The Ultimate Guide to Understanding Social Anxiety

The ultimate resource for understanding Social Anxiety. Continually updated by psychiatrist Dr. Jose Hamilton. Practical tips to overcome social anxiety.
Medically Reviewed by
Dr Hamilton

Understanding social anxiety is the most important step toward not feeling lost or unaware about why and when it happens. So, where do you start?

Social anxiety is a condition in which a person has an excessive fear of being closely watched, judged, and criticized in social situations.

In this continuously-updated post, you'll build a deeper understanding of the conditions and its symptoms through the answers to these common questions:

  • What is the name for the fear of being judged?
  • Is social anxiety a mental disorder?
  • What are the symptoms of social anxiety disorder?
  • What situations that commonly provoke anxiety?
  • How common is social anxiety disorder?
  • What causes social anxiety disorder?
  • How is social anxiety disorder diagnosed?
  • What should I do if I have social anxiety?
  • How is social anxiety disorder treated?
  • What is the outlook for people with social anxiety disorder?
  • Can the social anxiety disorder be prevented?

What is the name for the fear of being judged?

Sociophobia is the name for the fear of being judged. This fear is part of the social anxiety.

Is social anxiety a mental disorder?

Disorder, like syndrome, refers to a cluster of symptoms, thoughts, emotions and behaviors.

Psychiatrists and researchers use word "disorder" with the purpose of classification and study complex conditions.

While such simplification may be useful, a label leads to a loss of information and overlooks the uniqueness of the person being studied or treated. Things need a name.

Social anxiety is a mental disorder. In other words, social anxiety is a complex cluster of thoughts, emotions, and behaviors that can cause suffering.

What Are the Symptoms of Social Anxiety Disorder?

The two key symptoms of social anxiety are the intense anxiety in social situations and the avoidance of social situations.

Most of the people with social anxiety disorder feel that there is "something is not right," but don't realize what is actually happening.

Someone with social anxiety disorder is afraid that he or she will make mistakes, look bad, and be embarrassed or humiliated in front of others. Most of the time, the person is aware that the fear is unreasonable, yet is unable to overcome it.

Individuals with social anxiety may have twisted thinking, including false beliefs about social situations and the negative opinions of others.

Also, people with social anxiety often suffer from the fear of a situation before it even happens for days or weeks before the event. This pattern of thinking is known as anticipatory anxiety.

Social anxiety can manifest physical symptoms, including confusion, pounding heart, sweating, shaking, blushing, muscle tension, upset stomach, and diarrhea.

Children with this social anxiety may express their anxiety by crying, adhering to a parent, or having a fit of rage.

When extreme, anxiety can build into a panic attack.

A panic attack is the sudden onset of intense discomfort that reaches a peak within minutes and includes one or more of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, shaky, light-headed, or faint
  • Chills or heat sensations
  • Paresthesia (numbness or tingling sensations)
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control or “going crazy.”
  • Fear of dying

As a result of the social anxiety symptoms, the person experiences several social situations in extreme distress or may avoid them altogether.

What situations that commonly provoke anxiety?

Individuals with social anxiety disorder may be afraid of a specific situation, such as public speaking. However, most people with social anxiety disorder fear more than one social situation.

Below are the situations that commonly provoke anxiety1.

Do you want to share your opinion and discover what are the situations which provoke more anxiety?

What situations provoke your anxiety?

  • Using public bathrooms?
  • Eating or drinking while being watched?
  • Performing a job while being watched?
  • Writing while being observed?
  • Entering a room during an event?
  • Requesting information from a stranger?
  • Expressing your opinion?
  • Speaking up in meetings or a classroom?
  • Talking to people of authority?
  • Going to parties?
  • Making new friends?
  • Attending job interviews or examinations?
  • Giving presentations?
  • Starting to flirt?
  • Going on a romantic date?

How Common Is Social Anxiety Disorder?

Research show that 48% of the American population has some degree of shyness2, and a survey from Harvard Medical School estimates that the lifetime prevalence of extreme shyness, characterized as social anxiety disorder, is 12.1%3.

When we turn these statistics into numbers, we see that shyness affects 140 million Americans, and 15 million people suffer from social anxiety.

