Here’s a simple social anxiety test: When you hear a group of people laugh, do you wonder what they found so funny, or are you sure they’re laughing at you? That feeling of being judged and found lacking, of being doomed to embarrass yourself whenever you are around others, are hallmarks of social anxiety disorder, also called social phobia. Of course, we all worry about how we are perceived from time to time but social anxiety is different. It’s an overwhelming feeling of self-consciousness and inadequacy that can make even the most basic interactions — things as simple as walking across a crowded room, eating at a restaurant, getting a haircut, or going to the grocery store — a kind of torture. Those who have social anxiety disorder soon condition themselves to avoid these painful situations as much as possible. As a result, life shrinks and lessens: Personal and work opportunities are passed up, friendships and romance may never get off the ground, and potential remains unrealized. Adding to the distress, the person is often well aware that their feelings are irrational or overblown, yet they can’t seem to overcome them, making them feel even more inadequate and powerless. Meanwhile, those around them often react with puzzlement or contempt, unable to understand why things that most people take in stride overwhelm them.

Symptoms of Severe Anxiety

So why do some people have social anxiety disorder? Scientists can’t point to a single cause, but research indicates it may have to do with a certain type of neurochemistry that prompts overstimulation of the brain’s fear response. Imaging technology shows, for example, that negative comments cause a heightened reaction in the brains of those with social anxiety. A bias toward anxiety also tends to run in families, suggesting a genetic link. Stress and environmental factors may also contribute. Bullying or overprotective parenting, for example, can increase the likelihood that anxiety issues will develop. One thing that’s clear, however, is that social anxiety disorder is common — the most common of the anxiety disorders and the third most common mental health disorder, affecting an estimated 6.8% of the U.S. population. The signs and symptoms include:

Wanting to connect with others but feeling extreme anxiousness and self-consciousness, and worrying that you’ll do something to embarrass yourself.
Feeling that people are watching your every move and judging you.
Dreading interacting with others, often days or weeks before an event.
Passing up social invitations or opportunities to advance because it would mean interacting with others.
Feeling physically ill around others or in anticipation of being around others, including sweating, trembling, blushing, nausea and stomach issues.
Feeling like an outsider, and struggling to make friends and keep them.

Social anxiety disorder tends to reveal itself in a person’s early teens and is often mistaken as simple shyness. But the two run on separate tracks, research shows, with only 12% of shy youth in one study developing a social phobia issue. Social anxiety disorder is more debilitating and tends to go hand in hand with other mental health issues, such as depression. And because alcohol and drugs can seem to provide a quick way to deal with the distress, those with social anxiety disorder are more likely to develop addictions, which further limits their potential. And that’s one of the most disheartening things about social anxiety disorder — its ability to stop life cold. But it doesn’t have to be that way.

Reaching Out for Anxiety Help

In the documentary “Afraid of People,” narrated by Donny Osmond, one of many celebrities with social anxiety disorder, a variety of people share stories of their struggles with the condition and their steps toward recovery. A woman named Pam talks of becoming a secretary, knowing it was the type of job that would allow her to remain out of the spotlight, of passing up parties out of dread of meeting new people, of staying quiet in meetings even though she had things she wanted to contribute. Each day as she drove to work, her stomach would begin to tie itself in knots, she said. By the time she arrived, “I’m pretty much a mess.” A simple trip to the beauty salon meant researching things to talk about with the hairstylist so she wouldn’t feel humiliated by her inability to carry on a conversation. Pam underwent what is the recommended course of treatment for most people, a combination of antidepressants, which can help with the brain’s fear response, and cognitive behavioral therapy, which teaches healthier and more realistic ways of thinking about situations and reacting to them. Today, Pam is enjoying her connections with others in a way she never thought possible, and she hopes others won’t wait as long as she did to reach out for help. “You can be friends with people. You can be social. You don’t have to hide in your house or hide from social activities or work. There is a way to get past this. It’s liberating.”