Why are you so nervous?

At some point in your life, you’ve probably been nervous about something, like giving a speech or asking someone out on a date. This is a normal part of life. What happens though when your anxiety and fear over something lead you to avoid the situation completely and this results in major disruption to your life? How big of an impact can this have? Can you overcome it?

Social Anxiety DisorderDefinition

People have different personalities and life experiences that contribute to their comfort level in various social situations. Some people are naturally very outgoing and at ease in social situations, but others are more reserved and less comfortable in these situations. While it’s normal to feel nervous occasionally about certain situations, with social anxiety disorder, or social phobia, the individual experiences significant anxiety, fear, self-consciousness or embarrassment from everyday situations because they fear being scrutinized or judged by others. This can lead them to avoiding certain places, situations or things, which can affect their daily routine, work, school or other activities. The cause of social anxiety disorder is a combination of factors interacting together. One of these is that anxiety often runs in families, but it’s unclear if this is the result of genetics or a learned behavior from watching parents who have anxiety. It’s also thought that parents who are more controlling or overprotective often have children who are more anxious. For some individuals, they have anxiety about a particular thing after they had an embarrassing/unpleasant social situation involving a similar scenario in the past. This is also a risk factor for developing the disorder. The other main contributor is if you have an overactive amygdala because it controls your body’s fear response. Somethings that can provoke social anxiety disorder include interacting with unfamiliar people/strangers, attending parties/social gatherings, going to work/school, starting conversations, making eye contact, dating, entering a room in which people are already seated, returning items to a store, eating in front of others and using a public restroom.

Symptoms usually appear in early to mid-teens and can present with emotional/behavioral and physical symptoms. Emotional/behavioral symptoms include fear of situations in which you may be judged, worrying about embarrassing/humiliating yourself, intense fear of interacting/talking with strangers, fear that others will notice that you’re anxious, fear of physical symptoms embarrassing you, avoiding doing things, avoiding speaking to people, avoiding situations where you might be the center of attention, having anxiety in anticipation of a feared activity/event, enduring a social situation with intense fear/anxiety, spending time after a social situation analyzing your performance to identify flaws in your interactions and expecting the worst possible consequences from social situation. For younger children who have anxiety about interacting with adults or peers, they may cry, have a temper tantrum, cling to their parents or refuse to speak in social situations. Physical symptoms are blushing, fast heartbeat, trembling, sweating, upset stomach or nausea, trouble catching your breath, dizziness/lightheadedness, feeling that your mind has gone blank and muscle tension. Performance social anxiety is a type of social anxiety disorder that cause you to experience intense fear and anxiety only during speaking or performing in public, but not in other types of social situations. It’s key to realize that symptoms can change over time and may flare up if you’re dealing with a lot of stress or increased demands. If you don’t seek treatment, the disorder can disrupt your life by causing low self-esteem, trouble being assertive, negative self-talk, hypersensitivity to criticism, poor social skills, isolation and difficult social relationships, low academic/employment achievement, substance abuse and suicide/suicide attempts. It’s important to note that other anxiety disorders and mental health disorders, especially major depressive disorder, often occur with social anxiety disorder.

TreatmentFast Facts - Social Anxiety Disorder

The goal of treating social anxiety disorder is to reduce how much it impacts your daily life, so the intensity of treatment depends on how severe your symptoms are. There are two main methods of treatment—psychotherapy or medications. Some individuals benefit from using both of these together. Psychotherapy is typically the most effective because it helps you to recognize and change negative thoughts about yourself and teaches you skills to boost your confidence in social situations. The most effective type of psychotherapy is cognitive behavior therapy because it’s exposure-based therapy, which means that you gradually face the situations that you fear the most by starting with things that bother you, but not as much. In order to get the most out of your treatment, don’t miss therapy appointments, challenge yourself by setting realistic goals, take any medications as prescribed and inform your doctor if you have any changes in your condition.

There are two main classes of medications that your doctor might prescribe. The first are selective serotonin reuptake inhibitors (SSRIs), like paroxetine or sertraline. The second are serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine. Sometimes, your doctor might also prescribe antidepressants, benzodiazepines (they work well, but can be habit-forming and sedating) or beta blockers, which block the effect of epinephrine, so it’ll reduce your heart rate and blood pressure. This means that you’ll have a decrease in the pounding sensation of your heart and less shaking in your limbs/voice. Beta blockers are most often used for situational social anxiety disorder, like giving a speech, not for long-term use. With any of the medications, your doctor will start you at a low dose and gradually increase it until you get to a full dose. It’s important to note that it can take several weeks or months for you to notice an improvement in your symptoms, so don’t give up. For some, their symptoms decrease over time and they’re able to stop taking medication, but for others, they need to take medication for years to prevent a relapse.

There are some other important things to consider. Since symptoms can be worsened by stress, learning stress reduction techniques is important. Living a healthy lifestyle by getting exercise or be physically active on a regular basis, getting enough sleep and eating a healthy, well-balanced diet is key. Also, avoiding alcohol/nicotine and limiting/avoiding caffeine is beneficial because these can contribute to increasing anxiety. If you’re feeling anxious, take time to do something that you enjoy that will help you relax. One other thing is to participate in social situations by asking people with whom you feel comfortable to go with you. Another option is to prepare for conversation by reading an interesting news story that you can talk about with others. Often, it’s the initial getting a conversation started that most people fear and usually once a conversation is started, it’ll naturally progress and you’ll feel more comfortable.


There isn’t a way to predict what could cause you to develop social anxiety disorder, so it’s incredibly hard to prevent. There are things that you can do to prevent the disorder from taking over your life. The most important is getting help early because it’s harder to treat the longer you wait. Keeping a journal of your life will help you to identify areas that cause you stress and what helps you overcome them. Prioritizing what you need to do in your daily life can be helpful because this will allow you to focus your time and energy on the things that you need to and find time to participate in activities that you enjoy. The reason for doing this is to reduce the amount of stress that you’re under, which will help to decrease your anxiety. Avoiding alcohol, caffeine and nicotine is also crucial.

Social anxiety disorder can have a significant impact on your life, but by getting help, you’ll be able to live a life that is less anxiety ridden and more enjoyable. If you have any questions or concerns about social anxiety disorder, please speak with your doctor. If you would like more information, please visit the National Institute of Mental Health’s social anxiety disorder page at https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml