Social anxiety disorder, fear and avoidance

It’s normal to feel nervous in some social situations. For example, going on a date or giving a presentation may cause that feeling of butterflies in your stomach. But in social anxiety disorder, also called social phobia, everyday interactions cause significant anxiety, self-consciousness and embarrassment because you fear being scrutinized or judged negatively by others.

In social anxiety disorder, fear and anxiety lead to avoidance that can disrupt your life. Severe stress can affect your relationships, daily routines, work, school or other activities.

Social anxiety disorder can be a chronic mental health condition, but learning coping skills in psychotherapy and taking medications can help you gain confidence and improve your ability to interact with others.

Symptoms

Feelings of shyness or discomfort in certain situations aren’t necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on personality traits and life experiences. Some people are naturally reserved and others are more outgoing.

In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interfere with relationships, daily routines, work, school or other activities. Social anxiety disorder typically begins in the early to midteens, though it can sometimes start in younger children or in adults.

Emotional and behavioral symptoms

Signs and symptoms of social anxiety disorder can include constant:

■ Fear of situations in which you may be judged negatively

■ Worry about embarrassing or humiliating yourself

■ Intense fear of interacting or talking with strangers

■ Fear that others will notice that you look anxious

■ Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice

■ Avoidance of doing things or speaking to people out of fear of embarrassment

■ Avoidance of situations where you might be the center of attention

■ Anxiety in anticipation of a feared activity or event

■ Intense fear or anxiety during social situations

■ Analysis of your performance and identification of flaws in your interactions after a social situation

■ Expectation of the worst possible consequences from a negative experience during a social situation

For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.

Performance type of social anxiety disorder is when you experience intense fear and anxiety during speaking or performing in public but not in other types of more general social situations.

Physical symptoms

Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:

■ Blushing

■ Fast heartbeat

■ Trembling

■ Sweating

■ Upset stomach or nausea

■ Trouble catching your breath

■ Dizziness or lightheadedness

■ Feeling that your mind has gone blank

■ Muscle tension

Avoiding common social situations

Common, everyday experiences may be hard to endure when you have social anxiety disorder, including:

■ Interacting with unfamiliar people or strangers

■ Attending parties or social gatherings

■ Going to work or school

■ Starting conversations

■ Making eye contact

■ Dating

■ Entering a room in which people are already seated

■ Returning items to a store

■ Eating in front of others

■ Using a public restroom Social anxiety disorder symptoms can change over time. They may flare up if you’re facing a lot of changes, stress or demands in your life. Although avoiding situations that produce anxiety may make you feel better in the short term, your anxiety is likely to continue over the long term if you don’t get treatment.

When to see a health care provider

See your health care provider or a mental health professional if you fear and avoid normal social situations because they cause embarrassment, worry or panic.