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[Home](https://www.nimh.nih.gov/) \| [Help for Mental Illnesses](https://www.nimh.nih.gov/health/find-help) [Información en español](https://www.nimh.nih.gov/health/topics/espanol) - [Mental Health Information](https://www.nimh.nih.gov/health) - [Get Involved](https://www.nimh.nih.gov/get-involved) - [Research](https://www.nimh.nih.gov/research) - [Funding](https://www.nimh.nih.gov/funding) - [News & Events](https://www.nimh.nih.gov/news) - [About Us](https://www.nimh.nih.gov/about) [Health Topics NIMH offers expert-reviewed information on mental disorders and a range of topics.](https://www.nimh.nih.gov/health/topics) [Statistics NIMH statistics pages include statistics on the prevalence, treatment, and costs of mental illness for the population of the United States.](https://www.nimh.nih.gov/health/statistics) [Brochures and Fact Sheets Download, read, and order free NIMH brochures and fact sheets about mental disorders and related topics.](https://www.nimh.nih.gov/health/publications) [Help for Mental Illnesses If you or someone you know has a mental illness, there are ways to get help. 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[What causes social anxiety disorder?](https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness#part_6257) - [How is social anxiety disorder diagnosed?](https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness#part_6258) - [What other illnesses can co-occur with social anxiety disorder?](https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness#part_10296) - [How is social anxiety disorder treated?](https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness#part_10297) - [How can I support myself or a loved one with social anxiety disorder?](https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness#part_12099) - [How can I find help?](https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness#part_6259) - [What are clinical trials and why are they important?](https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness#part_12103) - [For more information](https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness#part_6254) - [Reprints](https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness#part_11021) # Social Anxiety Disorder: What You Need to Know - [En español](https://www.nimh.nih.gov/health/publications/espanol/trastorno-de-ansiedad-social-mas-alla-de-la-simple-timidez) ## What is social anxiety disorder? Social anxiety disorder is a common type of anxiety disorder. A person with social anxiety disorder feels symptoms of anxiety or fear in situations where they may be scrutinized, evaluated, or judged by others, such as speaking in public, meeting new people, dating, being on a job interview, answering a question in class, asking for help, or having to talk to a cashier in a store. Doing everyday things, such as eating or drinking in front of others or using a public restroom, may also cause anxiety or fear due to concerns about being humiliated, judged, or rejected. This fear often feels uncontrollable and can interfere with daily life. People with social anxiety disorder may worry about engaging in social situations for weeks before they happen. Sometimes, they end up avoiding places or events that cause distress or generate feelings of embarrassment. In some cases, anxiety may arise only during performance situations such as giving a speech, competing in a sports game, or playing a musical instrument on stage. Social anxiety disorder usually starts during childhood or adolescence and may resemble extreme shyness or avoidance of public situations or social interactions. It occurs more frequently in women than in men, and this difference is more pronounced in adolescents and young adults. With the right treatment and support, people with social anxiety disorder can manage their anxiety and improve their quality of life. ## What are the signs and symptoms of social anxiety disorder? When having to perform in front of or be around others, people with social anxiety disorder may: - Blush, sweat, or tremble - Have a rapid heart rate - Feel their “mind going blank,” or feel sick to their stomach - Have a rigid body posture or speak with an overly soft voice - Find it difficult to make eye contact, be around people they don’t know, or talk to people in social situations, even when they want to - Feel self-consciousness or fear that people will judge them negatively - Avoid places where there are other people or situations where they may have to interact with others - Analyze their performance and identify self-perceived flaws in interactions - Expect the worst possible consequences from a negative social situation Children and teens with social anxiety disorder may experience similar symptoms to adults, but also may: - Try to avoid going to school - Have difficulty making friends - Complain of stomachaches or headaches - Have emotional outbursts in social situations - Refuse to speak or participate in social situations For all people with social anxiety disorder, symptoms may fluctuate over time and are often worse during times of significant stress or change. Avoiding situations that cause anxiety may feel helpful in the short term, but the anxiety is likely to remain without treatment. ### Is it normal stress or an anxiety disorder? Life can be stressful—a person may feel stressed about a demanding job, a performance at school, or a life change. Everyone feels stress from time to time. Stress is the physical or mental response to an external cause, such as having a lot of homework or having an illness. