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Social anxiety disorder, also called social phobia, is a long-term and overwhelming fear of social situations.
It's a common problem that usually starts during the teenage years. It can be very distressing and have a big impact on your life.

For some people it gets better as they get older. But for many people it does not go away on its own without treatment.

It's important to get help if you are having symptoms. There are treatments that can help you manage it.

Symptoms of social anxiety

Social anxiety is more than shyness. It's a fear that does not go away and affects everyday activities, self confidence, relationships and work or school life.

Many people occasionally worry about social situations, but someone with social anxiety feels overly worried before, during and after them.

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 - you may feel like you're being watched and judged all the time

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

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

have panic attacks, where you have an overwhelming sense of fear and anxiety, usually only for a few minutes

Many people with social anxiety also have other mental health issues, such as depression, generalised anxiety disorder or panic disorder.

When to get help for social anxiety

It's a good idea to see a GP if you think you have social anxiety, especially if it's having a big impact on your life.

It's a common problem and there are treatments that can help.

Asking for help can be difficult, but a GP will be aware that many people struggle with social anxiety and will try to put you at ease.

They'll ask you about your feelings, behaviours and symptoms to find out about your anxiety in social situations.

If they think you could have social anxiety, you'll be referred to a mental health specialist to have a full assessment and talk about treatments.

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

Things you can try to overcome social anxiety

Self-help can help reduce social anxiety and you might find it a useful first step before trying other treatments.

The following tips may help:

try to understand more about your anxiety - by thinking about or writing down what goes through your mind and how you behave in certain social situations, it can help to keep a diary

try some relaxation techniques, such as breathing exercises for stress

break down challenging situations into smaller parts and work on feeling more relaxed with each part

try to focus on what people are saying rather than just assuming the worst

Read more about anxiety, fear and panic and how to manage them.

You may also find it useful to read an NHS self-help guide for social anxiety.

Treatments for social anxiety

A number of treatments are available for social anxiety.

The main options are:

CBT is generally considered the best treatment, but other treatments may help if it does not work or you do not want to try it.

Some people need to try a combination of treatments.

Support groups

There are several charities, support groups and online forums for people with social anxiety and other anxiety disorders, including:

Social anxiety in children

Social anxiety can also affect children.

Signs of social anxiety in a child 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

being very reliant on their parents or carer

Speak to a GP if you're worried about your child. They'll ask you about your child's behaviour and talk to them about how they feel.

Treatments for social anxiety in children are similar to those for teenagers and adults, although medicines are not normally used.

Therapy will be tailored to your child's age and will often involve help from you.

You may be given training and self-help materials to use between sessions. It may also take place in a small group.

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Find out about social anxiety (social phobia), including the symptoms, getting treatment and what you can do yourself to help overcome it.

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What it's like to suffer from social phobia.

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What it's like to suffer from social phobia.

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By Thomas A. Richards, Ph.D., Google+

Psychologist/Director, Social Anxiety Institute

All day, every day, life is like this. Fear. Apprehension. Avoidance. Pain. Anxiety about what you said. Fear that you said something wrong. Worry about others' disapproval. Afraid of rejection, of not fitting in. Anxious to enter a conversation, afraid you'll have nothing to talk about. Hiding what's wrong with you deep inside, putting up a defensive wall to protect your "secret". You are undergoing the daily, chronic trouble of living with this mental disorder we call social anxiety disorder.

Very few people understand the agonizing and traumatic depth of social anxiety disorder. Social anxiety makes people go inside themselves and try to "protect" this secret. Most people with social anxiety disorder try to hide it from others, especially from family and loved ones. There is fear that family members may find out they suffer from social anxiety, and then view them differently or outright reject them. This is almost never true, but the fear of this happening makes many people with social anxiety stay in their dark closet.

*If you are seeking treatment for social anxiety, start here*

Social anxiety disorder (social phobia) is the third largest psychological problem in the United States today. Millions of people quietly endure this pain every day, believing there is no hope for them getting better.
What is social anxiety like?
A man finds it difficult to walk down the street because he's self-conscious and feels that people are watching him from their windows. Worse, he may run into a person on the sidewalk and be forced to say hello to them. He's not sure he can do that. His voice will catch, his "hello" will sound weak, and the other person will know he's frightened. More than anything else, he doesn't want anyone to know that he's afraid. He keeps his eyes safely away from anyone else's gaze and prays he can make it home without having to talk to anyone.

A woman hates to stand in line in the grocery store because she's afraid that everyone is watching her. She knows that it's not really true, but she can't shake the feeling. While she is shopping, she is conscious of the fact that people might be staring at her from the big mirrors on the inside front of the ceiling. Now, she has to talk to the person who's checking out the groceries. She tries to smile, but her voice comes out weakly. She's sure she's making a fool of herself. Her self-consciousness and her anxiety rise to the roof.

Another person sits in front of the telephone and agonizes because she's afraid to pick up the receiver and make a call. She's even afraid to call an unknown person in a business office about the electric bill because she's afraid she'll be "putting someone out" and they will be upset with her. It's very hard for her to take rejection, even over the phone, even from someone she doesn't know. She's especially afraid to call people she knows because she feels that she'll be calling at the wrong time -- the other person will be busy - and they won't want to talk with her. She feels rejected even before she makes the call. Once the call is made and over, she sits, analyzes, and ruminates about what was said, what tone it was said in, and how she was perceived by the other person....her anxiety and racing thoughts concerning the call prove to her that she "goofed" this conversation up, too, just like she always does. Sometimes she gets embarrassed just thinking about the call.

"I would freeze up every time I had to meet someone in authority...."

A man hates to go to work because a meeting is scheduled the next day. He knows that these meetings always involve co-workers talking with each other about their current projects. Just the thought of speaking in front of co-workers raises his anxiety. Sometimes he can't sleep the night before because of the anticipatory anxiety that builds up.

Finally, the meeting is over. A big wave of relief spills over him as he begins to relax. But the memory of the meeting is still uppermost in his mind. He is convinced he made a fool of himself and that everyone in the room saw how afraid he was when he spoke and how stupid he acted in their presence. At next week's meeting, the boss is going to be there. Even though this meeting is seven days away, his stomach turns raw with anxiety and the the fear floods over him again. He knows that in front of the boss he'll stammer, hesitate, his face will turn red, he won't remember what to say, and everyone will witness his embarrassment and humiliation.

He has seven miserable days of anxiety ahead of him, to think about it, ruminate over it, worry about it, overexaggerate it in his mind...over and over again.

A student won't attend her university classes on the first day because she knows that in some classes the professor will instruct them to go around the room and introduce themselves. Just thinking about sitting there, waiting to introduce herself to a room full of strangers who will be staring at her makes her feel nauseous. She knows she won't be able to think clearly because her anxiety will be so high, and she is sure she will leave out important details. Her voice might even quaver and she would sound scared and tentative. The anxiety is just too much to bear -- so she skips the first day of class to avoid the possibility of having to introduce herself in public.

"I'm the only one in the world who has these horrible symptoms...."

Another young man wants to go to parties and other social events -- indeed, he is very, very lonely -- but he never goes anywhere because he's very nervous about meeting new people. Too many people will be there and crowds only make things worse for him. The thought of meeting new people scares him -- will he know what to say? Will they stare at him and make him feel even more insignificant? Will they reject him outright? Even if they seem nice, they're sure to notice his frozen look and his inability to fully smile. They'll sense his discomfort and tenseness and they won't like him - there's just no way to win -

"I'm always going to be an outcast," he says. And he spends the night alone, at home, watching television again. He feels comfortable at home. In fact, home is the only place he does feel comfortable. He hasn't gone anywhere in twelve years. He has no network of support to help him overcome these horrible symptoms.

"It's just easier to avoid social situations."

In public places, such as work, meetings, or shopping, people with social anxiety feel that everyone is watching and staring at them (even though rationally they know this isn't true). The socially anxious person can't relax, "take it easy", and enjoy themselves in public. In fact, they can never relax when other people are around. It always feels like others are evaluating them, being critical of them, or "judging" them in some way. The person with social anxiety knows that people don't do this openly, of course, but they still feel the self-consciousness and the judgment while they are in the other person's presence. It's sometimes impossible to let go, relax, and focus on anything else except the anxiety. Because the anxiety is so very painful, it's much easier just to stay away from social situations and avoid other people.

"More than anything, he doesn't want anyone to know he's afraid...."

Many times people with social anxiety simply must be alone -- closeted -- with the door closed behind them. Even when they're around familiar people, a person with social phobia may feel overwhelmed and have the feeling that others are noticing their every movement and critiquing their every thought. They feel like they are being observed critically and that other people are making negative judgments about them.

