Social Anxiety Disorder (SAD) is a mental health condition that causes you to experience excessive worry in social situations. Although everyone experiences anxiety on occasion, people with SAD face intense and constant anxiety that affects their everyday lives. They are often worried that they will be judged by the people around them or that they will do something embarrassing when they’re around other people. These fears can lead to avoiding social situations as a way of coping.

SAD can affect people of any gender, age, sexual identity, body size or ethnicity, though it is more common in women.

What is the difference between anxiety in social situations and Social Anxiety Disorder?

Everyone feels anxious sometimes, like when taking an exam or speaking in public. It’s a normal reaction that is meant to keep us safe from dangerous situations.

When anxiety is helpful and adaptive, it is in response to the situation and goes away when the source of the anxiety ends. However, sometimes, anxiety can become intense, and gradually shift from being a proportionate response to a disproportionate one. When someone has a disproportionate response to a situation, they appear to react more strongly than their peers might and than the situation warrants. For example, people who do not experience mental health difficulties tend not to become extremely anxious and panicked after being invited to a small social gathering, but someone with SAD might.

Why do people develop Social Anxiety Disorder?

There are a range of factors that can play a role in someone developing SAD and the causes can vary from person to person. Highly stressful or traumatic experiences can play a role in someone developing SAD. Factors associated with your home life growing up can increase your chances of developing SAD. Having a family member with SAD can also increase your risk of developing SAD. A lot of people with SAD start experiencing symptoms in their teenage years, though younger children and adults can develop the condition as well.

Signs and symptoms of Social Anxiety Disorder

There are a variety of symptoms of SAD and everyone experiences anxiety differently. Some people have performance-type anxiety and struggle with things like public speaking, but not with social interactions more generally. Others may struggle with everyday experiences, such as going to work or school, eating in front of others, or using public toilets.

Below is a list of symptoms associated with SAD. It’s important to remember that not everyone with SAD will experience all of these symptoms. Equally, this list does not cover every symptom someone with SAD might have. Since we all experience anxiety from time to time, keep in mind that having a few of these symptoms does not necessarily mean you have SAD.

Emotional and behavioural symptoms

• Intense fear of being judged by those around you
• Strong fear of embarrassing yourself
• Feeling self-conscious in front of others
• Fear of people noticing your physical symptoms of anxiety
• Difficulty speaking to strangers
• Mind going “blank” in social situations
• Panic attacks
• Avoiding participating in public/social events, especially those where you might be the centre of attention
• Difficulty making eye contact

Physical symptoms

• Blushing
• Sweating
• Elevated heartbeat
• Nausea
• Trembling
• Feeling light-headed

Treatment for Social Anxiety Disorder

When your anxiety in social situations is negatively impacting your life, getting treatment can help. If you think you are experiencing SAD and would like to access support, visiting your GP to discuss treatment options can be a good place to start. There are a variety of treatments available for people with SAD, including talk therapies and medications.

If you have SAD, you might already have found certain ways of managing your symptoms. For example, you may avoid anxiety-inducing situations, or rely on substances like drugs or alcohol.

It is natural to develop coping mechanisms in order to distract yourself or ease your anxiety temporarily. However, certain ways of coping, while effective in the short-term, can lead to unwanted consequences. Avoiding anxiety-inducing situations is unlikely to improve your symptoms over time. Similarly, drinking alcohol or taking drugs may ease some of your symptoms in the short-term, but they may actually make your anxiety worse in the long-term.

If your current coping strategies are causing you trouble, working with a therapist can help you find new ones that work better for you.

Talk therapy for SAD

Psychotherapy or talk therapy can also help you identify where your anxiety comes from and understand why you’re having anxious thoughts. Your therapist can help you recognise and challenge negative thoughts and gain confidence in social situations. You can engage in psychotherapy as an individual or with small groups of adults facing similar challenges.

The most common type of psychotherapy for people with SAD is Cognitive Behavioural Therapy (CBT). This type of therapy involves identifying problematic thoughts and replacing them with more accurate, balanced ones to improve your behaviours and reactions in stressful situations.

When engaging in CBT, your therapist might use graded exposure techniques. These techniques help you gradually and safely face situations you’ve been avoiding, while also working on changing your thoughts about them. You might start with imaginary scenarios or role-playing and slowly move on to real-life situations. It’s important to have a therapist guide you through this process to ensure your exposure therapy experiences are both safe and effective.

Medication for SAD

There are medications available to help people manage SAD. The three main types are antidepressants, anti-anxiety medications, and beta-blockers. Don’t be discouraged if the first medication you try doesn’t work perfectly. These medications are prescribed for a variety of conditions and will have different side effects for different people. If you are open to taking medications, work with a GP or psychiatrist to find the one that works for you.

Antidepressants are usually the first medication prescribed for anxiety. Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, escitalopram, and sertraline are effective at treating anxiety as well as depression. Other antidepressants include serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine and duloxetine. Antidepressants can take a few weeks or months to become fully effective, and your doctor may work up to your full dose gradually to avoid the risk of side effects.

Another option is anti-anxiety medications, such as duloxetine. These work quickly to reduce anxiety symptoms, but they can be habit-forming so they are usually only prescribed as a short-term solution.

Finally, beta-blockers are sometimes prescribed for people with SAD. Beta-blockers help block the physical symptoms of anxiety caused by adrenaline. They are usually prescribed for specific anxiety-inducing events, like a public speaking event, rather than as a long-term solution.

Feeling overwhelmed and want to talk to someone?

• Get anonymous support 24/7 with our text message support service
• Connect with a trained volunteer who will listen to you, and help you to move forward feeling better
• Free-text SPUNOUT to 50808 to begin
• Find out more about our text message support service

If you are a customer of the 48 or An Post network or cannot get through using the ‘50808’ short code please text HELLO to 086 1800 280 (standard message rates may apply). Some smaller networks do not support short codes like ‘50808’.