DEAR MAYO CLINIC: I’m often nervous around people and sometimes avoid social situations. How can I tell if I’m just shy or if what I’m experiencing is actually social anxiety disorder?
ANSWER: It’s natural to feel some nervousness in certain social situations, such as talking in front of others, confronting a problem with someone or being among strangers. But social anxiety disorder goes beyond this, causing an excessive anxiety or fear of activities and situations in which you believe that others are watching you or judging you. In addition, you may fear that you’ll embarrass or humiliate yourself. This may lead to:
1. Intense fears of being in situations in which you don’t know people. This can make it hard to interact with strangers or initiate a conversation.
2. Anxiety to the level that it interferes with day-to-day living. This can make it difficult to use a public restroom, return an item to a store or order food.
3. Avoiding speaking to people out of fear of embarrassment.
4. Avoiding times where you might be the center of attention.
5. Worry about reacting in ways that you know are out of proportion to the situation, or being afraid that others will notice that you look anxious.
The anxiety you feel may cause physical signs and symptoms of nervousness and fear. These may include blushing, sweating, trembling, nausea, stomach upset, confusion, heart palpitations, diarrhea and cold, clammy hands.
Talk to your doctor if your symptoms disrupt your life.
Diagnosis of social anxiety disorder typically involves having a detailed discussion with your doctor or mental health care provider and often filling out psychological questionnaires or self-assessments. If a diagnosis of social anxiety disorder is reached, initial therapies – which are often used in combination – include cognitive behavioral therapy and medications.
Cognitive behavioral therapy improves symptoms in up to 75 percent of people with social anxiety disorder. It’s based on the idea that social situations generally won’t change or go away. Although social anxiety disorder tends to persist over a lifetime, expert medical or psychological help can make it easier for you to learn to manage your anxiety and become more comfortable and relaxed in social settings.