Social Anxiety Disorder: Signs, Self-Check and Treatment

Social anxiety is much more than shyness. It is an intense, persistent fear of being watched, judged or embarrassed in social situations, and it can make everyday things such as meetings, phone calls or eating in front of others feel overwhelming. It is one of the most common anxiety problems, it usually starts in the teenage years, and it is very treatable.

This guide explains what social anxiety feels like, what causes it, whether it counts as a disability in the UK and how it is treated.

Quick answer

Social anxiety disorder, also called social phobia, is a long-lasting, overwhelming fear of social situations because of worry about being judged, embarrassed or humiliated. It causes dread before events, physical symptoms such as blushing, sweating, shaking and a racing heart, and avoidance. It usually starts in the teenage years and is very treatable: NICE recommends CBT developed specifically for social anxiety as the first treatment.

What is social anxiety disorder?

Most people feel nervous before a presentation or a party. Social anxiety disorder is different: the fear is intense, lasts for months, is out of proportion to the situation and leads you to avoid things or endure them with great distress. It often affects school, work and relationships.

Put simply, social anxiety means being so afraid of how others see you that the fear starts to shape your life. Its older medical name is social phobia. It is caused by a mix of temperament, family and life experiences, and avoidance keeps it going.

What does social anxiety feel like?

Thoughts and feelings

• Dreading social situations for days or weeks beforehand
• Fear of saying something foolish or being criticised
• Feeling that everyone is watching you
• Going over conversations afterwards, focusing on what went wrong
• Low self-confidence

Physical symptoms

• Blushing, sweating, trembling or a shaky voice
• A racing or pounding heart
• Feeling sick or needing the toilet
• Your mind going blank

Behaviour

• Avoiding situations such as meetings, parties, phone calls or eating in public
• Using safety behaviours, such as rehearsing what to say, avoiding eye contact or staying near the exit
• Using alcohol to get through social events

Do I have social anxiety? A free self-check

Ask yourself whether, for six months or more, you have:

• Felt intense fear or dread in social situations, or before them, because you might be judged or embarrassed
• Worried a lot that others will notice you blushing, sweating, shaking or sounding nervous
• Avoided, or only just got through, everyday situations such as meetings, phone calls, parties, shops or eating in front of others
• Spent a long time going over conversations afterwards, focusing on what went wrong
• Found that the fear affects your work, studies, friendships or relationships

If you answered yes to several of these, you may have social anxiety disorder, and it is worth talking to someone. What separates social anxiety from ordinary nerves is that the fear is strong, lasting and gets in the way of life. Free online tests and questionnaires, such as the Social Phobia Inventory used by many NHS Talking Therapies services, can be a useful starting point, but they cannot diagnose you. A GP, psychologist or NHS Talking Therapies therapist can assess you properly.

What causes social anxiety?

• Temperament: some people are naturally more cautious or inhibited from childhood
• Family: social anxiety can run in families, through both genes and learned patterns
• Life experiences: bullying, harsh criticism, humiliation or rejection, particularly when young
• What keeps it going: avoidance and safety behaviours stop you learning that situations are manageable, and focusing on yourself during conversations makes you more self-conscious

Is social anxiety a disability?

It can be. Under the Equality Act 2010, a mental health condition counts as a disability if it has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities. Long-term usually means it has lasted, or is likely to last, at least 12 months. Many people with social anxiety meet this definition, which means employers must consider reasonable adjustments, such as written rather than spoken presentations or advance notice of meetings. Eligibility for benefits such as Personal Independence Payment depends on how the condition affects your daily life, not on the diagnosis itself. Citizens Advice and ACAS can give free guidance.

Social anxiety disorder treatments and therapy

Social anxiety disorder responds well to treatment, and talking therapy comes first. The main options are:

• CBT for social anxiety. NICE recommends individual cognitive behavioural therapy developed specifically for social anxiety disorder, usually up to 14 sessions over about four months. It helps you test feared predictions, drop safety behaviours and shift attention outwards.
• Supported self-help based on CBT, for people who prefer not to have face-to-face therapy.
• Medication. An SSRI such as escitalopram or sertraline may be offered if you prefer medication or therapy has not helped enough.
• Short-term psychodynamic therapy may be offered if you decline CBT and medication.

You can refer yourself to NHS Talking Therapies without seeing your GP.

In CBT for social anxiety, you and your therapist work out what keeps your fear going, then test it step by step in real situations, often starting with small experiments such as asking a shop assistant a question while dropping a safety behaviour. Sessions usually include tasks to practise between appointments. Therapy can be in person or by video, and progress is reviewed regularly so the plan can be adjusted.

Self-help for social anxiety

• Face feared situations gradually, starting with easier ones, rather than avoiding them
• Try dropping one safety behaviour at a time and notice what happens
• Focus on the conversation and the other person rather than on yourself
• Challenge predictions, such as everyone noticing you blush
• Keep caffeine low and avoid using alcohol to cope
• Practise slow breathing before and during events. See how to cope with anxiety

When to seek help

Call 999 or go to A&E if:

• You feel unable to keep yourself safe, or you or someone else is in immediate danger

Get urgent help the same day if:

• You have thoughts of harming yourself. Call NHS 111 and choose the mental health option, or call Samaritans free on 116 123, day or night

See your GP or refer yourself to NHS Talking Therapies if:

• Social anxiety is affecting your work, studies or relationships
• You are avoiding important situations
• You rely on alcohol or drugs to cope socially
• You also feel low or hopeless

Frequently asked questions

Is social anxiety the same as shyness?

No. Shyness is a personality trait that usually eases as you warm up. Social anxiety is more intense and persistent, and leads to distress and avoidance.

Does social anxiety go away?

Without treatment it often lasts for years and is unlikely to disappear on its own, because avoidance keeps it going. With CBT most people improve, and many recover fully or manage it well. Setbacks can happen at stressful times, but the skills you learn in therapy usually help you get back on track.

Can children have social anxiety?

Yes. It often starts in childhood or the teenage years. Speak to your GP if a child is avoiding school or social situations because of fear.

What is the fear of being judged called?

An intense fear of being judged, criticised or embarrassed by other people is called social phobia, or social anxiety disorder. It is different from a specific phobia, such as a fear of spiders, because it is about how others see you.

Does alcohol help social anxiety?

It may give short-term relief, but it makes anxiety worse afterwards, stops you learning to cope and can lead to dependence.

Anxiety support in Chiswick

Support for social anxiety is available at Omnia Lifestyle, 8 to 9 Bedford Corner, The Avenue, Chiswick W4 1LZ, close to Turnham Green station, on bus routes 94, E3 and 272. Limited parking is available on request when booking. Clinical psychology in Chiswick is provided by Prof (Dr) Diwakar Sukul, Chartered Clinical Psychologist, in person or by secure video, which can feel easier when face-to-face appointments are daunting. Some people combine this with yoga, tai chi or acupuncture. We can signpost you to your GP or NHS Talking Therapies if that is the better route.

Read more about stress and anxiety, see generalised anxiety disorder, anxiety symptoms, what a panic attack is and whether Ayurveda helps stress and anxiety, explore clinical psychology, yoga and tai chi, or book an appointment.

Book acupuncture in Chiswick: sessions from £50. Book online or call 020 4515 0000. Read more about acupuncture at Omnia.

This article is general information, not medical or legal advice. If you feel unable to keep yourself safe, call 999 or go to A&E.