The condition most often presents itself in adolescence or early adulthood but can occur at any time, including early childhood[note]Candice A. Alfano, Ph.D., and Deborah C. Beidel, Ph.D., ABPP 2011. Social Anxiety in Adolescents and Young Adults:. Translating Developmental Science Into Practice. American Psychological Association.[/note]. It is more common in women than in men.

What Causes Social Anxiety Disorder?

The cause of social anxiety disorder is a complex blend of biological, psychological, and environmental factors.

Social anxiety biological factors

Social anxiety disorder is currently thought to be associated with unusual functioning of brain circuits that regulate fear and the "fight or flight" response in the brain.

Hereditary factors may also contribute, because social anxiety may be somewhat more likely to occur when it is also present in parents, siblings or children.

Social anxiety psychological factors

Traumatic social experiences in the past, such as being bullied, neglected or humiliated by peers, may contribute to the development of social anxiety.

Social anxiety environmental factors

Children may develop their fear from observing the behavior of others or seeing what happened to someone else as the result of their behavior (such as being laughed).

Moreover, children who are sheltered or overprotected by their parents may not learn good social skills as part of their healthy development.

Social anxiety can get worse for those lacking social skills or experience in social situations.

How Is Social Anxiety Disorder Diagnosed?

Social anxiety disorder was known as social phobia in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It has been renamed social anxiety disorder in the fifth edition (DSM-5)4. This change reflects a new and broader understanding on how to diagnose the social anxiety disorder.

When you see a doctor, he will begin an evaluation by asking questions about your medical history and performing a physical exam. Although there are no lab tests to specifically diagnose social anxiety disorder, the doctor may use lab tests to make sure that a physical disease isn't the root of the social anxiety symptoms.

Other mental conditions, such as panic disorder, obsessive-compulsive disorder, and depression may overlap the social anxiety disorder. Many people with social anxiety disorder initially see the doctor with complaints related to these disorders. For example, depression may worsen social anxiety symptoms or the loneliness resulting from social anxiety may worsen depression.

Psychiatry is the medical specialty that diagnoses and treats mental health conditions. Psychiatrists use specially designed interview and assessment tools to evaluate a person for an anxiety disorder. The doctor bases his or her diagnosis of social anxiety disorder on reports of the intensity and duration of symptoms, including any problems with functioning caused by the symptoms.

The doctor then determines if the symptoms and degree of dysfunction indicate social anxiety disorder.

How Is Social Anxiety Disorder Treated?

The aim of social anxiety disorder treatment is to detangle thoughts, emotions, and behaviors to enable the sufferer to live free of what once got in their way.

The three primary goals of social anxiety treatment are:

To help the person identify misinterpretations about social interactions and develop healthier thoughts.

To minimize physical symptoms and assist the person to control their anxiety.

To help the person stop avoiding situations that once caused anxiety.

You can find a more in-depth look at social anxiety treatment options here.

What should I do if I have social anxiety?

Without treatment, Social Anxiety Disorder can interfere with a person’s regular daily routine, including school, work, social activities, and relationships.

The first step you should take if you have social anxiety is to understand the condition.

The first step you should take if you experience social anxiety is to use reliable sources to understand your condition.

The second step is to include those close to you, like family or friends, in the process by sharing what you’ve learned and asking for their support.

What is the outlook for people with Social Anxiety Disorder?

The prospects for sufferers of Social Anxiety Disorder are good. When treatment is pursued, many people improve and enjoy happier lives.

Can Social Anxiety Disorder be prevented?

Sadly, you can't prevent Social Anxiety Disorder. However, seeking help as soon as symptoms surface is necessary to successfully overcome it.


1. Ruscio AM, et al. Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. 2008. Psychol Med.

2. Carducci, BJ, & Zimbardo, PG 1995. Are you shy? Psychology Today, 28, 34 -40 ff.

3. Kessler RC, Chiu WT Demler O, Walters EE 2005. Prevalence, severity, and comorbidity of DSM-IV 12-month disorders in The National Comorbidity Survey Replication. Arch Gen Psychiatry.

4. Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. 2014.American Psychiatric Association.

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