in an embarrassing or humiliating way and that other people will think you are stupid, inadequate or foolish. In some cases the fear is only for certain situations where you will be looked at by others, even you know them. For example, you become very anxious if you have to ‘perform’ in some way, such as giving a talk or presentation, taking part in a discussion at work or school, etc. However, you are OK in informal social gatherings.
  • In other cases the fear occurs for most social situations where you may meet strangers. This can even include eating in public places, as you fear you may act in an embarrassing way.
  • You might have weeks of anxiety prior to a social event or an event where you have to ‘perform’.
  • You avoid these situations as much as possible.
  • If you go to the feared situation you become very anxious and distressed.

Some physical symptoms may include:

  • A fast heart rate.
  • The sensation of having a ‘thumping heart’ (palpitations).
  • Shaking (tremor).
  • Sweating.
  • Feeling sick (nausea).
  • Chest pain.
  • Headaches.
  • Stomach pains.
  • A ‘knot in the stomach’.
  • Fast breathing.
  • Blushing easily.
  • You may have an intense desire to get away from the situation.
  • You might even have a panic attack.

Social anxiety disorder can greatly affect your life. You might struggle at school or work as you tend to avoid any group work, discussions, etc. You might find it hard to obtain, or keep, a job. This may be because you feel unable to cope with the social aspects needed for many jobs, such as meeting with people. You might feel socially isolated and find it difficult to make friends.


Who has social anxiety disorder?

It is one of the most common mental health conditions worldwide. Roughly as 1 in 10 adults have social anxiety disorder to some degree. It usually develops as a teenager and is usually a lifelong problem unless treated. Just over twice as many women as men are affected.


What causes social anxiety disorder?

The cause is probably a combination of bad experiences as a child and your genetic ‘makeup’ which makes you more prone to this condition. In one study about half of affected people said their phobia began after one memorable embarrassing experience. The other half said it had been present for ‘as long as they could remember’, so it varies from person to person.


What are the treatment options for social anxiety disorder?

Cognitive and behavioural therapies

  • Cognitive behavioural therapy (CBT) is a type of therapy that deals with your current thought processes and/or behaviours and aims to change them by creating strategies to overcome negative thought patterns, which may help you to manage your social anxiety.


  • You can obtain leaflets, books, CDs, DVDs or MP3s, etc, on how to relax and how to combat anxiety. They teach simple deep-breathing techniques and other measures to relieve stress and anxiety.

Medicines for social anxiety

  • Antidepressants- Although mainly prescribed for the treatment of depression, they can also lessen the symptoms of anxiety. They interfere with brain chemicals such as serotonin, which are thought to cause anxiety symptoms. There are lots of different antidepressants, but selective serotonin reuptake inhibitors (SSRIs) seem best for anxiety disorders.
  • Benzodiazepines such as diazepam used to be the most commonly prescribed medicines for anxiety. They were known as the minor tranquilisers but they do have some serious known side-effects. They often work well to ease symptoms. The problem is they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Now they are not used much for persistent anxiety conditions.

In some cases a combination of treatments such as cognitive therapy and an antidepressant may work better than either treatment alone.


Social anxiety and alcohol

Although alcohol may ease symptoms in the short term, don’t be fooled that drinking helps to cure social anxiety. In the long run, it does not. Drinking alcohol to ‘calm nerves’ can lead to problem drinking and may make problems with social anxiety (and the depression that often accompanies it) worse in the long term. See a doctor if you are drinking alcohol (or taking street drugs) to ease social anxiety.


What is the outlook for social anxiety disorder?

With treatment social anxiety can be greatly improved!