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time. Anxiety is the body's reaction to stress and can occur even if there is no current threat. While occasional stress and anxiety are normal, they shouldn’t control your life. If anxiety doesn’t go away and begins to interfere with your daily activities, you may have an anxiety disorder. Learn more about [stress](https://www.nimh.nih.gov/health/publications/stress-listing). ## What causes social anxiety disorder? Social anxiety disorder may run in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety, and genetics influences how these brain areas function. In addition, researchers are looking at the role that stress and environmental factors play in the disorder. ## How is social anxiety disorder diagnosed? To be diagnosed with social anxiety disorder, a person must have strong fear or anxiety about social situations where they might be judged or scrutinized by others. They may try to avoid these situations or face them with extreme discomfort. These feelings must last at least 6 months and interfere with daily life, such as work, school, or relationships. If you think you’re experiencing symptoms of social anxiety disorder, talk to a health care provider, such as a primary care doctor, psychiatrist, psychologist, or clinical social worker. During the visit, the provider may ask when your symptoms began, how long they have lasted, how often they occur, and their impact on your life. After discussing your history, the provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms. ## What other illnesses can co-occur with social anxiety disorder? Some people with social anxiety disorder have other mental and physical health disorders or conditions, including depression, other anxiety disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder (ADHD), body dysmorphic disorder, or bipolar disorder. Social anxiety disorder is also commonly associated with alcohol and substance misuse. People with social anxiety disorder are less likely to seek help from a health care provider for diagnosis or treatment. Providers often identify the disorder when treating a person for a co-existing condition. The presence of multiple disorders can make treatment more complex, and people with social anxiety disorder and co-occurring mental disorders may benefit from a comprehensive treatment plan that addresses all aspects of their mental health. ## How is social anxiety disorder treated? Treatment for social anxiety disorder typically involves psychotherapy, medication, or both. Choosing the right treatment plan is based on a person’s needs, preferences, and medical situation, as well as consultation with a mental health professional or a health care provider. Finding the best treatment may take trial and error, and psychotherapy and medication can take some time to work. ### Psychotherapy Psychotherapy (also called talk therapy or counseling) can be effective when delivered in person or virtually via telehealth. A provider may support or supplement therapy using digital or mobile technology, like apps or other tools. Different therapies work for different types of people. Cognitive behavioral therapy (CBT), a research-supported type of psychotherapy, is commonly used to treat social anxiety disorder. CBT teaches a person different ways of thinking, behaving, and reacting to situations to help them feel less anxious and fearful. CBT also can help a person learn and practice social skills, which is very important for treating social anxiety disorder. CBT has been well studied and is the “gold standard” choice for psychotherapy. Exposure therapy is a CBT method that focuses on progressively confronting the fears underlying an anxiety disorder to help a person engage in activities they have been avoiding. Exposure therapy may be used along with relaxation exercises. CBT delivered in a group therapy format also can offer unique benefits for social anxiety disorder. Another treatment option for social anxiety disorder is acceptance and commitment therapy (ACT). ACT takes a different approach than CBT, encouraging nonjudgmental acceptance of thoughts and behaviors and promoting engagement in meaningful activities. ACT uses strategies such as mindfulness and goal setting to reduce a person’s discomfort and anxiety. There is a growing body of research demonstrating its effectiveness for treating social anxiety disorder. Learn more about [psychotherapy](https://www.nimh.nih.gov/health/topics/psychotherapies). ### Medication Health care providers may prescribe medication to treat social anxiety disorder. Different types of medication can be effective in treating this disorder, including: - Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) - Beta-blockers - Anti-anxiety medications, such as benzodiazepines SSRI and SNRI antidepressants are commonly used to treat depression, but they also can help treat the symptoms of social anxiety disorder. They may take several