Social Anxiety Disorder Symptoms and Signs
Social anxiety disorder is intense fear of being watched or judged in social situations, strong enough that those situations are avoided or endured with dread, and lasting six months or more.
Also called: Social phobia, Social anxiety.
ICD-10 F40.1 · ICD-11 6B04
Not shyness. A spotlight that points inward.
Most people get nervous before a speech or a first date. Social anxiety disorder is much bigger than that, and it reaches much further. It is an intense fear of being watched, judged or embarrassed. It is strong enough to shape a whole life around avoiding it.
It is not the same as being shy or introverted. Plenty of shy people enjoy company. People with social anxiety usually want connection badly. Fear is what stands in the way.
It is one of the most common anxiety disorders. It usually starts young, and it responds well to the right treatment. Most people wait many years before they get any.
FROM INSIDE
What it is actually like
Picture a meeting at work. You have something to say. Your heart is already racing. You rehearse the sentence for the fifth time, and the moment to speak passes.
When you do speak, most of your attention is on yourself. Is my voice shaking? Am I going red? Do they think I am stupid? You barely hear what anyone says back.
Afterwards, on the way home, you replay the whole thing. Each time you replay it, it looks worse than before.
A stage light pointed the wrong way
Imagine a spotlight meant to light up the people you are talking to. Instead it swings round onto you. Now you are blinded by your own glare, and you cannot see their faces at all.
WHAT IT DOES
Four common forms
The situations differ from person to person. The fear underneath is always the same. It is the fear of being judged.
Performing
This covers speaking in meetings, giving presentations, and being called on in class. It also covers eating or writing while others watch.
Meeting people
This covers small talk, parties, dates and phone calls. It also covers talking to anyone in authority.
Being noticed
This covers walking into a room where people are already sitting. It covers any moment of attention, even friendly attention.
Showing anxiety
This is the fear that others will see you blushing, sweating or shaking, or hear your voice tremble, and think less of you for it.
4% — WORLDWIDE
13 — YEARS OLD
16 — YEARS
98% — ON VIDEO
When it tends to begin
Peak age of onset: 15.
Median age of onset: 13.
Social anxiety usually begins in late childhood or the early teens. That is the age when what other people think starts to matter most. Without treatment it tends to last for years. It often leads to depression or heavy drinking later on.
How it is actually diagnosed
A pattern that meets all of the following, usually for six months or more.
- Strong fear or anxiety about social situations where you might be watched or judged
- Fear of acting in a way, or showing anxiety, that others will judge negatively
- Those situations are avoided, or endured with intense fear
- The fear is out of proportion to the real risk, and causes distress or gets in the way of life
- It is not better explained by another condition, a substance or a medical problem
Sometimes the fear is only about performing, such as public speaking. Doctors then record it as the performance-only type.
If it is worse than that right now
Social anxiety can be very isolating, and loneliness can make life feel hopeless. Many people with social anxiety also develop depression. If things feel unbearable, reaching out is hard. It is still the right step.
If you are thinking about harming yourself, contact emergency services or a crisis line now. Many crisis lines accept text messages.