Feeling uneasy in situations like a first date or a job interview is quite normal and happens to everyone. But when that nervousness escalates into a feeling of extreme discomfort, dread or apprehension about normal social interactions, it can result in a diagnosis of social anxiety disorder. The condition is often confused with shyness, but not all people who suffer from shyness have social anxiety disorder.

Also known as social phobia, social anxiety disorder involves significant anxiety and discomfort about being embarrassed, rejected or looked down upon in social or performance situations, according to the American Psychiatric Association (APA). Typical situations that spark social anxiety are using public restrooms, interacting with strangers and public speaking. A person with social anxiety disorder will avoid social situations or endure them with intense anxiety, despite recognizing that their fear is unreasonable or excessive.

Social phobia is a significant public health concern. According to the Anxiety and Depression Association of America (ADAA), social anxiety disorder affects approximately 15 million American adults and is the second most commonly diagnosed anxiety disorder following a specific phobia.

A 2020 study published in the journal PLoS One suggests that social phobia could be on the rise globally. Researchers analyzed surveys collected from almost 7,000 individuals aged 16 to 29 from seven different countries and found that 36% respondents met the threshold criteria for having social anxiety disorder. This is far higher than previous estimates of 12%. The data also showed that this increase was most pronounced among young people (aged 18 to 24).

Social anxiety disorder: Symptoms

According to the National Institute of Mental Health (NIMH), individuals with social anxiety disorder are highly apprehensive in social settings, more so than the occasional case of nerves some may experience in everyday encounters. They find it difficult to make eye contact, be around people they don't know, or talk to people in social situations, even when they want to.

People with social anxiety disorder tend to be concerned about being harshly judged by other people, even if it is not the case. There is a feeling that when they walk into a room, everyone is watching them. They are typically afraid of coming off as foolish and have an intense fear of embarrassing themselves.

Social phobia can also cause physical symptoms, such as:

Blushing, sweating or tremblingA rapid heart rateFeeling sick to the stomachHaving a rigid body posture or speaking with an overly soft voiceAccording to the APA, social anxiety can cause significant problems with daily functioning. Individuals with social anxiety disorder struggle with maintaining friendships and participating in social situations. They will rarely attend events alone and need to bring someone they know along for security.

To be diagnosed with social anxiety disorder, symptoms need to cause significant distress, last for more than six months and cannot be attributed to any other health conditions.

In addition, about 20% of people with social anxiety disorder also abuse drugs and/or alcohol, according to the publication Social Anxiety and Alcohol Abuse issued by the National Institute on Alcohol Abuse and Alcoholism.

Since many sufferers have difficulty in group settings, some end up consuming alcohol or abusing drugs alone. On the flip side, some may consume alcohol or use drugs as a way to fit in, according to the publication.

Social anxiety disorder: Causes

Unlike other anxiety disorders, there isn't a lot known about what causes social anxiety disorder.

"The causes of the disorder are thought to fall into either the biological or environmental camps," said Cheryl Carmin, a psychiatrist and director of the clinical psychology training program at the Ohio State University Wexner Medical Center.