All Conditions

Social Anxiety Disorder.

A persistent fear of being judged that quietly shrinks daily life.

Social anxiety disorder is marked by a chronic fear of being negatively judged by other people. These fears can be so profound that a person with social anxiety disorder may avoid any situation where they may be embarrassed or perceived negatively, preferring to either stay by themselves or with a few trusted individuals. This disorder can keep people stuck in a loop when they believe that their anxiety will be apparent to everyone else and this will be another reason why they will face judgment and ridicule. While some degree of nervousness in an unfamiliar social situation is to be expected, this condition may be diagnosed if the fears are so profound that they prevent a person from being able to talk to strangers, make phone calls, make new friends or show up for interviews etc. In these ways, social anxiety disorder shrinks the lives of those living with this condition. People often hear platitudes like “it’s all in your head” but social anxiety can be felt physically in the form of a racing heartbeat, flushed cheeks, shortness of breath, sweating, nausea and more.

When to seek help

Social anxiety disorder can often be confused with introversion or a shy personality. This is also the reason why many people don’t seek help for this condition, thinking that it is just their personality so they should learn to live with it. It is advisable to talk to a mental health professional about the diagnosis and treatment of this condition if your fear of being negatively judged is preventing you from partaking in social events, causing you to feel left behind in school, at work or in other important areas of functioning. With the right combination of medication and therapy, social anxiety disorder can be managed and the opportunity to live a much more fulfilling life can open up for people suffering from this condition.

How we can help

Self-assessment scales

These are the same validated scales clinicians use. Your answers stay on your device and take a few minutes.

Common questions

How is social anxiety disorder different from being shy or introverted?
Shyness and introversion are personality traits. They describe how much social stimulation a person prefers, not whether social situations cause clinically significant distress. Social anxiety disorder is a clinical condition. The fear of being judged is intense enough to interfere with work, school, or relationships, and it usually shows up physically as well, with racing heart, sweating, nausea, or difficulty speaking. The dividing line is functional impairment rather than personality. If avoidance is shrinking your life, that is worth talking to a clinician about.
What does treatment for social anxiety actually look like?
The strongest evidence is for cognitive behavioural therapy that includes graded exposure, where you practise the situations you fear in a structured way until your nervous system updates its threat estimate. SSRIs (sertraline, paroxetine, escitalopram) are the first-line medications and usually take four to six weeks to reach their full effect [1]. Many people benefit from a combination. Medication takes the edge off so that therapy is doable, and therapy changes the patterns that maintain the disorder over time.
Will I have to take medication forever?
Not necessarily. Many people taper off SSRIs after nine to twelve months of stability, especially if they have also done therapy that gave them tools to manage anxiety on their own. Tapering should be gradual and supervised. Coming off SSRIs too quickly can cause uncomfortable discontinuation symptoms. Some people choose to stay on medication for longer because life feels more workable with it, and that is a reasonable choice. Continuing medication long-term, when it helps and is well tolerated, is not a failure or a weakness.
My anxiety is mostly physical, with a racing heart, trembling, and blushing. Does that change what helps?
The core treatment is the same, with a few specifics worth knowing. Beta-blockers such as propranolol can blunt the physical symptoms in performance situations like presentations or interviews, and they are sometimes used as needed alongside SSRIs and therapy. Therapy will also work directly on your relationship with the physical symptoms, which is often where the loop locks. The secondary fear, often something like 'they will see me sweating', usually drives more anxiety than the sweating itself. A key part of effective treatment is working on the meaning you attach to those physical symptoms, not just the symptoms in isolation.