One of the worst circumstances, though, is meeting people who are "authority figures". Especially people such as bosses and supervisors at work, but including almost anyone who is seen as being "better" in some way. People with social anxiety may get a lump in their throat and their facial muscles may freeze up when they meet this person. The anxiety level is very high and they're so focused on "not failing" and "giving themselves away" that they don't even remember what was said. But later on, they're sure they must have said the wrong thing...because they always do.

How is it ever possible to feel "comfortable" or "natural" under these circumstances?

To the person with social anxiety, going to a job interview is pure torture: you know your excessive anxiety will give you away. You'll look funny, you'll be hesitant, maybe you'll even blush, and you won't be able to find the right words to answer all the questions. Maybe this is the worst part of all: You know that you are going to say the wrong thing. You just know it. It is especially frustrating because you know you could do the job well if you could just get past this terrifying and intimidating interview.

Welcome to the world of the socially anxious.

Social anxiety is the third largest psychological problem in the United States today. This type of anxiety affects 15 million Americans in any given year. Social anxiety disorder is not endemic to the U.S., it is a worldwide, culturally inclusive disorder. Unlike some other psychological problems, social anxiety is not well understood by the general public or by medical and mental health care professionals, such as doctors, psychiatrists, psychologists, therapists, social workers, and counselors.

In fact, people with social anxiety are misdiagnosed almost 90% of the time. People coming to The Social Anxiety Institute with diagnosable DSM-IV social anxiety disorder have been mislabeled "schizophrenic", "manic-depressive", "clinically depressed", "panic disordered", and "personality disordered", among other misdiagnoses.

Because few socially-anxious people have heard of their own problem, and have never seen it discussed on any of the television talk shows, they think they are the only ones in the whole world who have these terrible symptoms. Therefore, they must keep quiet about them.

It would be awful if everyone realized how much anxiety they experienced in daily life.

Unfortunately, without some kind of education, knowledge and treatment, social anxiety continues to wreak havoc throughout their lives. Adding to the dilemma, when a person with social anxiety finally gets up the nerve to seek help, the chances that they can find it are very, very slim.

Making the situation more difficult is that social anxiety does not come and go like some other physical and psychological problems. If you have social anxiety one day... you have it every day for the rest of your life, unless you receive the appropriate therapy from an experienced therapist.

The feelings I described to you at the beginning of the article are those of people with "generalized" social anxiety. That is, these symptoms apply to most social events and functions in almost every area of life. I suffered from social anxiety myself for twenty years before I ever saw the term or read about its symptoms in a book.

As with all problems, everyone with social anxiety has slightly different symptoms. Some people, for example, cannot write in public because they fear people are watching and their hand will shake. Others are very self-conscious and they find it too difficult to hold down a job. Still others have severe anxiety about eating or drinking in the presence of other people. Blushing, sweating, and "freezing" are other physiological symptoms. Some people with social anxiety feel that a certain part of their body (such as the face or neck) are particularly "strange looking" and vulnerable to being stared at.

They understand most of the time that their thoughts and feeling are irrational, but don't know how to think and believe rationally.

One thing that all socially anxious people share is the knowledge that their thoughts and fears are basically irrational. That is, people with social anxiety know that others are really not critically judging or evaluating them all the time. They understand that people are not trying to embarrass or humiliate them. They realize that their thoughts and feelings are somewhat irrational. Yet, despite this rational knowledge, they still continue to feel that way.

The good news is that social anxiety is not only treatable, but the treatment is also successful. Social anxiety no longer needs to be a life-long, devastating condition.

It is these automatic "feelings" and thoughts that occur in social situations that must be met and conquered in therapy. Usually these feelings are tied to thoughts that are intertwined in a vicious cycle in the persons' mind.

How can social anxiety be treated?

Many therapeutic methods have been studied, but cognitive-behavioral techniques have been shown to work the best. In fact, treatment of social anxiety through these cognitive-behavioral methods produces long-lasting, permanent relief from the anxiety-laden world of social anxiety.

Don't let semantics and terminology about therapy throw you off. While it is correct and best to say we use "cognitive-behavioral" therapy, this includes a mindfulness approach to overcoming it, and it most definitely includes an acceptance of things as we continue to get better.

A better life exists for all people who suffer from social anxiety...

Social anxiety responds to a comprehensive program of cognitive-behavioral therapy. To overcome social anxiety, completion of a CBT therapy group is essential. What socially-anxious people do not need is years and years of sitting around in a circle complaining about their problems. In fact, socially anxious people who are taught to "analyze" and "ruminate" over their problems make their social anxiety worse.

There is a better life for all people with social anxiety. Without treatment, social anxiety is a torturous and traumatic emotional problem. With effective treatment, its bark is worse than its bite. Add to this that the current research is clear that cognitive-behavioral therapy is highly successful in the treatment of social anxiety. In fact, people who are unsuccessful are the ones who are not persistent in their therapy and who won't practice simple anti-anxiety strategies at home - they are the ones who give up. (This very rarely happens, thankfully).

If a person is motivated to end the years of crippling anxiety, then comprehensive cognitive-behavioral treatment provides methods, techniques, and strategies that all combine to lessen anxiety and make the world a much more enjoyable place.

Many of us have been through the crippling fears and constant anxiety that social anxiety produces -- and have come out healthier and happier on the other side.

You can overcome social anxiety, too!

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What is it like to live with Social Anxiety? | Social Anxiety Institute

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By Thomas A. Richards, Ph.D., Google+ Psychologist/Director, Social Anxiety Institute All day, every day, life is like this. Fear. Apprehension. Avoidance. Pain. Anxiety about what you said. Fear that you said something wrong. Worry about others' disapproval. Afraid of rejection, of not fitting in. Anxious to enter a conversation, afraid you'll have nothing to talk about.

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1. Why do you have social phobia?

2. The causes of social phobia?

3. What do doctors think about this disease?

4. How to overcome this fear?

5. Is desensitisation training useful for social phobia?

6. Is avoidance an effective solution?

7. Is the problem of social phobia easy to solve for others?

8. How do I make friends?

9. Counsellors' views on social phobia?

10. What is the prevalence of people with social phobia?

11. What is the difference between people with social phobia and people without social phobia?

12. Do different cultures affect the number of people with social phobia?

13. Does regionalisation affect illness?

14. How do you tackle the exhaustion of feeling drained of energy after socialising?

15. Does a good friend's outgoing personality affect the patient?

16. Benefits of solitude for healing?

17. Why do people who like to be alone usually like art?

18. The impact of childhood trauma on later personality?

19. Does this get better with age?

20. How should we help ourselves?

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Social Anxiety Disorder: More Than Just Shyness

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Social Anxiety Disorder: More Than Just Shyness

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National Institute of Mental Health (NIMH)

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Are you afraid of being judged by others? Are you self-conscious in everyday social situations? Do you avoid meeting new people due to fear or anxiety? If you have been feeling this way for at least 6 months and these feelings make it hard for you to do everyday tasks-such as talking to people at work or school-you may have social anxiety disorder.

Social anxiety disorder is an intense, persistent fear of being watched and judged by others. This fear can affect work, school, and other daily activities. It can even make it hard to make and keep friends. The good news is social anxiety disorder is treatable. Learn more about the symptoms of social anxiety disorder and how to find help.

What is social anxiety disorder?

Social anxiety disorder is a common type of anxiety disorder. A person with social anxiety disorder feels symptoms of anxiety or fear in situations where they may be scrutinized, evaluated, or judged by others, such as speaking in public, meeting new people, dating, being on a job interview, answering a question in class, or having to talk to a cashier in a store. Doing everyday things, such as eating or drinking in front of others or using a public restroom, also may cause anxiety or fear due to concerns about being humiliated, judged, and rejected.

The fear that people with social anxiety disorder have in social situations is so intense that they feel it is beyond their control. For some people, this fear may get in the way of going to work, attending school, or doing everyday things. Other people may be able to accomplish these activities but experience a great deal of fear or anxiety when they do. People with social anxiety disorder may worry about engaging in social situations for weeks before they happen. Sometimes, they end up avoiding places or events that cause distress or generate feelings of embarrassment.

Some people with the disorder do not have anxiety related to social interactions but have it during performances instead. They feel symptoms of anxiety in situations such as giving a speech, competing in a sports game, or playing a musical instrument on stage.

Social anxiety disorder usually starts during late childhood and may resemble extreme shyness or avoidance of situations or social interactions. It occurs more frequently in females than in males, and this gender difference is more pronounced in adolescents and young adults. Without treatment, social anxiety disorder can last for many years, or even a lifetime.

What are the signs and symptoms of social anxiety disorder?

When having to perform in front of or be around others, people with social anxiety disorder may:

Blush, sweat, or tremble.

Have a rapid heart rate.

Feel their "mind going blank," or feel sick to their stomach.

Have a rigid body posture, or speak with an overly soft voice.

