Social anxiety disorder
社交焦虑障碍
What is social anxiety disorder?
Social anxiety disorder is marked, excessive fear or anxiety in social situations, such as conversation, being watched or performing, about being judged negatively for one’s actions or visible nerves. The situations are avoided or endured with intense fear.[1] It lasts at least several months and brings clear distress or impairment.[1]
Often confused
How it keeps going (schematic)
Schematic, not a self-test.
Select a box for details.
Introversion · A personality dimension Introversion and neuroticism are personality dimensions. In one study, social phobia, the older name for social anxiety disorder, was moderately correlated with both, yet neither one could tell which shy people had social phobia and which did not.
Shyness · A normal personality trait Many people feel nervous in social situations, especially when speaking in public. Shyness itself is a normal personality trait, and a child’s wariness of strangers in new settings is part of normal development. In one study, 18% of shy people had social phobia versus 3% of others: shyness raises the risk, but more than four in five shy people did not meet criteria, and social phobia was not simply severe shyness.
Social anxiety disorder · Clearly excessive, lasting, disruptive The diagnosis is considered only when social fear, anxiety and avoidance clearly exceed what is normal in the person’s culture, last for months and cause marked distress or impairment. People often first mention fear of visibly blushing, sweating or trembling rather than fear of being judged. A bullied child’s fear of peers may be a reasonable response.
Social situations · Talking, being watched, performing ICD-11 gives three kinds of example: talking with others; doing something while feeling watched, such as eating or drinking in front of people; and performing, such as giving a speech. Someone may fear just one kind of situation or several.
Fear of being judged · Of embarrassment, rejection, offending Worry that one’s actions or visible nerves will be seen negatively: as humiliating or embarrassing, leading to rejection, or offending others. ICD-11 and DSM-5 both include the fear of offending others, which is central to the Japanese taijin kyofusho.
Avoidance and safety behaviors · Relief for now The most direct response is to stay away; when that is impossible, people avoid in subtle ways, saying little or not meeting others’ eyes, and some use alcohol to dampen social anxiety. NICE assessment asks about these safety behaviors and whether attention is turned inward on oneself; individual CBT includes exercises that show their downside first-hand.
Before and after · Going over one’s performance Picturing beforehand what might go wrong, then replaying one’s performance afterward. NICE lists this before-and-after processing as something to ask about in assessment and to change in individual CBT.
Individual CBT · NICE’s first choice NICE recommends that adults first be offered individual cognitive behavioral therapy developed for social anxiety, based on the Clark and Wells or the Heimberg model. The former runs up to 14 ninety-minute sessions over about four months, using video feedback to correct a distorted self-image, training attention outward and testing negative beliefs with behavioral experiments. Group CBT works too but less well, so it is not the default; people who decline CBT can use a CBT self-help book with professional support.
Surveys around the world · Share of adults who ever had it The World Mental Health Surveys interviewed 142,405 adults in 28 surveys using DSM-IV criteria: about 4.0% overall, 12.1% in the US, 0.9% in Shenzhen and 0.5% in Beijing and Shanghai; half of cases had begun by age 14. ICD-11 notes that strongly collectivist societies may report much social anxiety yet fewer diagnoses, perhaps from greater tolerance of reticence or less recognition. The bars are drawn to scale.
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Key points
- Nerves about public speaking are common, and shyness is a normal personality trait.[1] In one study, over four in five shy people did not have social phobia, the disorder’s older name.[2][3]
- People often cope through subtle avoidance, such as saying little or avoiding eye contact, and by rehearsing beforehand and replaying afterward; NICE treatment targets these safety behaviors.[1][4]
- Across 28 surveys of 142,405 adults, lifetime prevalence was about 4.0%: 12.1% in the US, 0.9% in Shenzhen, 0.5% in Beijing and Shanghai. Half of cases began by age 14.[3]
- For adults, NICE recommends individual CBT designed for social anxiety, up to 14 sessions over about four months, rather than group CBT.[4]
An example
Three months into a new job, Lin eats lunch at her desk, afraid her hands will shake at a shared table. Before meetings she scripts a full page, speaks without looking up, then replays whether she said something wrong. Whether she needs help depends on whether this lasts for months and disrupts work and life.[1]
Misreadings and limits
Online, calling yourself socially anxious often just means introverted or shy, which is not the disorder: introversion is a personality dimension only moderately linked to social phobia.[2] This page is not for self-diagnosis. If the fear lasts months and keeps you from school, work or friends, a professional can assess it, and it is treatable.[1][4]
If you need help now
If you’re struggling to cope or having thoughts of harming yourself:
- US and Canada: call or text 988 (24/7)
- UK and Ireland: Samaritans, 116 123 (free, 24/7)
- Australia: Lifeline, 13 11 14 (24/7)
- Elsewhere: findahelpline.com
If you’re in immediate danger, call your local emergency number.
Psyfield is not a crisis service. Numbers checked October 2026.
Sources
- 1 World Health Organization (2025). 6B04 Social anxiety disorder. ICD-11 for mortality and morbidity statistics (2025-01 release). View source
- 2 Heiser, N. A., Turner, S. M., & Beidel, D. C. (2003). Shyness: Relationship to social phobia and other psychiatric disorders. Behaviour Research and Therapy, 41(2), 209–221. doi:10.1016/S0005-7967(02)00003-7
- 3 Stein, D. J., Lim, C. C. W., Roest, A. M., de Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bromet, E. J., Bruffaerts, R., de Girolamo, G., Florescu, S., Gureje, O., Haro, J. M., Harris, M. G., He, Y., Hinkov, H., Horiguchi, I., Hu, C., … Scott, K. M. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Medicine, 15, 143. doi:10.1186/s12916-017-0889-2
- 4 National Institute for Health and Care Excellence (2013). Social anxiety disorder: Recognition, assessment and treatment (CG159). NICE clinical guideline (published May 22, 2013). View source
Last checked against sources: October 28, 2026