What Is Social Anxiety Disorder, and Is It Real?

Lots of people feel a little nervous sometimes — like when speaking in front of a group or going to a party where you don’t know anyone. But when you have social anxiety disorder (SAD), it’s more than just feeling nervous or shy before a big presentation. 

SAD is a real mental health condition that causes major anxiety and fear in social situations, especially if there’s a chance other people might be watching or judging you. It’s a common anxiety disorder that affects more than 1 in 10 U.S. adults at some point in their lives. You might also know it by its older name — social phobia. 

It’s important to know that SAD is not the same as being shy or introverted. Those are personality traits, while SAD is a diagnosable mental health condition, with specific symptoms and treatments. For people with SAD, the physical and mental symptoms are usually serious enough that they start to interfere with daily life. Fortunately, therapy and medications can help. 

What are the symptoms of social anxiety?

People with social anxiety disorder can have many different symptoms. These can include psychological symptoms and changes in behavior, like: 

• Feeling nervous and anxious around other people

• Worrying that other people are criticizing or judging you

• Being afraid that you’ll embarrass yourself when you’re around other people

• Having difficulty speaking clearly or loudly enough

• Feeling like your mind is “going blank”

SAD can cause physical symptoms, too. These include: 

• Upset stomach

• Blushing

• Trembling

• Fast heart beat

• Feeling out of breath

• Sweating 

When you have SAD, these symptoms are troublesome enough that they mess with your daily life — including work, school, or personal relationships. And, in many cases, people with SAD even start to avoid certain situations or places that trigger their anxiety. 

Is performance anxiety the same as social anxiety disorder?

Performance anxiety is a type of social anxiety disorder. But people with performance anxiety only have symptoms when they have to speak or perform in public. This can include anxiety in any situation when you have to “perform,” including:

• Giving a talk or presentation

• Performing on stage as an actor, dancer, or musician

• Having sex

• Taking a test

• Going to an interview

• Playing sports 

What causes social anxiety disorder, and who gets it?

According to the National Institute of Mental Health, about 7% of adults and 9% of teenagers in the U.S. had social anxiety in the past year. There’s also some evidence that social anxiety has gotten worse in the past few years during the COVID-19 pandemic, especially in women, young people, and people who have a lower income. 

Anyone can have social anxiety disorder, including children. But some groups of people may be more likely to have SAD than others. Here’s what research shows: 

• Women are diagnosed more often than men.

• SAD usually first appears when you’re a child or teenager.

• SAD can run in families.

• SAD is more likely in people who have been bullied, teased, or experienced childhood trauma. 

• SAD can be related to challenging life situations, like having a job that requires you to do a lot of public speaking or performing.

How does social anxiety disorder develop?

Experts don’t know for sure what causes social anxiety disorder. Just like other anxiety disorders, it’s probably caused by a combination of your genetics, life experiences, and environment. 

How do you diagnose social anxiety disorder?

A healthcare provider can diagnose social anxiety disorder by talking with you about your symptoms. A provider can help figure out whether you have SAD — or if another mental or physical health problem could be causing your anxiety. 

Keep in mind: SAD is usually only diagnosed in people who have had symptoms for at least 6 months. And to be diagnosed with SAD, your symptoms also can’t be caused by a medical problem or by drug or alcohol use. 

Is there a test for social anxiety?

There’s no test that can diagnose you with social anxiety disorder. It can only be diagnosed through an interview with a trained healthcare professional. 

That said, there are screening questionnaires that can help figure out how well your symptoms “match” the symptoms of SAD. Questionnaires are also a great tool for tracking your symptoms over time, to see if they’re getting better or worse. 

The Liebowitz Social Anxiety Scale (LSAS) is a well-known questionnaire. You can take the LSAS online at the National Social Anxiety Center website. If you take this assessment, consider sharing the results with your healthcare provider. 

Can you prevent social anxiety disorder? 

Probably not. Just like anxiety disorders, there’s not much you can do to prevent social anxiety disorder. But fortunately, there’s a lot you can do to overcome it. Let’s take a closer look at available treatments. 

Social anxiety disorder treatment

For people with social anxiety disorder, medications and therapy are both good options. They seem to work equally well for overcoming social anxiety. And sometimes, people choose to use them together. The right treatment for you depends on your personal preferences, symptoms, and circumstances. 

Therapy

The best “talk therapy” for treating SAD is cognitive behavioral therapy (CBT). CBT can give you tools for managing your anxiety symptoms and help you change how you think about anxiety. Your therapist may also help you practice behaving differently in situations that make you feel anxious. Practicing relaxation techniques can also be an important part of CBT.

Other types of therapy that can be helpful for SAD include interpersonal therapy, supportive psychotherapy, psychodynamic psychotherapy, and mindfulness practices.

Medication

If medication is recommended for you, your provider might suggest starting with a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI). These medications affect the serotonin activity in the brain — a molecule that’s important for balancing mood and anxiety. 

Examples of first-choice medications for SAD include:

• Sertraline (Zoloft)

• Paroxetine (Paxil)

• Venlafaxine (Effexor)

• Citalopram (Celexa)

• Escitalopram (Lexapro)

• Fluvoxamine (Luvox)

Keep in mind that these medications can take several weeks to start working. And you might need to try a few different SSRI or SNRI medications before you find the right one for you. 

The main goal of medication is to stop or lessen your symptoms. Another goal is to prevent future relapses (stopping the symptoms of SAD from returning once you have been successfully treated).

SSRIs and SNRIs seem to be the most effective at accomplishing these goals. They also have fewer side effects than some of the other medications out there. But they don’t work for everyone. If that is true for you, there are other medications you can try instead of, or in addition to your SSRI or SNRI. 

These second-choice medications include:

• Benzodiazepines, like clonazepam (Klonopin) and alprazolam (Xanax)

• Gabapentin

• Pregabalin (Lyrica)

• Propranolol

Why trust our experts?

Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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