UNC Health Care
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Do You Have Social Anxiety Disorder?

We’ve all been there: nervous about a job interview, the first day of school, meeting a new group of people or speaking in front of others. Heart racing, palms sweaty, we power through and get it done—and often feel victorious for having met a challenge head-on.

But if you suffer from social anxiety disorder, the stress of these types of situations can be too much to handle, so you avoid them whenever possible. And if you must endure a social situation, such as a party, you leave feeling emotionally drained.

“When somebody has a social anxiety disorder, they experience symptoms of fear or anxiety in some specific or all social situations, and they typically will avoid these kinds of situations,” says UNC Health clinical psychologist Catherine Forneris, PhD. “If they’re things they absolutely have to do, they suffer a lot leading up to the interaction and when they’re actively in the situation, and they often feel pretty exhausted afterward.”

Having social anxiety disorder can interfere with your personal and professional life, but you can be overcome it with treatment.

Read on to learn more.

Symptoms of a Social Anxiety Disorder

Social anxiety is fairly common and affects about 7 percent of the population at any given time, Dr. Forneris says. People with social anxiety disorder, also called social phobia, experience extreme fear or anxiety in one or more social settings in which they fear being embarrassed or negatively evaluated by others.

The signs and symptoms of social anxiety are similar to those of a panic attack and can include:

  • Rapid heart rate
  • Sweating
  • Shaking
  • Nausea
  • Diarrhea
  • Difficulty sleeping
  • Feeling lightheaded or dizzy
  • Dry mouth
  • Extreme perspiration
  • Difficulty interacting with others even if you want to do so
  • Feeling self-conscious or embarrassed around others
  • Avoidance of places where there are other people

“It is often the same reactions you would have if something really scary happened to you, where you feel the fight-flight reflex get activated,” Dr. Forneris says. “You can feel a sense of dread when thinking about having to interact with somebody socially, and you may actively avoid social situations or have a very, very small social circle.”

These symptoms can cause people with social anxiety disorder to withdraw, and they might miss out on social or professional opportunities as a result.

Social Anxiety Can Run in Families

Social anxiety disorder sometimes runs in families.

“We know a lot of the anxiety disorders, depression and other kinds of mental health conditions do tend to run in families,” Dr. Forneris says. “So there may be some sort of genetic component.”

However, there are also developmental factors, she says. For example, a child might live with somebody who has social anxiety, so that child doesn’t learn how to effectively navigate social situations.

“He or she is taught that social situations should be approached with extreme caution,” Dr. Forneris says.

Trauma also can cause a host of mental health conditions, including social anxiety disorders. Finally, underdeveloped social skills can contribute to social anxiety. If you aren’t confident in your ability to connect with others, you may feel discouraged when talking with people and worry about doing it again.

Social Anxiety Disorder Is Treatable

Social anxiety disorder is usually treated with a type of counseling called cognitive behavioral therapy, which is an evidence-based common form of talk therapy.

This may begin with the therapist educating the patient and working on “basic skill-building, like how to introduce yourself to somebody, how to prepare for certain situations so you don’t worry that you’re not going to have anything to say, or that what you’re going to say is going to sound stupid or boring,” Dr. Forneris says.

Next, you may work with your therapist on exposure therapy, which is where you generate a list of feared social situations and rank them on a scale of 1 to 10. In careful exposures and with the help of your therapist, you’ll start at one of the easier ones, a 1 or 2, and move up in difficulty as you gain success.

“You would figure out how to put yourself in that social situation so that your brain can learn, ‘Gee, even though this was really difficult, I got through it,’” Dr. Forneris says. “And then the next time, it’s not as anxiety-provoking.”

For example, a lower item on your social anxiety hierarchy might be making a phone call to ask for an insurance quote. Your therapist would encourage you to try those types of calls until you feel more comfortable doing so. Then you would move up to the next item on a hierarchy, which might be going into a store and asking someone to help you find something.

“For every person, it would be different, but the idea is that you learn how to navigate these situations and you learn that you can survive the situation that causes you anxiety,” Dr. Forneris says.

Because anxiety can accompany depression, your provider may prescribe medication that also helps ease your anxiety.

“Some antidepressants can help people with social anxiety disorder, especially if it’s extreme,” Dr. Forneris says. “Sometimes, medication is necessary to help the person engage more effectively in cognitive behavioral therapy. Cognitive behavioral therapy is what can help you build a skill set that will be sustainable over time.”

You can receive mental health therapy virtually—especially now during the coronavirus disease 2019 (COVID-19) pandemic.


If you think you may have social anxiety disorder, talk to your doctor. Need a doctor? Find one near you, or set up a virtual appointment.