Social Anxiety Disorder, Adult

Social anxiety disorder (SAD), previously called social phobia, is a mental health condition. People with SAD often feel nervous, afraid, or embarrassed when they are around other people in social situations. They worry that other people are judging or criticizing them for how they look, what they say, or how they act.

SAD involves more than just feeling shy or self-conscious at times. It can cause severe emotional distress. It can interfere with activities of daily life. SAD also may lead to alcohol or drug use, and even suicide.

SAD is a common mental health condition. It can develop at any time, but it usually starts in the teenage years.

What are the causes?

• This disorder is also associated with an overactive amygdala. The amygdala is the part of the brain that triggers the response to strong feelings, such as fear.

What increases the risk?

• People who have a family history of anxiety disorders.
• Females.
• People who have a physical or behavioral condition that makes them feel self-conscious or nervous, such as a stutter or a long-term (chronic) disease.

What are the signs or symptoms?

• Speak in public.
• Go shopping.
• Use a public bathroom.
• Eat at a restaurant.
• Go to work.
• Interact with people you do not know.

• Blushing.
• A fast heartbeat or shortness of breath.
• Sweating.
• Shaky hands or voice.
• Confusion.
• Light-headedness.
• Upset stomach, diarrhea, or vomiting.

How is this diagnosed?

This condition is diagnosed based on your history, symptoms, and behavior in social situations. You may be diagnosed with this type of anxiety if your symptoms have lasted for more than 6 months and have been present on more days than not.

Your health care provider may ask you about your use of alcohol, drugs, and prescription medicines. He or she may also refer you to a mental health specialist for further evaluation or treatment.

How is this treated?

• Cognitive behavioral therapy (CBT). This type of talk therapy helps you learn to replace negative thoughts and behaviors with positive ones. This may include learning how to use self-calming skills and other methods of managing your anxiety.
• Exposure therapy. You will be exposed to social situations that cause you fear. The treatment starts with practicing self-calming in situations that cause you low levels of fear. Over time, you will progress by sustaining self-calming and managing harder situations.
• Prescription medicines. These medicines may be used by themselves or in addition to other therapies.
• Biofeedback. This process trains you to manage your body's response (physiological response) through breathing techniques and relaxation methods. You will work with a therapist while machines are used to monitor your physical symptoms.
• Techniques for relaxation and managing anxiety. These include deep breathing, self-talk, meditation, visual imagery, muscle relaxation, listening to music, and yoga. These techniques are often used with other therapies to keep you calm in situations that cause you anxiety.

These treatments are often used in combination.

Follow these instructions at home:

Alcohol use

• Limit how much you have to:
  • 0–1 drink a day for women who are not pregnant.
  • 0–2 drinks a day for men.
• Know how much alcohol is in a drink. In the U.S., one drink equals one 12 oz bottle of beer (355 mL), one 5 oz glass of wine (148 mL), or one 1½ oz glass of hard liquor (44 mL).

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Practice techniques for relaxation and managing anxiety at times you are not challenged by social anxiety.
• Return to social activities using techniques you have learned, as you feel ready to do so.
• Avoid caffeine and certain over-the-counter cold medicines. These may make you feel worse. Ask your pharmacist which medicines to avoid.
• Keep all follow-up visits. This is important.

Where to find more information

• National Alliance on Mental Illness (NAMI): nami.org
• Social Anxiety Association: socialphobia.org
• Mental Health America (MHA): mhanational.org
• Anxiety and Depression Association of America (ADAA): adaa.org

Contact a health care provider if:

• Your symptoms do not improve or get worse.
• You have signs of depression, such as:
  • Persistent sadness or moodiness.
  • Loss of enjoyment in activities that used to bring you joy.
  • Change in weight or eating.
  • Changes in sleeping habits.
• You become more isolated than you normally are.
• You find it more and more difficult to speak or interact with others.
• You are using drugs.
• You are drinking more alcohol than usual.

Get help right away if:

• You harm yourself.
• You have suicidal thoughts.

• Call 911.
• Call the National Suicide Prevention Lifeline at 1-800-273-8255 or 988. This is open 24 hours a day.
• Text the Crisis Text Line at 741741.