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Date: 03/03/22- 14/03/22

Author Name: Udita Singh

Qualifications: B.A.(Hons), M.A. Applied Psychology (Specialisation in Clinical Psychology)

Designation: Consultant Psychologist, ACRO Mental Health Services.

Word count: 3,218 words

Reading time: 28 mins

Reviewed by: Aishwarya Krishna Priya, Sareem Athar and Mariyam Mohammed.

“Anxiety does not empty tomorrow of its sorrows, but only empties today of its strength.” - Charles Spurgeon (1)

What is social anxiety?

Social anxiety disorder is a type of anxiety disorder marked by a profound fear in social situations, causing severe distress and impaired ability to function in some parts of daily life (2,3). It is also known as social phobia, and it is one of the most common mental disorders (4).It can be so severe that the simplest interactions such as ordering at a restaurant, making eye contact, going to school or the office, dating, using a public restroom, eating in front of others, or answering calls can cause panic (5). This can lead to avoidance that can disrupt daily life and affect daily routine, school, work and the ability to develop a close relationship with people outside of the family (6). People with a social anxiety disorder may know that their fears are illogical and unreasonable, but they feel helpless to defeat them (7).

Let’s say it’s your first day at your new job (8). Maybe you are nervous, or jittery. You want to make a good impression (9,10). Those feelings are quite normal and may help you be more alert and careful (11). But after a few weeks, once you are used to the job, and you know your coworkers, that nervousness usually diminishes (12). But, for some people that initial anxiety is high, and it stays high over time (13). For those people, the fear of being judged negatively by new people might be so daunting that it affects their ability to do their job well (14). Even the idea of having to be somewhere where they may be scrutinised by others might make them not want the job in the first place. This describes social anxiety disorder (15,16).

Do you find it hard to socialise with other people? Do you feel overwhelmed at the thought of going to a social event? Are you extremely afraid of being judged by others? Are you very self-conscious in everyday social situations? Do you avoid meeting new people? These are all trademark signs of social anxiety (17,18).

It is the second most commonly diagnosed anxiety disorder following specific phobias (19). Furthermore, it can be very easy to confuse social anxiety with shyness since they share many of the same characteristics (20). While shyness is a personality trait, social anxiety is a mental illness. Social anxiety disorder can cause significant disruption of a person’s daily life (21,22).

How is social anxiety disorder diagnosed?

Social anxiety disorder is a disorder that involves fear, anxiety, and sometimes panic when social situations occur (23,24). So, the first criterion to diagnose the disorder is anxiety or fear in social situations where there is a possibility of exposure to scrutiny (25). This is one of the key characteristics of a social anxiety disorder (26). The emphasis is really on these social situations or on that somebody is afraid of being negatively evaluated by others (27).

The second criterion is the fear of acting in a way that will result in a negative evaluation (28). Somebody could be afraid that they might humiliate or embarrass themselves and this takes on a lot of different forms in terms of what specifically a person is worried will happen and what types of social situations can trigger that (29). This is not only related to public speaking but it can be all different types of public performance (30).

The next criterion is that social situations almost always result in anxiety or fear (31). If there is an individual who occasionally has an intense anxiety reaction to different social situations, they may not qualify for a diagnosis (32,33).

People with social anxiety make sure that social situations are avoided or they are endured with intense fear or anxiety (34). The next criterion is that the anxiety and fear are out of proportion to the actual threat (35). It is not unusual that individuals are worried or have anxiety about situations that are threatening (36). Most of the time, that reaction is out of proportion to what is going on, meaning, there may be some threat present, but it does not rise to the level that matches the anxiety, fear, or panic that we observe (37).

The next criterion is that the disturbance lasts longer than six months (38). It is quite persistent. Also, it must lead to clinically significant distress in social, occupational, and other areas (39). So there are instances where people have a social anxiety disorder but it only relates to performing (40):it could be work performance, public speaking, etc (41).

How prevalent is it?

Since it is one of the most common anxiety disorders, a social anxiety disorder can be found in around 7 to 13% of the population (42). It has been found that at least 1 in 8 people suffer or get diagnosed with social anxiety disorder in the course of their life (43,44). With regard to gender, it has been noted that there is no such difference in the occurrence according to gender; for both males and females, it occurs at a similar rate (45).

What is it like living with social anxiety?

Depending on the intensity of it, it can be pretty mild, and just lead to anxiety at parties, anxiety about speaking in front of groups, etc (46). But for some people, it leads to avoidance and it could be quite problematic if the person is unwilling to go out and socialise if they are unable to turn their camera on in a Zoom call, if they are unable to make or maintain friendships, then it can not only be debilitating, but it can also lead to other disorders like depressive disorders because of a lack of connection, a lack of positive reinforcement by getting out there and experiencing what life has to offer (47). So, it can be quite challenging (48, 49).

How does social anxiety differ from other anxiety disorders?

All anxiety disorders are maintained by “experiential avoidance” (50). So if there is anxiety, and the person is letting that anxiety control their behaviour, and lead them to avoid whatever situation they are fearful of, then that same process plays out (51). In social anxiety, what the person is avoiding has to do with socialising (52). The feared stimulus is a social environment or situation (53).

What are its symptoms?

1. You are always self-conscious: One aspect of social anxiety is the extreme fear of being judged (54,55). If you have social anxiety, you will constantly worry about the way you look or act and what others think of you (56). Your greatest fear is embarrassing yourself in front of others (57). A shy person, on the other hand, will only worry about being judged in certain situations, like in public speaking or when meeting someone new (58).

2. Your anxiety feels out of hand: there are times when it is normal to feel shy or nervous around other people, for example when you move to a new school or college or have to perform in front of an audience (59). But social anxiety is irrational and unwarranted (60). You may feel distressed about things as simple as making eye contact with someone, using public transportation or eating in front of other people (61).The fear is always there…(62).

3. It interferes with your performance: have you ever called in sick to work when your anxiety became too overwhelming? Or have you kept quiet when you were having trouble in class? Social anxiety can impact your performance in many ways (63,64). With the constant fear of people’s judgement, you may even be afraid to do well to avoid drawing attention (65). You don’t pitch ideas in meetings, raise your hand in class, or join clubs because of how much anxiety it creates (66).

4. It affects your relationships: While it is hard to make friends when you are shy, it can feel almost impossible when you have social anxiety (67). For a shy person, it is usually about breaking the ice and going through the initial awkwardness of meeting each other (68). But having social anxiety can complicate your relationships (69,70). You feel tense and uneasy around people, no matter how close you are or how long you have known them (71).

5. It does not go away with familiarity: it is normal to feel shy at the beginning of a new relationship, but as you get to know each other, the tension will start to subside (72). This is not the case if you have social anxiety (73). Instead, you always experience fear, distress, and embarrassment whenever you are around other people(74). It doesn’t matter if it is your parents, siblings, or your best friend; you always feel uneasy and stressed unless you are alone (75).

6. You overanalyse everything: Social anxiety can make you obsess over your social interactions, body language, and tone of voice; to see if they mean what they are saying or not (77).

7. You avoid social situations: Are you often absent or very late to social gatherings? It is a serious matter if your social anxiety leads you to avoid social situations altogether (78,79). You decline invitations, refuse to speak in front of others, and would rather sit in the corner to avoid being noticed and mingle with anyone else (80).

8.You have physical symptoms: do you feel nausea, dizziness or chest palpitations when you are in social situations? (81) Just like most anxiety disorders, social anxiety is often accompanied by physical symptoms (82). Some common ones are sweaty palms, shortness of breath, lightheadedness and trembling (83). While these are also the same signs of someone having a panic attack, you will be able to tell the difference if you only show these symptoms when anticipating or being out in a social setting (84,85).

What are the signs a