Find it difficult to make eye contact, be around people they don't know, or talk to people in social situations, even when they want to.

Feel self-consciousness or fear that people will judge them negatively.

Avoid places where there are other people.

What causes social anxiety disorder?

Risk for social anxiety disorder may run in families, but no one knows for sure why some family members have it while others don't. Researchers have found that several parts of the brain are involved in fear and anxiety and that genetics influences how these areas function. By studying how the brain and body interact in people with social anxiety disorder, researchers may be able to create more targeted treatments. In addition, researchers are looking at the ways stress and environmental factors play a role in the disorder.

How is social anxiety disorder treated?

If you're concerned you may have symptoms of social anxiety disorder, talk to a health care provider. After discussing your history, a health care provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms. A health care provider may refer you to a mental health professional, such as a psychiatrist, psychologist, or clinical social worker. The first step to effective treatment is to get a diagnosis, usually from a mental health professional.

Social anxiety disorder is generally treated with psychotherapy (sometimes called "talk therapy"), medication, or both. Speak with a health care provider about the best treatment for you.

Psychotherapy

Cognitive behavioral therapy (CBT), a research-supported type of psychotherapy, is commonly used to treat social anxiety disorder. CBT teaches you different ways of thinking, behaving, and reacting to situations to help you feel less anxious and fearful. CBT also can help you learn and practice social skills, which is very important for treating social anxiety disorder. CBT has been well studied and is the gold standard for psychotherapy.

Exposure therapy is a CBT method that focuses on progressively confronting the fears underlying an anxiety disorder to help you engage in activities you have been avoiding. Exposure therapy is sometimes used along with relaxation exercises. CBT delivered in a group therapy format also can offer unique benefits for social anxiety disorder.

Another treatment option for social anxiety disorder is acceptance and commitment therapy (ACT). ACT takes a different approach than CBT to negative thoughts and uses strategies such as mindfulness and goal setting to reduce your discomfort and anxiety. Compared to CBT, ACT is a newer form of psychotherapy treatment, so less data are available on its effectiveness. However, different therapies work for different types of people, so it can be helpful to discuss what form of therapy may be right for you with a mental health professional.

For more information on psychotherapy, visit the National Institute of Mental Health (NIMH) psychotherapies webpage.

Medication

Health care providers may prescribe medication to treat social anxiety disorder. Different types of medication can be effective in treating this disorder, including:

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)

Beta-blockers

Anti-anxiety medications, such as benzodiazepines

SSRI and SNRI antidepressants are commonly used to treat depression, but they also can help treat the symptoms of social anxiety disorder. They may take several weeks to start working. Antidepressants may also cause side effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe, especially if the dose starts off low and is increased slowly over time. Talk to your health care provider about any side effects that you may experience.

Beta-blockers can help control some of the physical symptoms of social anxiety disorder, such as rapid heart rate, sweating, and tremors. Beta-blockers are commonly the medication of choice for the "performance anxiety" type of social anxiety disorder.

Benzodiazepines, which are anti-anxiety sedative medications, are powerful and begin working right away to reduce anxious feelings. These medications can be very effective in rapidly decreasing anxiety, but some people build up a tolerance to them and need higher and higher doses to get the same effect. Some people even become dependent on them. Therefore, a health care provider may prescribe them only for brief periods of time if you need them.

Both psychotherapy and medication can take some time to work. Many people try more than one medication before finding the best one for them. A health care provider can work with you to find the best medication, dose, and duration of treatment for you. People with social anxiety disorder usually obtain the best results with a combination of medication and CBT or other psychotherapies.

For basic information about these and other mental health medications, visit NIMH's Mental Health Medications webpage. Visit the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, and information on newly approved medications.

Support Groups

Many people with social anxiety find support groups helpful. In a group of people who all have social anxiety disorder, you can receive unbiased, honest feedback about how others in the group see you. This way, you can learn that your thoughts about judgment and rejection are not true or are distorted. You also can learn how others with social anxiety disorder approach and overcome the fear of social situations.

Support groups are available both in person and online. However, any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a health care provider.

Both psychotherapy and medication can take some time to work. A healthy lifestyle also can help combat anxiety. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support. To learn more ways to take care of your mental health, visit NIMH's Caring for Your Mental Health webpage.

How can I support myself and others with social anxiety disorder?

Educate Yourself

A good way to help yourself or a loved one who may be struggling with social anxiety disorder is to seek information. Research the warning signs, learn about treatment options, and keep up to date with current research.

Communicate

If you are experiencing social anxiety disorder symptoms, have an honest conversation about how you're feeling with someone you trust. If you think that a friend or family member may be struggling with social anxiety disorder, set aside a time to talk with them to express your concern and reassure them of your support.

Know When to Seek Help

If your anxiety, or the anxiety of a loved one, starts to cause problems in everyday life-such as avoiding social situations at school, at work, or with friends and family-it's time to seek professional help. Talk to a health care provider about your mental health.

Are there clinical trials studying social anxiety disorder?

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions-including social anxiety disorder. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit NIMH's clinical trials webpage.

Finding Help

Behavioral Health Treatment Services Locator

This online resource, provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), helps you locate mental health treatment facilities and programs. Find a facility in your state by searching SAMHSA's online Behavioral Health Treatment Services Locator . For additional resources, visit NIMH's Help for Mental Illnesses webpage.

Talking to a Health Care Provider About Your Mental Health

Communicating well with a health care provider can improve your care and help you both make good choices about your health. Find tips to help prepare for and get the most out of your visit at Taking Control of Your Mental Health: Tips for Talking With Your Health Care Provider. For additional resources, including questions to ask a provider, visit the Agency for Healthcare Research and Quality website .

If you or someone you know is in immediate distress or is thinking about hurting themselves,call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website .

Reprints

The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy the images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

For More Information

MedlinePlus (National Library of Medicine) ( en español )

ClinicalTrials.gov ( en español )

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 22-MH-8083
Revised 2022

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Social Anxiety Disorder: More Than Just Shyness

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Information about social anxiety disorder, including common signs and symptoms, treatment options, and how to find help.

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Social anxiety, which is also referred to as social anxiety disorder or social phobia, is a mental illness in which a person has a fear of or worry concerning social situations that does not go away. This anxiety may be accompanied by mutism, which is the inability or unwillingness to speak in certain situations.

Social anxiety is more commonly seen in children and middle-aged women, with 9% of youth and 12% of adults being affected by social anxiety. However, this condition may remain unrecognized for a very long period.

Historical perspective

Before the term "anxiety" was defined, this condition was generally expressed as "stress" or "nerves disorder." The understanding of this disorder was very poor in common people and even by health professionals. For this reason, very few people got effective treatment.

The recognition of social anxiety happened slowly over several hundreds of years and was based on the diagnosis of the condition in several cases.

The historical developments in the field can be described in three stages including the pre-developmental period, initial developmental period, and recent developments.

Pre-developmental period

Social anxiety was first described by Hippocrates as "shyness" in early 400 B.C. People who "love darkness as life" and "thinks every man observes him" fell into this category.

The term "phobia" for fear or terror was coined by the Greeks long ago. In fact, the Greeks used the word phobia with a Latin or Greek prefix to convey different kinds of fear. Some of the social anxieties included scopophobia, which is the fear of being observed, xenophobia, which is defined as a fear of strangers, and anthropophobia, which is a fear of people.

During the eighteenth century, European psychiatrists, psychologists, and authors started examining the topic. This raised a considerable amount of questions and viewpoints. It also brought to light many manifestations of social anxiety. However, the idea of providing recognition to the study of social anxiety as a discipline did not arise until the 20th century.

Initial developmental period

Casper was the first person to study ereutophobia. In 1846, he described it in his report as "a serious social anxiety affecting a young man." Pitres and Regis conducted studies in 1807 and 1902 on this phobia. A comprehensive review on this topic was published by Claparede during the same period.

Social phobia was first included by Janet as a separate section in her reference to the classification of phobias in 1903. In 1910, Hartenberg described many forms of social anxiety under the generic name of shyness, such as performance anxiety, timidity, and personality disorder.

The term "social neurosis" was used to describe the condition of extremely shy patients in 1938 by Schilder, a psychiatrist. Joseph Wolpe, a South African psychiatrist, determined a path for the improvement of behavioral therapy for the treatment of phobias in 1950 by developing a technique called systematic desensitization. This led to an increased involvement of researchers in behavioral therapy of phobias.

Apart from these, there were no landmark developments until the 1960s, although people like Morita (Japan, 1930s) showed interest in the area. Many terms and names like 'Kontaktneurosen' or 'social neurosis' were duly mentioned in the literature of Britain and Germany.

