Social anxiety, also called social phobia, is a disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with social anxiety have a persistent, intense, and chronic fear of being watched and judged by others and of being embarrassed or humiliated by their own actions. Their fear may be so severe that it interferes with work or school and other ordinary activities. While many people with social phobia recognize that their fear my be excessive or unreasonable, they are unable to overcome it. They often worry for days or weeks in advance of a dreaded situation.

Physical symptoms often accompany the intense anxiety of social anxiety and include blushing, profuse sweating, trembling, and other symptoms of anxiety, including difficulty talking and nausea or other stomach discomfort. Social anxiety often runs in families and may be accompanied by depression or alcohol dependence.

How Common Is Social Anxiety?
• About 3.7% of the U.S. population ages 18 to 54 (approximately 5.3 million Americans) has social anxiety in a given year.
• Social anxiety occurs in women twice as often as in men, although a higher proportion of men seek help for the disorder.
• Social anxiety often starts in childhood and worsens or exacerbates in adolescence.

What Treatments Are Available for Social Anxiety?
Research supported by NIMH and by industry has shown that there are two effective forms of treatment available for social anxiety: certain medications and a specific form of short-term psychotherapy called cognitive-behavioral therapy. Medications include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as well as drugs known as high potency benzodiazepenes. Some people with a form of social anxiety called performance phobia have been helped by beta-blockers, which are more commonly used to control high blood pressure.

Cognitive-behavior therapy is also very useful in treating social anxiety. The central component of this treatment is exposure therapy, which involves helping patients gradually become more comfortable with situations that frighten them. The exposure process often involves three stages. The first involves introducing people to the feared situation. The second level is to increase the risk of disapproval in that situation so people build confidence that they can handle rejection or criticism. The third stage involves teaching people techniques to cope with disapproval. In this stage, people imagine their worst fear and are encouraged to develop constructive responses to their fear and perceived disapproval.

Cognitive-behavior therapy for social anxiety also includes anxiety management training. For example, teaching people techniques such as deep breathing to control their levels of anxiety. Another important aspect of treatment is called cognitive restructuring, which involves helping individuals identify their misjudgments and develop more realistic expectations of the likelihood of danger in social situations.

Supportive therapy such as group therapy, or couples or family therapy to educate significant others about the disorder, is also helpful. Sometimes people with social anxiety also benefit from social skills training.

What Other Illnesses Co-Occur with Social Anxiety?
Social anxiety can cause lowered self-esteem and depression. To try to reduce their anxiety and alleviate depression, people with social phobia may use alcohol or other drugs, which can lead to addiction. Some people with social anxiety may also have other anxiety disorders, such as panic disorder and obsessive-compulsive disorder.