weeks to start working. Antidepressants may also cause side effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe, especially if the dose starts low and is increased slowly over time. Beta-blockers can help control some of the physical symptoms of social anxiety disorder, such as rapid heart rate, sweating, and tremors. Beta-blockers are commonly the medication of choice for the “performance anxiety” type of social anxiety disorder. Benzodiazepines, which are anti-anxiety sedative medications, are powerful and begin working right away to reduce anxious feelings. These medications can be very effective in rapidly decreasing anxiety, but some people build up a tolerance to them and need increasing doses to get the same effect. Some people even become dependent on them. Therefore, a health care provider may prescribe them only for brief periods of time. Learn more about [mental health medications](https://www.nimh.nih.gov/health/topics/mental-health-medications). Read the most up-to-date information on medications, side effects, and warnings on the [U.S. Food and Drug Administration (FDA) website](https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm) . ### Support groups Some people with social anxiety find support groups helpful. In a group of people who all have social anxiety disorder, a person can receive unbiased, honest feedback about how others perceive them. This allows them to learn that their thoughts about judgment and rejection may not be true or are distorted. A person can also learn how others with social anxiety disorder approach and overcome the fear of social situations. Support groups are available both in person and online. However, any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a health care provider. ### Healthy habits Practicing a healthy lifestyle also can help combat anxiety, although this alone cannot replace treatment. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends you trust for support. Learn more ways to [take care of your mental health](https://www.nimh.nih.gov/health/topics/caring-for-your-mental-health). ## How can I support myself or a loved one with social anxiety disorder? ### Educate yourself A good way to help yourself or a loved one who may be struggling with social anxiety disorder is to seek information. Research the signs and symptoms, learn about treatment options, and keep up to date with current research. ### Communicate If you are experiencing social anxiety disorder symptoms, have an honest conversation about how you’re feeling with someone you trust. If you think a friend or family member may be struggling with social anxiety disorder, set aside a time to talk with them to express your concern and reassure them of your support. ### Know when to seek help If your anxiety, or the anxiety of a loved one, starts to cause problems in everyday life—such as avoiding social situations at school, at work, or with friends and family—it’s time to seek professional help. ### Practice compassion Be kind and patient with yourself and others. Acknowledge progress, no matter how small, and recognize that managing social anxiety disorder may involve setbacks along the way. ## How can I find help? If you have concerns about your mental health, talk to a primary care provider. They can refer you to a qualified mental health professional, such as a psychologist, psychiatrist, or clinical social worker, who can help you figure out the next steps. Find [tips for talking with a health care provider](https://www.nimh.nih.gov/health/publications/tips-for-talking-with-your-health-care-provider) about your mental health. You can [learn more about getting help](https://www.nimh.nih.gov/health/find-help) on the NIMH website. You can also learn about [finding support](https://www.samhsa.gov/find-support) and [locating mental health services](https://findtreatment.gov/) in your area on the Substance Abuse and Mental Health Services Administration (SAMHSA) website. If you or someone you know is struggling or having thoughts of suicide, call or text the [988 Suicide & Crisis Lifeline](https://988lifeline.org/) at **988** or chat at [988lifeline.org](https://988lifeline.org/) . In life-threatening situations, call **911**. ## What are clinical trials and why are they important? Clinical trials are research studies that look at ways to prevent, detect, or treat diseases and conditions. These studies help show whether a treatment is safe and effective in people. Some people join clinical trials to help doctors and researchers learn more about a disease and improve health care. Other people, such as those with health conditions, join to try treatments that aren’t widely available. NIMH supports clinical trials across the United States. Talk to a health care provider about clinical trials and whether one is right for you. Learn more about [participating in clinical trials](https://www.nimh.nih.gov/health/trials). ## For more information Learn more about [mental health disorders and topics](https://www.nimh.nih.gov/health). For information about various health topics, visit the [National Library of Medicine’s MedlinePlus](https://medlineplus.gov/) resource. ## Reprints The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. 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