The idea of classifying social phobias as a separate category from other normal phobias was first put forward by a British psychiatrist named Isaac Marks in 1960. In the second edition of " Diagnostic and Statistical Manual of Mental Disorders (DSM-II)" published by the American Psychiatric Association (APA) in 1968, a narrow definition was provided for social anxiety. To this end, it is "a specific phobia of social situations or an excessive fear of being observed or scrutinized by others."

Recent developments

Since the existing definition was a narrow one, in 1980, the APA officially added social phobia as a psychiatric diagnosis in their third edition of DSM. In this edition, social phobia is described as "a fear of performance situations," and did not include fears of less formal situations such as casual conversations. According to DSM-III, it was difficult to diagnose a patient with both social anxiety and avoidant personality disorder.

A research on social anxiety was initiated in 1985 by Michael Liebowitz (a psychiatrist) and Richard Heimberg (a clinical psychologist). Prior to this, the condition was considered to be a "neglected anxiety disorder" due to the lack of studies on the topic.

In 1987, the APA made a revision to the DSM-III in which they included changes in the diagnostic criteria. Instead of considering "significant distress" symptoms alone for diagnosis, they also added "interference or marked distress" symptoms. It allowed the diagnosis of social phobia and avoidant personality disorder in the same patient. They moved one step ahead and introduced a term called "generalized social phobia" for referring to more intense and distributive forms of the disorder.

In the DSM-IV, which was published in 1994, the term social phobia was replaced by "social anxiety disorder (SAD)." SAD described the depth of the disorder as "marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others." There were also some small modifications to the diagnostic criteria.

In the latest revision of DSM, which is DSM-V, further changes in the diagnosis of social anxiety disorder were updated and published in 2013.

"Talk!" | Anna Vite | TEDxChallengeEarlyCollegeHighSchool

References

Further Reading

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Social anxiety, which is also referred to as social anxiety disorder or social phobia, is a mental illness in which a person has a fear of or worry concerning social situations that does not go away. This anxiety may be accompanied by mutism, which is the inability or unwillingness to speak in certain situations.

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Statistics on the prevalence of the disease by age in different countries

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Statistics on the prevalence of the disease by age in different countries

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Moving To A New Country And Dealing With Social Anxiety

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On this episode, Angelique shares her story about moving to a new country, dealing with social anxiety, and uncovers the truth about moving to a new city.

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I also wanted to talk a little about anxiety as an artist.

I've met dozens of artists who suffer from some form of anxiety, but I've noticed not a lot of professional artists talk about it. I only recently started seeing artists address it in Instagram posts once in a while. Maybe due to social media, we are seeing these topics discussed more openly in the community, and I am thankful for that. I am not ashamed about my afflictions, rather I feel empowered to talk about it because I've seen the benefits of being true to myself.

I've been dealing with social anxiety my whole life, but never knew what it was until about two years ago. I just thought constant internal turmoil was normal and that someday it would stop - like if I pushed myself into social situations or lived a "normal" life. All the while, suffering in silence, wondering what was wrong with me.
It may sound crazy to live like this, but I grew up in a small town where no one talks about these things. And I'm not the only one. Not by far.

What is social anxiety? I'll quote here:

"All day, every day, life is like this. Fear. Apprehension. Avoidance. Pain. Anxiety about what you said. Fear that you said something wrong. Worry about others' disapproval. Afraid of rejection, of not fitting in. Anxious to enter a conversation, afraid you'll have nothing to talk about. Hiding what's wrong with you deep inside, putting up a defensive wall to protect your "secret". You are undergoing the daily, chronic trouble of living with this mental disorder we call social anxiety disorder.

Very few people understand the agonizing and traumatic depth of social anxiety disorder. Social anxiety makes people go inside themselves and try to "protect" this secret. Most people with social anxiety disorder try to hide it from others, especially from family and loved ones. There is fear that family members may find out they suffer from social anxiety, and then view them differently or outright reject them. This is almost never true, but the fear of this happening makes many people with social anxiety stay in their dark closet."
Source: https://socialanxietyinstitute.org/living-with-social-anxiety

Thankfully, my eyes were opened when I started streaming on Twitch in 2015, and met many others like myself. Once I knew what social anxiety was, I could finally start addressing it directly. I paid attention to what triggered me, and started to learn ways to reduce the anxiety during certain situations.

The hardest part was realizing my entire life was a trigger. My career, my social life, expectations by family and friends... it was all causing me extreme anxiety. On the outside I was "normal" - most people never knew anything was wrong because I am very good at hiding my problems. I was successful in what I was doing, but at the expense of my mental health.

The biggest change I needed to make was in my career. I realized that as either a designer or photographer (which is how I made my living), every single day I was putting myself into situations which majorly triggered my social anxiety.
Around the same time I was embracing my true passion, painting, and decided to take steps to make that my career. I am so thankful I have taken this path, as it is much more in tune with my natural comfort. I am not having to deal with people or social expectations every day. I'm not saying you should avoid all social situations, (in fact I think that is worse) but I think it's important to allow yourself some room to understand your problem and address it at a pace you are comfortable with.

So what does this have to do with plein air painting?
Last year when I bought watercolors and stepped outside to paint for the first time, it was a revelation. Everything about it brought me joy and sent me to a place of peace and harmony with nature.
It became my medication.. my therapy.

Getting outside in the wilderness to paint is one thing, but when it comes to urban sketching and popular hiking trails, that's where it gets tricky for someone with social anxiety. Those are usually some of the most accessible places but the most populated. So sometimes the hardest part is making myself leave the house.

So in this video, I show you the steps I take to make it happen.

Once I'm out there, even though I am sometimes surrounded by large groups of people/pedestrians, my sketchbook is my shield. I can be in my own world, perfectly safe with my art.

It's a way for me to be out in the world with more comfort.

I hope that any artist reading this who suffers from social anxiety will someday know what this comfort feels like. If you want to discuss it, please feel free to message me or leave a comment below <3

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078. Artists & Social Anxiety, Part 1 - Plein air painting as art therapy - Sarah Burns - Scotland Art

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Artists & Social Anxiety, Part 1 - Plein air painting as art therapy

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The Artist's Journey of Self-Redemption

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"The best way out of anxiety is often to expose yourself to the things you are afraid of. "

"The World when Living with Social Anxiety" by Sinthia Cousineau

I was born premature, and was always physically smaller and weaker than others, for I happen to have a smaller bone structure. Due to this I was often picked on as a child because I was considered "skinny" and "weak". While growing up other kids used to call me all kinds of cruel names because of my weight. As I aged into my teenage years verbal aggression began to gravitate into psychological and physical abuse. People would often want to test out my strength to prove to me that being skinny was a negative thing. Today, not a single day goes by in which someone would not tell me that I have to change, that I need to put on more weight, that I am too skinny.

Although I have accepted the way God made me, society has not which can result in many dangerous situations for me. For example, when I was 14 years old, I was pushed down an entire flight of stairs and ended up cracking my rib simply because some of the older boys wanted to test out my strength to prove that skinny is weak, and I was outnumbered 4 to 1. I still remember landing on some kind of metal rod that hit my rib, the pain so terrible I literally saw stars. Unable to move or speak, I had to helplessly lay on the floor for 10 minutes whilst I recovered, watching my attackers laugh as they walked away. I still carry the bruise with me today. I often returned home from school crying with bruises or emotional injuries. As I got older and taller my injuries became more psychological.

I had to learn to avoid people to avoid fights, I had to learn to hide to avoid insults. Later I attended an all-girls high school hoping I could finally feel safe, however I was severely psychologically bullied by girls who felt threatened by my size. We all know how teenage girls can be when they have low self-esteem! Being a skinny girl in a school at a time when other girls were into dieting, and really caring about physically appearance is never a good thing. I remember one incident in which I wanted to participate in a race, and I had just began the race when I overheard one of my classmates who was on the same team, mutter "She will never make it, she is too weak!" My own team, rather than support me cheered against me. Another time I was merely trying to get a book in the library when one girl felt the need to randomly punch me in the stomach, later stating that she did so simply because I was skinny, stating that she is stronger.

Every time I ate in the cafeteria I had to prove myself, by overeating or eating junk food, to avoid the negative comments about being skinny. I always had eyes on me to judge how much I'd eat. If I did not overeat or if I ate healthy I often got called anorexic. I used to make myself so nauseated because I would over-eat. I have an extremely fast metabolism therefore was unable to gain weight. I got called "twig", "anorexic ", "skeleton" by people who were unaware that I actually just had small bones. I used to wear big hoodie sweaters all the time to hide that I was skinny, even when it was the hottest summer day. It was better to suffer the heat & risk passing out than it was to endure the social hostility. I was shy, but I still tried to make efforts to socialize with the girls in my school. Often they shunned me, ignored me and never treated me like I mattered......I was alone.....I felt like a ghost. for years. In bullying terms this is known as isolational bullying and girls are experts at that. They destroyed my reputation and ignored me with the sole purpose of trying to make me feel insignificant. I passed most of my youth as a shadow, for I existed yet was overlooked and ignored. I realized that in the eyes of the world I was just "tall and skinny" and it became the identity that would label me.

