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Everyone experiences anxiety at some point in their life. People become anxious when they have to face a highly stressful situation like taking a test or going for a job interview. When one is anxious and under stress, the body reacts; hands become clammy, the heart beats a little faster, and one can even feel lightheaded or dizzy. This is a natural and necessary, “fight or flight” reaction. Anxiety in moderate doses is perfectly healthy. Worry can even be good for you; it can motivate you to get things done.
Feeling nervous around new people or in social situations is also pretty normal. We’ve all felt judged or said and/or done something embarrassing in front of people. Most of the time, we can move on from these experiences and get through it.
However, when someone experiences extreme worry, distress, or tension in social situations, to the point where it is getting in the way of their relationships or of living a healthy life, they might have social anxiety disorder.
Social anxiety involves being extremely self-conscious and/or afraid of being judged and humiliated. When someone has social anxiety disorder, their fears of embarrassment or failure are out of proportion to the actual situation, can produce extreme distress, and can cause them to completely avoid social situations altogether.
Social anxiety disorder is different for different people. For some, it can mean being terrified of specific social situations, like public speaking, using a public bathroom, meeting new people, parties, crowds or eating in front of people. For others, it can just be a general feeling of dread or discomfort in multiple social situations.
Social anxiety disorder and agoraphobia: Some people who experience social anxiety or other anxiety disorders can develop more complications. A person who has severe social anxiety might become so worried about it that they begin to avoid any places or situations that might bring them into contact with people, to the point where it interferes with their ability to live their life. This avoidance can develop into agoraphobia, which is the extreme fear and avoidance of crowded spaces or enclosed public places that may lead you to panic and feel trapped.
It is not:
- The result of any actions or personal failures of the individual.
- A sign or result of low intelligence or weakness.
- Being “shy/quiet” or “unfriendly”.
Like all mental health issues, social anxiety disorder is complicated. The causes and risk factors can include a number of things working in combination, like genetics, biology, personality, environment, or life experiences.
Some possible causes/triggers could include:
- Family history – anxiety disorders can run in families. This could be because of genetic, learned, or environmental factors.
- Genetics/biology –There is some evidence that the biochemistry of the brain can be linked to social anxiety.
- Life experiences – Someone who has experienced family conflict, bullying or abuse may be at a higher risk for developing social anxiety disorder.
Social anxiety often, but not always, starts in childhood.
Below is a list of signs and symptoms for social anxiety disorder. The following list should not be used to diagnose yourself or someone else. It is only intended to provide general information. If you think you might be experiencing a mental illness, you should see your doctor.
These symptoms will often appear when faced with a social situation, or might begin in anticipation of having to face a social situation. You might notice that many of these signs or symptoms could be explained by any number of issues, not just social anxiety disorder.
- Feelings of extreme worry/anxiety in anticipation of social situations.
- Enduring social situations with high levels of anxiety before, during and/or afterward.
- “Overthinking” social situations or events (before, during and/or after).
- Distorted thinking (e.g. believing people are thinking negatively about you or judging you despite a lack of evidence or evidence that suggests otherwise).
- Physical symptoms such as blushing, sweating, rapid heart rate, upset stomach, shaking, dry mouth, feeling very hot, etc.
- Being immensely afraid of losing track of a conversation.
- Being overly quiet or afraid to speak.
- Panic attacks.
- Avoidance of social situations.
- Withdrawal from friends/family, work or school to avoid interaction with others.
- In children: clinging to parents, tantrums and excessive crying/shyness in social situations.
Social anxiety disorder is treatable. For any mental health concern, if signs or symptoms are interfering with your life in any way, it’s time to seek help. You don’t have to wait for things to get really “bad” before seeking help.
For instance, if sleep patterns, eating, relationships, school, work, or enjoyment of life is being affected, it’s a good idea to talk to someone. That someone could be a friend you trust, a teacher, your family doctor, a crisis line, or counsellor.
If it is a friend you are concerned about, they may resist help or not even recognize that they need it. They might need you to make the first step.
As always, if you feel like your friend might hurt him/herself or someone else, it’s time to call emergency services.
Visit the Help Section to find out how to get help for yourself or a friend.
Like other mental health issues, social anxiety disorder and how it is experienced will differ from person to person. Because each case is unique, the treatment will likely be different for each individual.
Social anxiety disorder can be treated with specific types of therapy, like cognitive behavioural therapy (where you learn coping strategies and ways to deal with troubling thoughts, feelings and behaviours) and support groups (where you can connect with others going through similar situations and support one another). Counselling to improve self-esteem and social skills, and relaxation techniques such as deep breathing, may also help a person deal with social anxiety disorder.
Medication can also help to stabilize someone enough to get the most out of therapy and to better function in their life. Every person is different, so if medication is used, it may take a while to find the medication that works best for you.
For some, spending time in a treatment clinic or hospital is the best option, while for others, outpatient (getting help from a professional without having to actually “stay over” in a hospital) is better.
Family members of someone who has social anxiety disorder may participate in therapy, support groups or benefit from learning about it and ways to support their loved one at home.
