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Social anxiety disorder, previously known as social phobia, is a mental illness. It belongs to a group of mental illnesses called anxiety disorders. People with social anxiety disorder feel very nervous and uncomfortable in social situations or in situations where they have to do something in front of other people, like participate in meetings or introduce themselves to new people. They often feel like they will say or do the wrong thing. They might think that other people will easily notice signs of their anxiety and judge them negatively and assume they're weird or incapable. They might also be afraid of offending other people or being rejected by others.1
What does it look like?
It's normal to feel nervous or anxious going to an interviewing, performing in public, or meeting people for the first time. Most people feel uncomfortable but can still get through the situation or event without much trouble. They may feel self-conscious or worry if they make a small mistake in front of others, but still have a realistic view on any consequences.
People with social anxiety disorder feel some sort of anxiety, fear, or worry around social situations where they could be closely evaluated. They may experience a lot of worry or dread in the days or weeks before a situation they fear, like a meeting, presentation or large event. At times, they may experience panic attacks—a very intense burst of fear that peaks in a matter of minutes.1 If someone with social anxiety disorder can’t avoid the situation altogether, they experience very strong anxiety during the event.1 (Some people who perform or speak publicly for a living are comfortable in general social situations like meeting new people or going to a party, but experience social anxiety during performances or speaking in public. This is called performance-only social anxiety disorder.)1
A key part of social anxiety disorder is having a response that is disproportionate to the situation or overestimating negative consequences. Sociocultural factors should be considered when determining if a person's response is out of proportion to the situation. People with social anxiety disorder believe that something bad will happen as a result of the social interaction. They might fear that they’ll be fired if they make a mistake when they speak at a work meeting or fear that everyone will make fun of them if they talk to others at school. Some adults recognize that their anxiety is excessive or unrealistic and see that the consequences they fear probably won't happen. People who have experienced difficult situations like bullying may not see consequences as unrealistic because they've experienced harm in the past.1
Social anxiety disorder can have a big impact on well-being and quality of life. People may avoid relationships with others, drop out of school, turn down work opportunities, or stop pursuing hobbies and other interests. While the illness can really affect lives, many people never seek treatment. If you think you have social anxiety, it's important to talk to your doctor or health care provider—there are many treatments to help you manage anxiety.1
Social anxiety disorder in children
Children with social anxiety disorder feel some sort of anxiety, fear or worry in social situations with other children. Young children may not understand that their anxiety is excessive. Children may not know that their discomfort is caused by anxiety, and they may not be able to describe what they're feeling. They may express anxiety in other ways, such as avoiding social activities, refusing to go to school or acting out in other ways (e.g. crying, tantrums, clinginess).1
Social anxiety disorders and other mental illnesses
People who are diagnosed with social anxiety disorder are more likely to be diagnosed with another anxiety disorder, depression, or a substance use problem. Different mental illnesses can interact with social anxiety disorder in different ways. People who don't have many social relationships may experience depression later on, while people who are self-conscious about themselves or the way they appear to others as a result of another health challenge may go on to experience social anxiety disorder. Some people with social anxiety use alcohol or other substances to help them relax and feel more comfortable around others, which can increase the risk of a substance use problem.1
Who does it affect?
Social anxiety disorder is one of the most common mental illnesses in adults. It's estimated that 8-12% of people may experience the illness at some point in their lives. Social anxiety is more likely to affect women and often starts when people are in their early teens.2,3
Could I have social anxiety disorder?
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I'm terrified other people will think I’m stupid, rude or strange if I say something wrong
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I'm scared to do things in front of other people, like contribute to meetings at work, give presentations, or eat in the lunch room
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When I'm in an uncomfortable social situation, I stammer, feel my muscles tensing up, shake or experience other physical signs of anxiety
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I avoid social situations that make me anxious, and I dread upcoming situations I can't avoid
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I drink a lot or use other substances to lower my anxiety before I to go to a social event
If you agree with some or all of the above statements, the best thing to do is talk to your doctor.
What can I do about it?
There are a few different things you can do:
Psychotherapy
Many people with social anxiety disorder benefit from an evidence-based form of psychotherapy called cognitive-behavioural therapy or CBT. It is considered the gold-standard psychological treatment for social anxiety disorder.4 A mental health professional trained in CBT can help you work through the thoughts or beliefs and behaviours that contribute to or maintain your social anxiety. CBT also teaches assertiveness skills, social skills and relaxation skills. CBT is usually a short-term treatment. You can get the most out of treatment by actively participating in treatment and regularly practicing CBT skills.4
Medication
Antidepressants, anti-anxiety medications or anticonvulsants can be used alone or in combination with psychotherapy to reduce your body's response to anxiety.4,5 There are many factors to consider when deciding if medication is a good treatment option for you. It is best to speak to your doctor for more information.
Self-management
Self-management is all of the small things you do every day to take care of yourself. Regular exercise, eating as well as you can, getting enough sleep, managing stress, and monitoring your use of alcohol and other drugs can help reduce anxiety and build up your mental health. Talk to your health care team for more ideas.
Where do I go from here?
In addition to talking to your family doctor, check out the resources below for more information about social anxiety disorder:
Anxiety Canada
Visit www.anxietycanada.com for the MindShift app to help manage anxiety, MAP (My Anxiety Map) self-management resources, an online directory of anxiety programs and services across Canada, and more information about anxiety and anxiety disorders.
BC Partners for Mental Health and Substance Use Information
Visit www.heretohelp.bc.ca for info sheets and personal stories about social anxiety disorder. You'll also find more information, tips and self-tests to help you understand many different mental health problems.
BC Mental Health Support Line
Call 310-6789 (no area code) 24 hours a day to connect to a BC crisis line, without a wait or busy signal. This line isn't only for people in crisis. You can call 310-6789 for information on local services or if you just need to talk to someone.
HealthLink BC
Call 811 or visit www.healthlinkbc.ca to access free, non-emergency health information for anyone in your family, including mental health information. Through 811, you can also speak to a registered nurse, a health systems navigator to help you find local resources, a pharmacist, a dietitian, or an exercise professional.