With time, the psychological abuse got so bad that even some of my teachers began to show hostility. For example, I used to enjoy playing badminton and was rather good at it, I applied for the team two years in a row. I went to the try-outs and performed well. The teacher refused to admit me on the team both times because of my weight, and instead took the students who did not even bother going to the try-outs. Another time I participated in the England Exchange, and prior to the trip one teacher felt the need to tell me "You better not slow down the group!" ....Ironically I was the fastest walker in the entire group. Another teacher once called my home simply to discuss the fact that I was skinny. When I wanted to participate in the school play the only role that was offered to me was that of the corpse! All I wanted in those days was a normal student life, but I was unfairly treated due to my size. I even received several hate messages from strangers on Facebook that would tell me to kill myself because I was so skinny! Such threats I would often and still receive on the streets. Women would walk up to me and directly insult my weight. I had a few cases when women even tried to punch me, thankfully by this time I was rather good at defending myself.

Even today, people constantly feel the need to point out I am skinny, constantly telling me to change to fit societies ridiculous norms of beauty. I worked in a church where even a nun would often insult my weight, telling me I look like crap because I am thin..... a NUN! She would tell me it is wrong to be skinny, that I look ugly, tired, and unattractive in any aspect she could think of. She was so threatened by my appearance that each time she saw me she tried to bring down my self-esteem. Skinny-shaming is real yet is often overlooked in todays society. I find it ironic in a sense for I am a girl who never dieted in my life, and who never cared about trying to loose weight and does not judge other's by their size. I place more value on trying to be a good person and contribute to society, whilst society only seems to value what I look like.

""Why is it considered wrong to tell someone they are too fat and need to eat less, but ok to tell someone they are too skinny and need to eat more?""
-Sinthia Cousineau

The worst was the feeling of total loneliness. I remember feeling nervous to go to school, because I never felt safe or welcomed.... never belonging. Nobody I could truly trust, not even the teachers whom were supposed to be the people I was meant to look up too. I remember barely talking, and often sitting alone in my corner. I had nobody, and could not bring myself to trust the few friends I had. I felt like the world did not see me for who I was, but that all they saw was this tall skinny girl. There are no words I can use to describe the loneliness I've endured for over a decade. Due to the negative experiences I began to develop trust issues, I could not bring myself to trust others and when I did I would often get disappointed and it was too much to bare. Having to accept that I was alone, I would maintain my sanity by drawing and would to draw to occupy my mind, to spare myself from the darkness surrounding me. However as the cruelty of others increased my social anxiety began to take a toll on me for the worst.

When I had enough courage to try the world of dating, which happens to be one of the greatest fears for someone with social anxiety. I would often have to deal with men who would always comment on my weight with comments like "Are you afraid of gaining weight?" , "Are you really going to eat that?", and comments about my body size. Statements like "real women have curves" would greatly annoy me. To be seen for my body, not the person I was, was socially traumatic. I even had cases of men who thought the best idea of flirting with me was to say "you got a pointy elf nose!" or "I like your body", and " I like you because you have long legs" (They cared little about my personality, interests, who I was). You can imagine how I felt! They would watch me intensely as I ate, commented on my outfits, and made weird remarks about my looks, all which enhanced my fears of judgment. For a girl with social anxiety it was rather traumatic to be so objectified. A person with social anxiety fears negative comments, and judgment......always being watched and insulted on physical appearance is not what a girl wants to deal with, with or without social anxiety. Such disrespect made it extremely difficult to trust people again......I isolated myself socially to not have to endure such objectification and disrespect again. I wanted to be surrounded by people who valued me for the person I was......but became disconnected from the social world.

I would often draw my pain, and the common elements that showed up in my drawings were roses, tears of blood, and eyes. Like most young girls I dreamt of romance and true love. However, I'm what you would call a hopeless romantic, on my quest to find true love I have encountered mostly heartbreaks. People have told me I am cursed in love, but the reality is that most people cannot look past appearances.

I drew many crying roses, which to me symbolizes the pain I endured from being so harshly judged on physical appearance. Each time I liked a guy who did not notice me because I was not curvy enough, or each time I had my heart broken by a guy who only dated me because he liked my skinny body, rather than me as a person I would draw a crying rose. I eventually could not take it anymore, and decided that I was better off alone.....so I isolated myself to avoid more emotional damage. My social anxiety and fears of reliving past trauma made it difficult to date again....to trust again. I wanted fewer friends, I socialized less, and spent most of my time alone or with family.

The pain and loneliness I felt from my social isolation was beyond imagining, so I drew to feel less alone. I am no stranger to heartbreak, betrayal and disappointment, and rather then let the pain defeat me I used it to create something beautiful. Heartbreak actually inspired most of my artworks. I use my emotional pain as a major source of inspiration in most of my works. I like to focus on the themes of life and death, nature because it brings life to my heart, and death which represents the suffering. This is a major theme for my life because I always struggled to live between the two worlds. The rose symbolizes love and romance, and these roses have eyes which represent the judgment and social anxiety. The roses are red, and often would cry out tears of blood, which symbolizes the highest degree of pain. As my pain grew the roses got more beautiful, for these roses represented the suffering in my heart. I turned my suffering into something beautiful. and lively as a way of consoling myself.

Then I realized that my life was entirely consumed by social anxiety. I wanted to change that.....to free myself of the fear that once consumed every aspect of my life. I deserved a chance of a normal life and I therefore began controlling the thoughts in my own mind by applying cognitive-behavioral therapy methods I learnt as a psychology student, replacing the irrational fear with realistic thoughts. I used exposure therapy to place myself in the situations I was terrified of. I took a job as a tour guide to force myself to do the one thing I was most terrified of, speak in a crowd and be the center of attention. I began to socialize more and trust people again. I try to educate people about bullying and skinny-shaming. But the one thing that truly helped me was art. I would always resort to drawing when I felt my anxiety was getting out of control. Drawing would calm the irrational thoughts in my mind. I would create artworks that reflected the pain, anxiety and fear I felt. This helped me express myself and to show others what it feels like to live in a constant fear.

""Once I conquered the irrational thoughts of my own mind, I was set free.""
-Sinthia Cousineau

It has been a few years since I have freed myself from the fears that once consumed my life. Although I still fight to control the irrational fear I owe my gratitude to art for it allowed me to let go of my past, to move on with a more positive future. In many ways art saved me......it gave me life. Artistic expression has certainly played a vital role in my life. Social anxiety never truly leaves a person, but with art I am no longer trapped in the prison of fear.

Due to my own personal experience, I now wish to help other people suffering from anxiety and bullying to overcome their fears though expressing themselves artistically. I decided to become a teacher so I could be a better teacher than the ones who taught me. I want to help the children who are victims of bullying not contribute to their pain. This was when I first realized that the field of art education would be perfect for me, until I discovered art therapy another field in which I could apply art to help others who have suffered like I have.

I realize that some of the stuff I wrote is highly personal, but I feel the need to share it so that those suffering from similar situations know that they are not alone. It is important to share, for we are all human and we all suffer in our own way. I do not wish to hide my past, for the hardships I endured made me the person I am today.

Yet, not a single day goes by in my life where someone would not tell me I have to change because I am too thin. Nonetheless, I still try to treat everyone around me with kindness for I know far too well what it is like to live in a world without kindness.

""Walk away from your fears and anxieties & you will be truly free""
-Sinthia Cousineau

""Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind.""
~Dr. Seuss

""Ceramic Eyes"" by Sinthia Cousineau

"Social Anxiety Flower" by Sinthia Cousineau
-July 2nd, 2016

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"The best way out of anxiety is often to expose yourself to the things you are afraid of. " "The World when Living with Social Anxiety" by Sinthia Cousineau I was born premature, and was always physically smaller and weaker than others, for I happen to have a smaller bone structure.

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Paintings Representing 10 Different Anxiety Disorders

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Paintings Representing 10 Different Anxiety Disorders

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I was five or six years old the first time I felt social anxiety. The same bitter feeling I experienced that day, came back to me repeatedly throughout my life. I was in Spanish class and the teacher was asking every student to read out loud a paragraph of a book. As soon as she finished saying the instruction, my body started to shake like crazy. I suddenly became stressed out for having to read in front of everyone else. "What if I mess this up? What if they make fun of me?" My heart was pounding harder and harder each time the teacher came closer to me. When the moment came, I stood up, shaking, with a trembling voice, and made it through the whole thing. I was glad the horror had ended and also afraid that it could happen again.

