People with social anxiety disorder, also known as social phobia, suffer from an intense fear of becoming humiliated in social situations — specifically the fear of embarrassing oneself in front of other people. They worry that they will not measure up, or that they will mess up when talking, speaking to, or interacting with others.

In these feared performance and social situations, individuals with social anxiety experience concerns about embarrassment and are afraid that others will judge them to be anxious, weak, “crazy,” or stupid. They may fear public speaking because of concern that others will notice their trembling hands or voice or they may experience extreme anxiety when conversing with others because of fear that they will appear inarticulate.

A person with social anxiety disorder may avoid eating, drinking, or writing in public because of a fear of being embarrassed by having others see their hands shake. Individuals with social phobia almost always experience symptoms of anxiety — such as heart palpitations, dry mouth, tremors, sweating, gastrointestinal discomfort, diarrhea, muscle tension or trembling, a shaky voice, blushing, and even confusion. In severe cases, a person may experience a full-blown panic attack.

People with social anxiety recognize their fear is excessive or unreasonable.

These symptoms can become a source of added concern where a person with social anxiety will worry that the symptoms they’re experiencing will result in unwanted and embarrassing attention. People with social phobia either avoid social or performance situations, or endure them with intense anxiety or stress. They can also suffer from anticipatory anxiety regarding the upcoming event or social situation. This can set up a vicious cycle of anticipatory anxiety leading to poor performance (whether real or just perceived) in the situation, which leads to even more anxiety for future situations.

Most people who have social anxiety recognize that their fear is excessive or unreasonable. They seek to avoid any of the feared situations in their life. If they are forced into one of their feared situations, they experience it with intense anxiety.

The incidence of social anxiety disorder in the United States is somewhere between 5 to 13 percent of people who will experience it during their lifetime.

Research indicates that women outnumber men three to two among those with symptoms of social phobia. Men, however, have been more likely to seek treatment.

A variety of studies have demonstrated that social phobia is most likely to develop in the teenage years, though it can start earlier or later. Mental health professionals report that many people suffer quietly for years, looking for help only when their fears have precipitated a major life crisis.

Social anxiety disorder is readily treated through a combination of psychotherapy and medications.

Types of Social Phobia

For some people, almost any social circumstance is a cause for fear and anxiety. These individuals are said to have generalized social phobia. People for whom just one or two situations produce anxiety are considered to have the nongeneralized form of the disorder.

Some researchers have suggested that another way to group people with social anxiety disorder is based on the kind of situation that triggers anxiety. Two primary categories have been proposed: performance and interactional.

The performance group includes people who have strong anxiety at the idea of doing something in front of, or in the presence of, other people. Such situations include dining out, working, giving a speech or using a public restroom.

The interactional group includes people whose fears center on circumstances where they have to converse or otherwise engage with others, such as meeting new people.

Mental health professionals also have recognized that some people develop symptoms of social phobia as an outgrowth of other medical or physical problems. Individuals with Parkinson’s disease, obesity, disfigurement or other conditions sometimes can have severe anxiety that their physical appearance or actions will attract attention and disdain. While sharing similar symptoms, the Diagnostic and Statistical Manual for Mental Disorders specifically excludes a diagnosis of social phobia if the fears exhibited can be tied to these medical or physical conditions.