Social anxiety disorder

Social anxiety disorder is a common type of anxiety disorder. It's a strong, lasting fear of being watched, judged or embarrassed in situations with other people. Lots of people feel nervous before a big presentation. With social anxiety disorder, the fear shows up before, during and after everyday situations, and it can shape what you're willing to do.

It usually starts in childhood or the teen years, and for many people it doesn't go away on its own without treatment. Some people feel it mainly in performance situations, like giving a talk or playing music on stage. Others feel it across many parts of life.

Common signs, in plain language

• Worrying about a conversation, meeting or event for days or weeks beforehand
• Fear of being judged, embarrassed or seen as incompetent
• Blushing, sweating, trembling, a racing heart, or your mind going blank
• Trouble making eye contact or talking with people, even when you want to
• Avoiding things like phone calls, parties, eating in front of others or speaking up at work
• Replaying conversations afterward and picking apart what you said

Most people with social anxiety disorder know their fear is bigger than the situation calls for, but knowing that doesn't make it go away. These signs are a general guide, not a checklist for diagnosis.

Social anxiety often goes unrecognized. People with it are less likely to seek help, and it's often noticed only when someone gets care for something else, such as depression. A careful evaluation looks at:

• Which situations bring on the fear, and what you avoid or push through
• When it started, how long it has lasted, and how it affects work, relationships and daily life
• Conditions that often come with it, such as depression, panic disorder or generalized anxiety
• Alcohol or other substance use, since some people come to rely on it to get through social situations
• Your health and current medications, to rule out other causes

This is part of a comprehensive psychiatric evaluation, where the goal is a clear understanding before any treatment decision. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.

Social anxiety disorder is treatable. Treatment usually involves therapy, medication, or both, and finding the right fit can take some trial and error.

Medication, when it fits. SSRI and SNRI antidepressants can ease the symptoms of social anxiety disorder. Sertraline, paroxetine and venlafaxine extended-release are FDA-approved for it. They may take several weeks to start working, so we start carefully and adjust one step at a time. For anxiety that shows up mainly when you perform, such as giving a talk, a beta-blocker can ease physical symptoms, though it doesn't treat the anxiety itself. We explain every option so you can decide together with your provider.

Time to talk in every visit. Depending on your clinician, visits may include practical, CBT-informed strategies: noticing the predictions anxiety makes about how others see you, shifting your attention outward to the conversation, and taking small, planned steps toward situations you've been avoiding. Avoiding a situation brings relief in the moment, but the anxiety tends to stay. Read more about how therapy fits into our visits.

Therapy alongside us. Cognitive behavioral therapy (CBT), including exposure therapy, is the best-studied therapy for social anxiety. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.

Regular follow-ups. We check in regularly to see what's helping, watch for side effects and adjust carefully.