Deep by Mario Sanchez Nevado

Anxiety can be painful, disabling, discouraging, frustrating, all at the same time. It will arrive in the worst possible moment, and it will make you feel weak and afraid. It will make you think you're not worth it. It will make you sabotage yourself. That's why it is so important to know how it works, to feel it coming, and protect ourselves from it until it goes away.

Panic Attack Be Anxious For Nothing by Anthony Falbo

The Anxiety of Saint Joseph by James Jacques Joseph Tissot

The Scream by Edvard Munch

People with anxiety have learned to deal with it in a lot of different ways, such as relaxation exercises, yoga, meditation, therapy, sports, and art. This last one has proven to be particularly helpful, because turns out that it is actually very cathartic. Writing a song, a book, a poem, or taking a picture, creating a sculpture, or a movie; they help people let out anything that messes with their minds. I guess that's why they say artists are crazy. They are just letting out everything they're dealing with, as everybody has to, but in a different way.

Untitled by Monica Rohan

One In Four by Scarlett Raven

El grito nº 3 by Oswaldo Guayasamin

Art is a very useful pain reliever for anxious people, because as it assists to vent the stress, it also helps other (non-anxious) people understand what they're going through. It's fascinating to think about art in this way. It's a very powerful way to show vulnerability to strangers. It doesn't matter if it came out weird, complex, or too abstract. They don't care if people like it or not, of if they make fun of it. They just let it all out to feel better, to have a painless mindset.

Social Anxiety by Marla Edwards

Life Feeds on Life by Robert Wolverton Jr

Anxiety by Mary Woronov

Art forms that show what anxiety feels like usually are popular and-eye catching, but also very disturbing. They disrupt our mind and make us feel uncomfortable. But that's okay, because anxiety itself is very uncomfortable, so it's only natural that its art forms end up being awkward. That's the beauty of art when it comes to mental health: its esthetic elements will never be diminished for the message, whether it is happiness, sadness, stress, or anger, and the result will be equally appreciated.

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You might also enjoy reading:

If You Suffer From Anxiety, Your Brain Probably Has These 7 Amazing Abilities

10 Physical Signs That Tell You Might Suffer From Anxiety

***

Cover photo by: Souzay

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The Pain Of Crippling Anxiety In 10 Paintings - Cultura Colectiva

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I was five or six years old the first time I felt social anxiety. The same bitter feeling I experienced that day, came back to me repeatedly throughout my life. I was in Spanish class and the teacher was asking every student to read out loud a paragraph of a book.

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The Science Behind Social Anxiety | Healing Holidays

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Read our latest blog for social anxiety & the science behind it, from the award-winning hypnotherapist Malminder Gill. Book with Healing Holidays.

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Prevalence and correlation of social phobia among undergraduate health science students in Gondar, Ethiopia

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Prevalence and correlation of social phobia among undergraduate health science students in Gondar, Ethiopia

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Methods

An institution based cross-sectional study was conducted at the University of Gondar from April to May 2018, Gondar Ethiopia.

Regular undergraduate students at the University of Gondar College of Medicine and Health Sciences were included in the sample and excluded critically ill students.

The sample size was determined by using the single population proportion formula involving the use of Epi-info version 7 with a 95% CI, a 4% margin of error, and a social phobia of 27.5% from previous study conducted among high school adolescents in Ethiopia [ 20]. Assuming a 5% non-response rate, 503 students were recruited randomly by using the simple random sampling technique. The total number of students in the college with their identification number taken from the UoG CMHS registrar office; then the required sample was selected through lottery method. The lists of dormitory students took from the UoG CMHS Student's union dormitory affairs.

Data were collected using a pre-tested self-administered questionnaire, which contained socio-demographic factors, social support, clinical factors, and substance use factors. Social support was collected by the Oslo 3-item social support scale, which had a 3-item questionnaire commonly used to assess social support and used in several studies. The sum score scale ranges from 3 to 14, and had three broad categories: "Poor support" 3-8, "moderate support" 9-11, and "strong support" 12-14 [ 21]. Social phobia was measured by using 17 items social phobia inventory (SPI) scale with cut-off point's ≥ 21. Its score ranges from 0 to 68, which was rated from 0 (not at all) to 4 (extremely) [ 22]. Social phobia inventory scale validated in different countries among adults and adolescents [ 23, 24].

Data were entered into Epi-info 7 software after checking for completeness and imported to SPSS version 21 for analysis. Univariate analysis was done to see the association of each independent variable with the outcome variable. Those variables a P-value less than 0.2 were entered into the multivariate logistic regression model to identify the effect of each independent variable with the outcome variables. The strength of the association evaluated by the adjusted odds ratio with a 95% CI, and less than 0.05 P-values were considered statistically significant.

Results

Socio-demographic characteristics

A total of 503 students was included in the study with a response rate of 100%. The mean age of the respondents was 22.17 (± 10) years. Out of the participants, 362 (72%) were male, 472 (93.8%) were single, 289 (57.5%) were coming from the rural residence, and over two-fifth (43.3%) were between the ages of 18 and 21 years. Among the respondents, 185 (36.8%) were 3rd-year students and their grade scored between a range of 2.75 and 3.5 (Table 1).

Table 1 Distribution of students by socio-demographic factors at UoG, CMHS, in 2018 (N = 503)

Clinical, social, and substance characteristics

A small number, 13 (2.6%) of the participants had history of mental illness, 84 (16.7%) had a chronic physical illness, and about 3.2% had family history of mental illness. Of the participants, almost two in five (43.3%) students had moderate social support and nearly two in five (41.4%) had poor social support. Regarding the current use of the substance: over two-thirds (43.7%) of the students were drinking alcohol and 56 (11.1%) were taking khat at the movement (Additional file 1).

Prevalence of social phobia

The 17-items of social phobia inventory were summed and the single variable was generated. The new variable ranges from 0 to 68 in absolute value. A total of 84 (16.7%) students had mild social phobia (scored about 21 to 30) and 47 (9.3%) of the students had a moderate social phobia (scored 31 to 40). A small number, 19 (3.8%) and 7 (1.39%) of the students had severe and very severe social phobia, respectively (Fig. 1). We further categorized social phobia into two levels (no social phobia and social phobia). This study showed that the prevalence of social phobia symptoms among participants was 31.2% with (95%, CI 27.3, 35.6%) (Additional file 2).

Bar chart showing that the distribution SPI score for students at the University of Gondar, Northwest Ethiopia in, 2018 (N = 503)

Factors associated with social phobia

Among all covariates, female sex, students studying in the 1st year, family history of mental illness, and poor social support had less than 0.2 a P-value in the univariate logistic regression and were considered as the multiple logistic regression models.

In the multivariable analysis suggested that the odds of social phobia, increased by 2.8 times (95% CI 1.40, 5.60) for students had poor social support compared to students had good social support. Female students were about 2.3 times (95%, CI 1.50, 3.60) more likely risk of social phobia compared to counterparts. Students studying in the 1st year were 5.5 times (95%, CI 1.80, 17.20) more likely to develop social phobia compared to counterparts. Similarly, the risk of social phobia for students whose residence from the rural areas increased by 1.6 times (95%, CI 1.00, 2.40) compared to students whose residence from the urban areas (Table 2).

Table 2 Factors associated with social phobia among students in the University of Gondar, Northwest Ethiopia in, 2018 (N = 503)

Discussion

In this study, the prevalence of social phobia and possible association with various factors was assessed. The results of the present study revealed that a remarkable proportion of students had social phobia. The prevalence of social phobia among students was found to be 31.2%.

Regarding prevalence, our result is consistent with those of other studies carried out in Ethiopia, Nigeria, India, and Australia the prevalence was estimated at 27.5%, 31.1%, 28.6%, and 30%, respectively [ 20, 25, 26, 27].

On the other hand, the current study finding was higher than those of other studies done in two areas of Saudi Arabia, Canada, Iran, and India, the prevalence was estimated at 14.1%, 16.3%, 7.9%, 17.2%, and 7.8%, respectively [ 5, 7, 9, 11, 28]. The variations might be the distinctions in sample sizes, measurement tools, rating scales, gender differences, and the socio-cultural contrast between Ethiopia and the other countries. In two areas of Saudi Arabia, the sample size was higher than in our study, while the measurement tool was the same [ 5, 28]. Besides the above differences, in two areas of Saudi Arabia took male and female students in their studies respectively [ 6, 27]. In Canada, Iran, and India, the diagnostic interview schedule III, Leibowitz questionnaires, and social interaction anxiety scale tools were used to assess the social phobia among university students, respectively.

