Social Anxiety Disorder: Your GoodRx Guide

What is social anxiety disorder?

Social anxiety disorder is a common mental health condition. It is much more than being shy or introverted. The condition leads to a persistent fear of being judged by other people. It can limit your activities and affect your daily life, relationships, work, school, and more. 

For some people, anxiety symptoms may only occur when performing. For example, your anxiety spikes when you give a speech or take a test. This is a specific type of social anxiety called performance anxiety. 

Social anxiety disorder is associated with other mental health conditions. Examples include depression, generalized anxiety, and substance use. 

You or someone you know likely has social anxiety. It will affect 12% of people in their lifetime. Symptoms often start in childhood or adolescence. Social anxiety disorder affects more women than men. 

Many people do not seek treatment for social anxiety disorder for many years. But it is a real mental health condition that can be treated. 

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What causes social anxiety disorder?

The cause of social anxiety disorder is not completely understood. It’s likely caused by a combination of genetics and environment. Some known risk factors for developing social anxiety include:

• Having a family history of social anxiety

• Experiencing bullying or teasing as a child

• Surviving childhood trauma

• Having new responsibilities that require more speaking

For some, social anxiety may be learned or inherited from a parent. In some cases, it can start after experiencing an embarrassing event. 

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Symptoms of social anxiety disorder

Signs of social anxiety disorder will happen in social situations. You might experience the following symptoms:

• Having a fast heart rate

• Blushing or sweating

• Experiencing nausea

• Trembling

• Avoiding eye contact

• Speaking with a soft voice

• Finding it difficult to speak

• Feeling self-conscious or embarrassed

• Being afraid you’ll do something embarrassing and others will judge you

• Avoiding certain situations or places due to social anxiety

For some people, social anxiety symptoms may only happen when you have to perform. Examples include giving a speech or taking an exam. You may not have social anxiety in general social situations.

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How is social anxiety disorder diagnosed?

You may be diagnosed with social anxiety disorder if your fear of social situations significantly impacts your life. Your provider will make a diagnosis if you have the following: 

• Excessive fear or anxiety about one or more social situations

• Fear about acting in an embarrassing or humiliating way

• Consistent anxiety about social situations 

• Avoidance of social situations due to significant fear

• Anxiety that is out of proportion to the actual risk you face

• Persistent fear and anxiety that lasts at least 6 months

• The distress impacts your relationships, work, or other parts of life

• You symptoms aren’t caused by substance use, a medical condition, or another mental health condition

In children, social anxiety may show up as crying or clinging to loved ones. Children will also experience social anxiety with their peers, not just with adults.

Treating social anxiety disorder

There are many treatment options for social anxiety disorder including therapy and medications. The right treatment for you will depend on many factors such as:

• Your symptoms

• Your other health conditions

• Your preferences 

Psychotherapy is one helpful treatment for social anxiety disorder. There are many different types of therapy. Usually, the first-choice option is cognitive behavioral therapy (CBT). 

CBT can help you identify and change negative patterns of thinking. You may also do exposure therapy to help you practice managing your fear about social situations. Over time, this can help you become more confident in social settings. Your provider may also recommend social skills training.

Some people do well with a short period of treatment. Others may need therapy for longer periods of time. Often, a combination of medication and therapy are most helpful for social anxiety disorder. 

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Medication for social anxiety disorder

There are many different types of medications that may be used for social anxiety. They include: 

• Selective serotonin reuptake inhibitors (SSRIs) are usually the first-choice medications for social anxiety disorder.

• Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant that may help.

• Beta-blockers like propranolol may be used to help manage physical symptoms of anxiety such as increased heart rate, tremors, or sweating. You would take these as-needed before an event that causes you to feel anxious. Beta-blockers are often used for performance anxiety. 

• Some other medications that may be considered to treat social anxiety include hydroxyzine (Atarax) and buspirone (Buspar).

• Benzodiazepines may be helpful to take as needed for anxiety. These medications have serious risks and side effects including dependence, overdose, and death. That is why providers tend to prescribe benzodiazepines as a last resort.

It’s important to discuss medication options with your healthcare provider. The right medication for you will depend on many factors. It can also take time to find the right one. 

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Living with social anxiety disorder

There are also several steps you can take at home to help you manage social anxiety. You may want to try:

• Support groups to help you connect with others going through a similar experience

• Practicing public speaking and performing through classes or a Toastmasters club

• Mindfulness exercises, such as meditation or yoga

• Aerobic exercise, such as running or biking

• Healthy sleep habits, since social anxiety is associated with insomnia

You may also be interested in potential natural remedies:

• Supplements have limited evidence, but some such as kava, passionflower, or magnesium may provide some benefit.

• Cannabidiol (CBD) has shown some benefits for social anxiety disorder.

Before adding supplements, check with your provider. Some supplements and natural remedies can interact with your medications.

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