Along with treatment from your doctor or therapist, there are things you can do to help and support your own recovery.
If you have to wait to get an appointment, there are many places that offer support while you wait. Find out where to call in your area.
Every story is different, and sometimes people need to try different types of supports before they find the right plan for them. Be patient, and don’t give up.
A person living with social anxiety disorder, like any other person, will benefit from maintaining wellness and having good supports in their life.
Myth: Social anxiety is the fear of public speaking.
Fact: Social anxiety can be about many different specific situations, like public speaking, using a public bathroom, eating in front of people or being in a crowded room with new people. It can also be more general, like a sense of intense anxiety around people overall. The common thread among each of these is the feeling of being “evaluated” and the intense worry that accompanies it.
Myth: Social anxiety just means that you feel nervous or shy.
Fact: Having an anxiety disorder of any kind is more than “being nervous” or “shy”. Some people who have social anxiety are overwhelmingly anxious but are really good at hiding their feelings and don’t appear “shy” at all. Others withdraw or avoid social situations altogether. The difference between typical nervousness or shyness and social anxiety disorder is that when you have social anxiety disorder, the fear and anxiousness doesn’t occur in a way that is typical or in proportion to the situation. It interferes with a person’s ability to live a happy and healthy life.
Myth: You will only get anxiety if you are a nervous person.
Fact: Anyone at any point in time can develop an issue with anxiety. It is one of the most common mental health problems faced today, particularly among young people.
Myth: Since anxiety is "in your head," anxiety disorders are not true illnesses.
Fact: An anxiety disorder is an extreme form of uncontrollable worry and fear that causes serious misery and impairment. It is absolutely an illness, one that can be observed through brain activity and often has physical symptoms too. If it's not treated, it can dramatically limit a person’s quality of life.
Myth: People with anxiety are weak and should just pull themselves together.
Fact: People are not diagnosed with an anxiety disorder unless it's much more overwhelming and impairing than the typical anxiety people feel. People with anxiety disorders often need treatment to manage their feelings and feel safe. Having a disorder has nothing to do with a person’s “strength”. It is a combination of biological, psychological, and environmental factors that lead to the illness. Telling someone who has an anxiety disorder to “just calm down” or "pull it together" is like telling someone who needs glasses to “just see better”. It simply doesn’t work that way.
Myth: Avoiding anxiety producing situations is a good way to manage your worry.
Fact: This seems like an easy solution, but remember that anxiety disorders can be hard to pinpoint, and anxiety can be triggered by everyday things (like being outside, or being around people) that need to be a part of living a healthy life. For many people, treatment for an anxiety disorder actually includes slow and monitored exposure to the thing or situation that triggers the fear, while working on building coping strategies.
Myth: Sometimes I get very nervous when I have to speak in front of people. I must have an anxiety disorder.
Fact: Everyone experiences stress and anxiety. A disorder is only diagnosed when the worry is extreme, irrational, excessive, causes great distress, or affects your life significantly.
Supporting someone with any type of serious illness can be challenging. Ways to help and support a friend or loved one who is living with social anxiety disorder:
- Know the signs and symptoms of social anxiety disorder and other anxiety disorders.
- The anxious thoughts and worries someone has when they have an anxiety disorder may not make any sense to you, but they feel very real to the person dealing with them. Instead of trying to apply logic or explain the fears away, try thinking of a time when you were really worried and empathize with how your friend is feeling.
- Know that people with social anxiety still want friends. It’s easy to misread the behaviour of someone with social anxiety as being unfriendly or standoffish. Be friendly and see where it takes you.
- Try to encourage your friend to come out and be social, but listen to them and understand if they aren’t feeling up to it.
- Try to avoid being critical. Someone who has social anxiety is likely already really critical of themselves and needs someone around who is non-judgemental.
- Treatment is a process. Medications and therapy can take time to help. Be aware of this and try to be supportive as your friend adjusts.
- Be a sounding board. Listening without judgement and without trying to “fix” their problems can be incredibly helpful.
- Ask your friend how else you can help. It may be as easy as just providing a distraction, asking them to do simple, relaxing things with you (e.g. like hanging out, watching a movie, etc.).
- If your friend is in the hospital, go and visit them if you are able. The hospital may be scary and overwhelming for them and a friendly face can help. Make sure to ask about visitor rules first.
- Encourage professional help for your friend when needed (see Help Section)
- Set some boundaries for yourself, and take care. You can’t help someone if you’re feeling overwhelmed yourself.
See the Help Section for more info about helping a friend and self care.
The information on this page is a simple overview of a complicated health issue. The content has been taken from CAMH, CMHA, and the Anxiety Disorders Association of Canada. For more in-depth information, please visit these sources or speak to a medical professional.
Ontario – call ConnexOntario to find out where there are mental health supports in your community.
Crisis – in any situation where someone is at risk of hurting themselves or others, call 911 or a local crisis line.
Please see the Help Section for more information and resources.
Facts about mental health issues and illnesses. It is not meant to replace a doctor’s advice. Please consult a medical professional.