However, our result was lower than those of other studies conducted in Saudi, India, Iran, two areas of Iraq and reported 60%, 46%, 78.9%, 58.5%, 80%, and 55.7%, respectively [ 12, 13, 19, 29, 30]. The discrepancy might be the sample size alterations and assessment tool differences. In Saudi, the study conducted among medical students and tested by using social phobia scale which differed from our assessment tool [ 19], in India, the study participants were only medical students but in our study all health science students included [ 30], in two areas of Iraq, college students and nursing students included in their studies respectively [ 13, 29].

Regarding associated factors, female sex was 2.3 times more likely at risk of increasing social phobia compared to male students. This study supported by those of other studies, females are not equally participated in all activities because of cultural influence when compared to male in Ethiopia [ 20], and in Iran, female students had highly prevalence of social anxiety disorder compared to male students [ 11]. The rate of specific phobias in women was double those of men [ 1]. The prevalence of social phobia near to double in female students compared to male students and the difference might be neglectful parenting styles and authoritarian difference between female and male students. Cultural and biological factors that may underlie sex differences in anxiety disorders [ 31, 32]. Social phobia has been faced comparatively high in female students compared to male students in our culture; males dominated and received special care from their parents. This is the major factors which affect the psychology of females and led to social anxiety symptoms and as a result, females have felt uncomfortable in social gatherings.

Poor social support was 2.8 times more likely to develop social phobia compared to good support this is comparable with the study done in Ethiopia [ 20], in Saudi Arabia, female students who had low income were exposed to social anxiety disorder [ 27], in India, medical students came from low socioeconomic class were a high risk of social phobia during their education [ 16], and school-age adolescents from urban residence had insufficient income families were more risk of social phobia [ 33].

Students studying in the 1st year were 5.5 times had social phobia compared to 5th-year students. This study was supported by other study was done in Indian medical college students compared to 2nd-year students but in our study the reference took from 5th-year students because most of the studies had low prevalent of social phobia in the last years of their study [ 17]. The 1st and 2nd-year students were highly risky for social phobia, the reason might be the University settings where they forced to live for away from their parents for the first time and expose for new environmental stressors including social situation [ 1, 34].

In Turkish, the 1st and 2nd-year university students had higher anxiety stress scores than other students [ 35]. Stress and environmental factors play a role in interpersonal stressors and thus can contribute to the development of social anxiety and differences in background, appearance, language, social and emotional development, all can affect whether or not a student fits in the university [ 36].

Finally, students coming from the rural areas were 1.6 times the risk of increasing social phobia compared to urban areas. Which was supported the studies done in India [ 14] and residence of students from the rural area in India medical college students developed social phobias which were consistency to our study [ 17]. Similar studies in Egypt, the prevalence of social phobia among male students were higher in urban areas but among female students were higher in rural areas [ 32] and the magnitude of social phobia was higher among rural areas' students than urban and suburban students [ 37]. In Benin, the University of Parakou (UP) the impact of social phobia on academic performance among students living in rural areas were more risky to social phobia than those living in urban areas which means the prevalence of social phobia depends on the environment [ 34]. In Taiwan, rural adolescents were highly vulnerable to specific phobias compared to urban residences [ 38]. Another study conducted in India, risk factors of social anxiety in medical students were no significant difference between rural and urban residence [ 39]. The people living in rural areas were higher physical symptoms compared to those living in rural areas. The people belonging to urban areas had higher harm avoidance compared to those living in rural areas [ 36].

Conclusion and recommendations

In this study, the overall magnitude of social phobia was found to be 31.2%. Female sex, poor social support, students studying in the 1st year, and rural residence were explanatory variables significantly associated with social phobia. The ministry of education and the University of Gondar better to develop guidelines to solve the aforementioned factors. Further research on risk factors for social phobia should be conducted to strengthen and broaden these findings.

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The prevalence and correlates of social phobia among undergraduate health science students in Gondar, Gondar Ethiopia - BMC Research Notes

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Objective Social phobia is highly prevalent among university students. The lowest and highest point prevalence of social phobia among undergraduate university students was estimated at 7.8% and 80%, respectively. However, research into social phobia and associated factors among undergraduate university students in low and middle-income countries has been limited.

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Social anxiety is a troubling disorder for both dogs and their owners. Some dogs experience nervousness or fear in situations that involve other dogs or people. It may happen when you take your dog to the park, crowded events, or the veterinarian. Shyness or trembling are signs of anxiety; aggression may also occur. This condition is easier to manage early in a dog's life, but there are strategies you can use to help an older dog cope with social stressors.

What Is Social Anxiety?

Social anxiety refers to a condition in which dogs fear people or other animals and have a heightened stress response to sights and sounds-particularly in unfamiliar environments. Depending on the dog, the level of anxiety in a social setting can be mild or extreme. It can cause a dog to behave in ways that are not normally observed when it's in a familiar environment.

Symptoms of Social Anxiety in Dogs

Dogs with social anxiety may be calm and happy with their family members but become anxious around strangers or unfamiliar dogs; these dogs are also likely to panic when leaving home. The signs of this disorder range from mildly distressing to severe and potentially dangerous.

Symptoms

Dogs with social anxiety often try to hide behind their owners and may even tremble or whine in fear. These poor pups may become so nervous that they pee or poop spontaneously, and they may also pant excessively or drool. While some dogs respond to anxiety by becoming very timid, others may feel trapped and cornered, which often results in aggression and can be dangerous to people or dogs within reach.

Causes of Social Anxiety

Proper socialization is essential for all dogs. Failure to socialize a dog early in life can result in crippling social anxiety, fear, and aggression. Some dogs that are more vulnerable to social anxiety, but it can affect almost any dog under certain circumstances.

Puppies who are not regularly introduced to new people, dogs, places, and experiences can be overwhelmed when they are taken out of familiar surroundings or required to socialize. Proper socialization at a young age can help them learn to adapt to new situations throughout their lives.

Adult dogs can also experience social anxiety. It is most common in dogs rescued from puppy mills or abusive and neglectful situations. They may have had little or no human contact or only negative experiences with humans.

Stray dogs may be anxious because they have a general distrust of people and busy places. This may be something they learned that was necessary for survival on the street.

Dogs who grow up in rural areas or who are sheltered in their homes and rarely leave may become very fearful when taken out of their home territory.

Diagnosing Social Anxiety in Dogs

Social anxiety is easy to spot in dogs, but a veterinary behaviorist can help pinpoint the source of an individual's discomfort with unfamiliar people, dogs, and places. They are trained to identify potential medical problems, learned behaviors, and conflict aggression -and they can help with strategies to overcome these issues.

If your dog is often anxious, there are steps you can take to help it overcome fear.

Begin by introducing your dog to one person, ideally in your home or yard. Allow your dog to initiate contact and ensure it has a safe retreat where it can go if it begins to feel overwhelmed. Don't force contact, and reward calm behavior and efforts to "meet" the new person (approaching, sniffing).

When introducing your dog to another dog, remain calm and speak quietly so that your dog senses your comfort with the situation. Choose a gentle, relaxed dog that will not seem threatening to your dog. Stay at a comfortable distance, and limit the encounter to a short time. Again, reward your dog for calm behavior. At the first subtle sign of fear or anxiety, increase the distance between the two dogs or remove your dog entirely if necessary.

Take your dog to quiet outdoor areas and avoid crowds so that it develops comfort with the idea of outings before attempting to visit dog parks or walk along busy streets.

Prognosis for Dogs with Social Anxiety

Desensitizing a fearful dog is hard work. This can be a long, drawn-out process that can take weeks to months, but it's well worth it. Helping your dog overcome its fears will not only make your pup happier, but it will also make it easier for you to enjoy outings with your canine companion. Be attentive and carefully judge how much stimulation your dog can handle at one time, increasing the social challenges at your dog's pace.

How to Prevent Social Anxiety

Socialization is most successful when started early. Begin the puppy socialization process as soon as possible. This essentially trains your dog to handle itself in busy situations. A well-socialized dog is not fearful of crowds and plays well with other dogs.

Start by taking your puppy out to different places. It is best to do this after it has been fully immunized against parvo and distemper. By exposing a young dog to different sights, sounds, and people, you teach it to accept new life experiences as normal.

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Does your dog have social anxiety? Some dogs experience nervousness and fear in social situations. Learn the causes, treatment, and prevention.

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By Crocker Staff

Bay Area sculptor Calvin Ma recently gifted Duck Out, a ceramic figure suspended in the moment of fight or flight, to the Crocker. The sculpture joins another work by Ma, Around and Around. Through both sculptures, Ma provides a window into social anxiety, a disorder that impacts nearly 15 million American adults who experience a persistent, intense fear of being judged by others. "I never really felt comfortable in my own skin in social settings, so I created these characters to help tell stories about it," said Ma.

Born and raised in San Francisco, Calvin Ma studied industrial arts at San Francisco State University, originally pursuing an interest in toy design. He later transitioned to ceramics, earning his Master of Fine Arts in sculpture from the Academy of Art University. Ma - a rising star in contemporary art - is known for combining the nostalgia of childhood toys and action figures with the playful aspects of working in clay.

