What is social anxiety (social phobia)?

Social Anxiety Disorder (SAD), also called social phobia, is defined by an intense, persistent fear of social situations in which the person might be observed, evaluated, or judged by others.

How it differs from shyness: shyness is a personality trait — discomfort in new situations that eases with familiarity. Social anxiety is a clinical condition that does not improve just by "getting used to it" without treatment, tends to persist or even worsen over time, and causes significant avoidance (turning down invitations, avoiding promotions, refusing to give presentations).

Common manifestations: fear of public speaking, of eating in front of others, of starting conversations, of being the center of attention, of disagreeing with someone. The specific fear is of negative evaluation — of "looking stupid, anxious, or incompetent."

Physical symptoms during social situations: blushing, trembling, sweating, a shaky voice, palpitations, which often feed the fear itself (fear that others will notice these symptoms).

Treatment: CBT with gradual exposure to feared social situations is the first-line treatment with the strongest evidence. Interoceptive exposure (learning to tolerate the physical symptoms) is an important component. SSRIs can be used as an adjunct. With proper treatment, most people with SAD improve significantly.