Butterflies before a toast, a first date or a big meeting are part of life. Social anxiety disorder is something heavier: a fear of being judged that is strong and steady enough to start making choices for you about work, school and friendships.
Where shyness ends
The National Institute of Mental Health (NIMH) says social anxiety disorder may look like extreme shyness, and that while occasional stress and anxiety are normal, they should not control your life. For a diagnosis, NIMH explains, symptoms must last at least 6 months and interfere with daily life. Social anxiety disorder is a DSM-5-TR diagnosis, and a qualified clinician makes it.
Situations that can set it off
Examples NIMH gives include speaking in public, meeting new people, dating and job interviews. Everyday tasks, such as using a public restroom, can bring on the fear too. For some people the anxiety shows up only in performance situations, such as giving a speech.
What it feels like
The body often reacts first. NIMH lists blushing, sweating or trembling and a rapid heart rate. People may avoid places where others gather, or worry about an event for weeks before it happens.
When it usually starts
NIMH says social anxiety disorder usually begins in childhood or adolescence and may run in families. If you have felt this way since your school years, an evaluation as an adult is still worthwhile.
Treatment options
NIMH says treatment typically involves psychotherapy, medication or both. It names cognitive behavioral therapy (CBT), exposure therapy and acceptance and commitment therapy (ACT), and notes that CBT can also help people learn and practice social skills. Support groups, in person or online, help some people. If medication is considered, it is only when indicated, and you and your provider decide together.
Need to Talk to Someone?
In-person in West Ashley or telehealth statewide across South Carolina.
Talking to a provider
NIMH suggests starting with a health care provider, who may ask when your symptoms began, how long they have lasted and how often they happen. Thinking through those answers ahead of time makes a first visit easier, especially if talking about yourself is the hard part.
Starting from home
We see adults by secure video anywhere in South Carolina, so your first appointment can happen from your own couch, with in-person care in West Ashley when you are ready. Learn about our social anxiety disorder care and counseling by video, or request an appointment.
If anxiety ever comes with thoughts of suicide or self-harm, call or text 988. In an emergency, call 911 or go to the nearest emergency room.
Sources: NIMH, Social Anxiety Disorder: What You Need to Know (revised 2025); American Psychiatric Association, DSM-5-TR (social anxiety disorder).
This article is general information, not medical advice, and does not create a patient–provider relationship. Every situation is different, so see a provider who can evaluate yours and develop a plan of care. Any medication discussed here may not be right for you: the right choice depends on your diagnoses, other health conditions and current medicines, so take medication only as directed by the provider managing your care. If you are ever in doubt about an emergency, call 911 or go to the nearest emergency room.
Frequently Asked Questions
Shyness does not usually run your life. NIMH says social anxiety disorder involves fear of social situations that lasts at least 6 months and interferes with daily life. A qualified clinician can tell the difference.
It can be. NIMH says that in some cases the anxiety arises only in performance situations, such as giving a speech.
NIMH names cognitive behavioral therapy, exposure therapy and acceptance and commitment therapy. CBT can also help people learn and practice social skills.
Usually in childhood or adolescence, according to NIMH.