Camouflaged in a mallard duck costume, the figure in is caught stepping cautiously into a small pond, wings poised for escape. The sculpture is a part of Ma's most recent series titled Blend In, which builds on techniques and aesthetic concepts from a previous series called Homebodies. Ma states:

"As an adult, I face difficulties in the social environment. Meeting new people, being in the company of strangers, crowds, peers, and intermittently among friends and family brings about a heightened nervousness that takes over and impedes my ability to function socially."

The artist's conceptual evolution can be appreciated when comparing the subject matter and techniques of both works. In Around and Around and other works in the earlier Homebodies, Ma employs muted color palettes and woodgrain-like textures to echo childhood toy materials and a retreat to innocence, along with figures that peer from within armor-like toy structures. While Ma's nostalgia for simpler times is evident in his work, he also recalls experiencing reservation and apprehension as a child, when toys provided the relief of entertainment.

"I believe the tactile activity of playing with them coupled with my active imagination helped establish this passion for the action figure early on," Ma writes. "There was something about picking up your favorite hero or villain and creating stories and adventures that captivated me. It felt only natural to tap into this childlike sense of exploration and storytelling through my artwork."

Where Around and Around uses windows and doors to establish the toy as a metaphor for home and shelter, and works in the later Blend In series depict figures who are less separable from their costumes, as Ma conceals his subjects in forms of avian camouflage. The figure embodies the sensation felt by many whose fear manifests physically in a rigid body posture and avoidance of direct eye contact. Like Ma's figures, those who experience social anxiety may relate to the peace that the idea of escape brings, where one's own company can provide a welcome source of distraction as well as creativity.

Calvin Ma lives and works in the San Francisco Bay Area, where he shares a studio with this wife, ceramist Erika Sanada. Works by both artists are currently on display in the Crocker Art Museum's exhibition Cool Clay: Recent Acquisitions of Contemporary Ceramics.

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Calvin Ma's "Duck Out" Provides Insight Into Social Anxiety | Crocker Art Museum

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Calvin Ma provides a window into social anxiety, a disorder that impacts nearly 15 million American adults.

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While some people might relish the prospect of a new year party, for others socialising can trigger feelings of fear, anxiety and distress. Now researchers say microbes in the gut may play a role in causing social anxiety disorder, opening up fresh possibilities for therapies.

Scientists have previously found the gut microbiome - the collection of bacteria and other organisms that live in the gastrointestinal system - differs for people who have social anxiety disorder (SAD) compared with healthy individuals, while a growing body of research has revealed that microbes in the gut can influence the brain - and vice versa.

Now researchers have found that when microbes from the guts of people with SAD are transplanted into mice, the animals have an increased response to social fear.

The findings build on previous work showing similar results for conditions ranging from depression to irritable bowel syndrome.

Prof John Cryan, a co-author of the research from University College Cork, said that while it was known that genetics, the environment and other factors could also play a role in disorders including SAD, the new work highlighted the importance of our gut flora.

"The main point is we need to look after our microbes, especially throughout development and even in adulthood, to keep the social brain working appropriately," he said.

Writing in the Proceedings of the National Academy of Sciences, Cryan and colleagues report how they took faecal samples from six healthy people and six people with SAD, with DNA analyses confirming that the gut microbiome differed considerably between the two groups.

The team transferred each sample into six laboratory mice, giving a total of 72 creatures, all of whom had previously been given antibiotics to kill off their natural gut microbes.

The mice were subsequently presented with a series of tests to explore various aspects of their behaviour. To investigate social fear, the team gave the mice small electric shocks when they approached a new mouse, and then observed how the animals behaved around new mice when the shocks were no longer applied.

The results revealed that the mice who had received gut microbes from people with SAD had different levels of three bacterial species in their faeces than those who had received gut microbes from healthy people.

The team add that while behaviour of the mice did not differ for most of the experiments investigating anxiety and social behaviour, they did behave differently after the social fear experiment. While mice with gut microbes from healthy people quickly regained their curiosity towards strangers in the days that followed, those with microbes from people with SAD continued to be fearful of approaching other mice.

"They never fully recovered to be able to be social again," said Cryan.

Further analysis suggested levels of certain hormones and aspects of the immune system also differed between the mice.

"Both oxytocin, a key hormone involved in bonding, and the immune system have previously been implicated in social behaviour, therefore it was good to see that changes in these occurred in animals that received the SAD microbiota," said Cryan.

The team say the results suggest the gut microbiome can play a causal role in heightened social fear responses in social anxiety disorder, while the study also offers new avenues when it comes to developing therapeutics for people with SAD.

Cryan said that could include diets designed to alter the microbiome.

"Increasing the amount of fibres and fermented foods in the diet may have beneficial effects," he said. "And that's something that we're quite interested in exploring."

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Gut microbes may play role in social anxiety disorder, say researchers

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Study that involved transplanting people's microbes into mice may show way to possible therapies, say scientists

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The end of the world, sparsely populated, cold, the ultimate in freedom.

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There's no stress or anxiety with animals.

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The exchange of cultures is calming

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Sichuan is famous for its spiciness in China, and spicy food can release stress, feel happy, release dopamine, and make people happy.

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A nice tropical island holiday is the best way to relax and disconnect from society.

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I believe that the topics I have chosen are all based on personal emotions, whether it be anxiety, hesitation or fear, and can be categorised as research of the same nature. Questions of the same nature always lead to similar results, which means that I can find common ground amongst this wide range of emotions, summarise them and use them as part of my work!

Starting with my personal social phobia leads to more accompanying emotions. Synthesis Study. Emotions are a major problem for humans, and a large or small portion of the population struggles with their own personal emotions. By understanding these people in the midst of it one can get more useful information, one can get more of a picture of the masses, so that the work can be integrated into society and easily understood.

Through the FMP I wanted to learn more about the feedback of emotional issues such as social phobia and the physical behaviour and effects of these anxieties and fears. To express more deeply the problems reflected by such emotions . Does social phobia protect some people's personalities or does it undermine their socialisation and make them the exception? I think there are so many questions of this sort that I could open a bank of questions and make a list of them, making it easier for me to address them quickly and expeditiously. Upgrade them into my own usable language.

In the course of this exploration, I have experimented with the use of colour to express feelings, using watercolour, relying on its fluidity to show the emotions that bring about a feeling of a supermarket, a feeling of continuity, and then I will try to use more ways of painting to show these emotions.

Moreover, I want to use this work as a bridge of self-understanding and a real communication with myself, to know and understand myself is also an essential part of the road to become myself, into = the work for me is like my self-portrait, I will continue this self-help creativity, and to understand and face this problem. I will develop it into an animation or a comic strip, I think that stories are the simplest and most direct way to communicate ideas and feelings without so much complex thinking and imagination. Pictures help people to understand the work.

Social phobia is not a big problem, but it can make you miss a lot of opportunities and give up a lot of things that should be yours. This sense of loss is also a key word that I want to develop. I might collect more of these experiences and tell myself and people suffering from this emotion to leave all the constraints behind when they have the chance to express themselves and show only their strengths.

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I think there are three points in the FMP about social phobia that I should reflect on. Firstly, my understanding of social phobia is too self-centred. Second, my understanding of social phobia is superficial. Thirdly, I have not really confronted social phobia.

At the beginning of the study, I relied too much on self-experience and did not utilise more literature and known objective facts. The study was one-sided. My understanding of social phobia was superficial and lacked critical and dialectical thinking.

I need to learn more through secondary research. I need to learn more through secondary research. I need to understand the impact of national and cultural differences. I need to understand the story of social phobia in the context of a timeline. Perhaps historical stories and anecdotes about mental illness will help me understand it more realistically. Thinking about more ways of expressing how social phobia and the various psychological issues I have in my own mind can be uniquely and authentically expressed when there are so many artistic achievements about psychological issues. And not just being trapped in my own experiences.

As for the third point, I think I am a very weak person, I would choose to face or avoid without hesitation, if I want to express the emotions of social phobia that bring people tangled, troublesome and dilemmas, it means that I have to have really felt it, practice is more convincing than books and imagination. This affects whether or not the results I get will really impress people. You can't show a good result with a false sense of humour.

Stereotypically, emotional problems are strange and difficult to understand, and some people may say, "Why haven't I ever had one? Why are you not as cheerful as others when you are so well off? That's why this project came about, I should have learnt more about the history of social phobia, even though it doesn't seem like something with a deep history. Psychological problems have been around since the beginning of time, but people were too busy living their lives to think about their emotions. We can't limit our research to just humans, but animals and pets are also subject to this condition. Critters can be nervous, fearful, disturbed. Studying them systematically and showing them is what I need to do.