Social anxiety disorder: symptoms, causes, CBT and getting help

The NHS describes social anxiety disorder, also called social phobia, as a long-term and overwhelming fear of social situations. It is a common problem that usually starts during the teenage years and can be very distressing, with a big impact on your life. NHS inform adds that it can be a lifelong problem unless it is treated.

Many people occasionally worry about social situations, but someone with social anxiety feels overly worried before, during and after them. The NHS says it is more than shyness.

The NHS says you may have social anxiety if you:

• worry about everyday activities, such as meeting strangers, starting conversations, speaking on the phone, working or shopping

• avoid or worry a lot about social activities, such as group conversations, eating with company and parties

• always worry about doing something you think is embarrassing, such as blushing, sweating or appearing incompetent

• find it difficult to do things when others are watching, feeling like you are being watched and judged all the time

• fear being criticised, avoid eye contact or have low self-esteem

• often have physical symptoms like feeling sick, sweating, trembling or a pounding heartbeat (palpitations)

• have panic attacks, an overwhelming sense of fear and anxiety, usually lasting only a few minutes

The NHS says social anxiety is more than shyness: it is a fear that does not go away, and it affects everyday activities, self-confidence, relationships and work or school life. NHS inform says to contact your GP practice if anxiety is affecting your daily life, you are not looking after yourself, or you are finding it hard to manage any responsibilities you have.

The NHS also notes that many people with social anxiety have other mental health issues, such as depression, generalised anxiety disorder or panic disorder.

NHS inform says there is not always a clear cause. Sometimes it might be caused by social reasons, such as having been bullied or embarrassed in a social situation in the past; psychological reasons, such as thinking that others are paying close attention to you; or biological reasons, such as having a family member who is also socially anxious. It is most likely that socially anxious feelings come from a combination of these factors.

The NHS says a number of treatments are available, and CBT is generally considered the best treatment, though other treatments may help if it does not work or you do not want to try it. Some people need a combination of treatments. NICE guidance for England and Wales recommends individual CBT specifically developed for social anxiety disorder for adults, and says group CBT should not routinely be offered in preference to individual CBT.

The NHS says self-help can help reduce social anxiety and may be a useful first step before other treatments.

• Understand your anxiety better by writing down what goes through your mind and how you behave in social situations, perhaps in a diary.

• Try relaxation techniques, such as breathing exercises for stress.

• Break challenging situations into smaller parts and work on feeling more relaxed with each part.

• Try to focus on what people are saying rather than assuming the worst.

• Exercise regularly, stop smoking, cut down on alcohol and drink less caffeine (NHS inform).

• Use an NHS self-help guide or support groups such as Anxiety UK.

The NHS says social anxiety can also affect children. Signs include crying or getting upset more often than usual, getting angry a lot, avoiding interaction with other children and adults, fear of going to school or taking part in classroom activities, school performances and social events, not asking for help at school, and being very reliant on parents or carers.

Speak to a GP if you are worried about your child. Treatments are similar to those for teenagers and adults, although medicines are not normally used. Therapy is tailored to your child's age and often involves you, and may take place in a small group.

The NHS says it is a good idea to see a GP if you think you have social anxiety, especially if it is having a big impact on your life. A GP will be aware that many people struggle with social anxiety and will try to put you at ease. If they think you could have social anxiety, you will be referred to a mental health specialist for a full assessment.

You can also refer yourself directly to an NHS talking therapies service without a referral from a GP.

The NHS says for some people it gets better as they get older, but for many people it does not go away on its own without treatment. NHS inform says that with treatment many people are able to control their levels of social anxiety, although some treatments may need to be continued for a long time and there may be periods when symptoms worsen.

On the NHS, you can self-refer to a talking therapies service or ask your GP, who can refer you for assessment. Services and waiting times vary by area. Some people choose a private therapist for faster access. If you do, NICE guidance recommends CBT that has been specifically developed to treat social anxiety disorder.